Determinants Of Caregiving Research Articles

The Structures of Caring.

The World Health Organization defines social determinants of health as "the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life." This current journal issue has the theme of structural determinants of health. In 2016 (Creative Nursing Vol. 22), we published 49 articles in four issues addressing Determinants of Health: Social Determinants, Structural Determinants, Caregiver Determinants, and Global Determinants. This editorial presents the highlights of those four journal issues, then connects each of the articles in this current issue to the theme; these articles reveal the systems and structures that support our caring from many angles, levels, and perspectives. Readers are challenged to recognize the potential, embedded in every system and structure, for disparities in the provision of our care.

Burden experienced by informal caregivers of children with sickle cell disease (SCD): a qualitative exploratory study at Tamale Teaching Hospital, Ghana

ObjectiveThis study sought to explore the burden experienced by informal caregivers in caring for their children with sickle cell disease (SCD).DesignA qualitative exploratory design was employed in the study using...

Prevalence and determinants of caregivers’ self‐reported child abuse among children aged 3–6 years in the south of Iran

AbstractChild abuse is a problem that needs to be addressed worldwide. This is a cross‐sectional study to estimate the prevalence of child abuse among children aged 3 to 6 years and its associated factors in southern Iran. In total, 5142 participants were selected using multi‐stage random sampling. The estimated prevalence rates of neglect and physical and verbal/emotional abuse among children were 26.4% (95% confidence interval [CI] 25.2–27.6), 59.4% (95% CI 58.1–60.6), and 63.9% (95% CI 62.6–65.1), respectively. The results of logistic regression models showed that the child's sex was associated with physical abuse (odds ratio [OR]boy/girl 1.25; 95% CI1.11–1.41) and verbal abuse (ORboy/girl 1.17; 95% CI 1.04–1.32). However, parents living together was inversely associated with physical abuse (OR 0.45; 95% CI 0.25–0.80), verbal abuse (ORboy/girl 0.46; 95% CI 0.25–0.84), and neglect (ORboy/girl 0.53; 95% CI 0.31–0.88). Mother's education (ORuniversity degree/illiterate 0.58; 95% CI 0.35–0.98) was also inversely associated with physical abuse. The prevalence of child abuse in southern Iran is significantly higher than in several other countries in the region and other parts of the world. Social and family factors, including mother's education and parents living together, are important in reducing child abuse and its related mental and physical disorders during childhood. It is essential to train parents of young children about abuse and its negative effects on the health and social performance of children.

Modeling the Distress of Adult-Child Caregivers of People with Dementia: The Mediating Role of Self-Efficacy.

The increased tasks and responsibilities involved in supporting a parent with dementia (PWD) can induce distress in adult-child caregivers. Previous studies have shown that distress can be influenced by PWD and caregiver determinants, but few studies have considered the associations between these variables. This study tested a complex model of adult-child caregiver distress in which PWD and caregiver determinants and their associations are considered. 159 adult-child caregivers participated in this online study. PWD and caregiver determinants were assessed using questionnaires and their associations were investigated using the partial least squares path method. The model showed a significant partial mediation through self-efficacy (confidence in one's ability to organize and manage caregiving situations) between poor self-rated health and distress. Self-efficacy was a significant mediator of the relationship between informal social support and distress, and between preparedness and distress. The direct path between parental overprotection and distress was significant. The association between care and distress was significantly stronger for adult-child caregivers not living with their PWD. The model revealed the important mediating role of self-efficacy. Clinical interventions should improve the preparedness of adult-child caregivers and the quality of social support. The positive perception of their self-rated health may thus be promoted.

Caregiver’s burden and age are related determinants to quality of life in people with dementia

Dementia is a degenerative disease with poor prognosis. People with dementia will depend on their caregivers. Care for dementia patients aims to promote or preserve their quality of life. Identification of the factors that affect (determinants) the quality of life of people with dementia is required, and caregiver determinants are proven to play a role. The caregiver’s role could affect the frequency and variety of therapy. Long-term cognitive and physical disability in people with dementia further develops the caregiver’s burden. This study aimed to assess the determinants of caregivers which have a relation with the quality of life in people with dementia. This cross-sectional study involved subjects who are dementia patients at the Memory Clinic of Dr. Sardjito Hospital, Yogyakarta, Indonesia and fulfilled the inclusion criteria and did not meet the exclusion criteria. Subjects and caregivers were interviewed and helped to complete several questionnaires, including the DEMQOL, ZBI, and GDS. Analysis within variables was performed using Pearson, Mann-Whitney, and T-tests, followed by a multivariate linear regression analysis. As many as 76 people with dementia were included, with the majority having the diagnosis of vascular dementia (53.9%), and the average DEMQOL Career score was 80.58 + 17.62 and 81.82 + 20.80 for DEMQOL Proxy. Bivariate correlation analysis showed a significant correlation between the caregiver’s age, gender, family relation, burden (ZBI), and depression (GDS) with the quality of life people with dementia (p <0.05). In the multivariate analysis, caregiver’s age was related to the quality of life of people with dementia based on DEMQOL Career (B =0.270; p =0.001) and DEMQOL Proxy (B =0.271; p =0.001) and the caregiver burden was related to the quality of life of people with dementia based on DEMQOL Career (B =-0.629; p =0.000) and DEMQOL Proxy (B =-0.661; p =0.000). In conclusion, the determinants of caregiver that are significantly related to quality of life in people with dementia are caregiver’s burden and age.

Abstract 16550: Community Perception and Treatment of Sore Throat Among Children in a Rheumatic Heart Disease Endemic Setting

Introduction: Although Group A Streptococcal (GAS) pharyngitis (sore throat) can be treated, its complications -- acute rheumatic fever (ARF) and rheumatic heart disease (RHD) remain significant public health problems in low- and middle -income countries. Examining community perceptions and health seeking behavior for sore throat in these settings could translate into effective ARF/RHD prevention strategies. Objective: To develop a local explanatory model of sore throat health seeking behavior that can be used in designing ARF/RHD preventive interventions Methods: This focus group discussions-based qualitative study was conducted in 3 districts of Uganda (Lira in the north, Wakiso in central and Mbarara in the west). Overall, 50 participants were included in these discussions about sore throat in children. Thematic analysis was done on transcribed and translated audio recordings. Results: Perception of sore throat, treatment practices and challenges/barriers to seeking proper care for sore throat were major topics discussed during the focus group discussions. Across the 3 districts, sore throat was perceived to be a common and serious problem within the community. Although the majority of participants could not tell the exact cause of sore throat, they believed that poor hygiene could be a related factor. Variable methods of treatment were used across all districts. However, traditional medicine use and practices were more common in Lira and Wakiso districts while there was more trust in modern medicine in Mbarara district. Improvement in a child’s symptoms was the most common reason for stopping treatment. Individual, societal and health system factors such as distance to health facility, long waiting time and lack of medicines influenced care givers’ decisions to seek proper care for sore throat. Conclusions: Our findings show interplay between care givers’ knowledge, beliefs and preferences and the health care system as major determinants of caregivers’ behavior to seek proper care for pharyngitis. Community ARF/RHD educational programs in Uganda should emphasize the consequences of untreated or poorly treated pharyngitis and the importance of seeking proper care and treatment.

Determinants of caregivers' awareness of Universal Newborn Hearing Screening in Malaysia

ObjectiveThis paper aims to investigate the effects of perceived attitude and anxiety on awareness of UNHS among caregivers in Malaysia. MethodsUsing cross sectional research approach, data were collected and some 46 out of 87 questionnaires distributed to caregivers attending UNHS programs at selected public hospitals were usable for analysis (response rate of 52.8%). Partial Least Squares Method (PLS) algorithm and bootstrapping technique were employed to test the hypotheses of the study. ResultsR square value is 0.205, and it implies that exogenous latent variables explained 21% of the variance of the endogenous latent variable. This value indicates moderate and acceptable level of R-squared values. Findings from PLS structural model evaluation revealed that anxiety has no significant influence (β = −0.091, t = 0.753, p > 0.10) on caregivers' awareness; but perceived attitude has significant effect (β = −0.444, t = 3.434, p < 0.01) on caregivers' awareness. ConclusionCaregivers' awareness of UNHS is influenced by their perceived attitude while anxiety is not associated with caregivers' awareness. This implies that caregivers may not believe in early detection of hearing impairment in children, thinking that their babies are too young to be tested for hearing loss. Moreover, socio-economic situation of the caregivers may have contributed to their failure to honor UNHS screening appointments as some of them may need to work to earn a living while some may perceive it a waste of time honoring such appointments. Non-significant relationship between anxiety and caregivers' awareness may be due to religious beliefs of caregivers. Limitations and suggestions were discussed.

Determinants of caregivers’ vaccination intention with respect to child age group: a cross-sectional survey in South Korea

ObjectiveThis study examined how knowledge, risk perception, health beliefs and multidimensional health locus of control (HLC) were associated with caregivers’ intention to vaccinate their child, and how these associations varied...

Determinants of Caregivers' Use and Adoption of Household Water Chlorination: A Qualitative Study with Peri-Urban Communities in the Peruvian Amazon.

The gap between the efficacy and the effectiveness of household water treatment in reducing diarrhea-related morbidity indicates the need for a better understanding of the determinants of long-term behavior change. To explore the barriers to drinking water chlorination in the Peruvian Amazon, where diarrhea is endemic among under-5 children, we conducted qualitative research with 23 caregivers from peri-urban communities of Iquitos, Peru. Our inquiry drew on the Transtheoretical Model of behavior change and the Integrated Behavioral Model for Water, Sanitation, and Hygiene to identify the most relevant contextual, psychosocial, and technological determinants of initial action and long-term adoption of chlorination. Our findings suggest that the decision to try out this practice resulted from the combined effect of knowledge of chlorination benefits and product availability and affordability. Progress from action to adoption was influenced by caretakers' understanding of dosage, the packaging of chlorine products, knowledge and skills for multipurpose laundry bleach, the taste of treated water, and reinforcement. This analysis suggests that a focus on these determinants and the household domain may help to improve the sustainability of future intervention efforts.

Vaccination coverage and its determinants among migrant children in Guangdong, China

BackgroundGuangdong province attracted more than 31 million migrants in 2010. But few studies were performed to estimate the complete and age-appropriate immunization coverage and determine risk factors of migrant children.Methods1610 migrant children aged 12–59 months from 70 villages were interviewed in Guangdong. Demographic characteristics, primary caregiver’s knowledge and attitude toward immunization, and child’s immunization history were obtained. UTD and age-appropriate immunization rates for the following five vaccines and the overall series (1:3:3:3:1 immunization series) were assessed: one dose of BCG, three doses of DTP, OPV and HepB, one dose of MCV. Risk factors for not being UTD for the 1:3:3:3:1 immunization series were explored.ResultsFor each antigen, the UTD immunization rate was above 71%, but the age-appropriate immunization rates for BCG, HepB, OPV, DPT and MCV were only 47.8%, 45.1%, 47.1%, 46.8% and 37.2%, respectively. The 1st dose was most likely to be delayed within them. For the 1:3:3:3:1 immunization series, the UTD immunization rate and age-appropriate immunization rate were 64.9% and 12.4% respectively. Several factors as below were significantly associated with UTD immunization. The primary caregiver’s determinants were their occupation, knowledge and attitude toward immunization. The child’s determinants were sex, Hukou, birth place, residential buildings and family income.ConclusionsAlarmingly low immunization coverage of migrant children should be closely monitored by NIISS. Primary caregiver and child’s determinants should be considered when taking measures. Strategies to strengthen active out-reach activities and health education for primary caregivers needed to be developed to improve their immunization coverage.

A Study of Determinants of Caregivers’ Attitudes towards Utilization of Residential Care in the UK: Focused on Scottish Family Caregiver in Edinburgh City

A Study of Determinants of Caregivers’ Attitudes towards Utilization of Residential Care in the UK: Focused on Scottish Family Caregiver in Edinburgh City

Relationships between the characteristics of oncohematology services providing palliative care and the sociodemographic characteristics of caregivers using health indicators: social support, perceived stress, coping strategies, and quality of work life

The aim of this study was to analyze the relationships between the characteristics of the management of oncohematology services and the psychosocial determinants of caregivers' health at work including social support, stress, and coping strategies. Investigation using questionnaires was carried out about nurses and nurse aides in hematology and oncology services. All hematology and oncology services of Western France were requested. Five questionnaires concerning sociodemographic characteristics, measurements of quality of work life, of social support, of perceived stress, and of coping strategies and quality of work life were delivered among health professionals. Five hundred seventy-four questionnaires from 53 different services were analyzed. There were 57.4% nurses and 42.6% nurse aides. Some 94.1% were female and 33.5% were older than 40 years. Several characteristics of oncohematology services were significantly linked to health indicators, as the need for time and recognition, the importance of training (in palliative care, pain management, and help relationship), the care of patients and their families, the interdisciplinary efficiency, and external interventions (psychologists and volunteers). We showed that participative management which includes implementation of service projects and of multidisciplinary staff influence the quality of work life of health professionals. We showed also how much the characteristics of services organized around an effective social support (need for recognition) favor a better quality of work life among caregivers, influencing their perceived stress and their coping strategies. To our knowledge, it is the first study showing a relationship between participative management (including multidisciplinary staffs, approach with a service project, and internal training) and the quality of work life in the domain of health care. The implementation of this model should be promoted in health care services.

Wellbeing perception of institutional caregivers working for people with disabilities: Use of Subjective Happiness Scale and Satisfaction with Life Scale analyses

Little scientific research has focused on the measure of how positive wellbeing of people caring for people with disabilities. The purposes of the present study are to explore the wellbeing perception and its determinants of caregivers who caring for people with disability. We employed a cross-sectional, self-administrative structured questionnaire survey to recruit 88 caregivers in this study. Those caregivers were defined as staff who working in residential care or day care services for people with disabilities in social welfare settings. Wellbeing was measured using two scales which included Subjective Happiness Scale (SHS), and Satisfaction With Life Scale (SWLS). The mean score of SHS and SWLS were 4.9 ± 1.0 (range = 1.3–6.8) and 4.6 ± 0.9 (range = 1.6–6.0). There were 42.5% respondents expressed they were happy and 31.0% were slightly happy, 31.0% felt satisfied with life and 39.3% reported they were slightly satisfied while 20.2% were slightly unsatisfied. With respect to the determinants of respondent's SHS in a multiple linear regression, we found the factors of perceived health status and SWLS were variables that can significantly predict the SHS score ( R 2 = 0.321, adjusted R 2 = 0.267), respondent's gender and household income and SHS score were variables that can significantly predict the SWLS score ( R 2 = 0.374, adjusted R 2 = 0.317). This study suggests the health and welfare service authorities should pay attention to the wellbeing profile and determinants of caregivers who working for people with disability to improve their quality of life.

Determinants of dental care visits among low-income African-American children

The objective of the authors' analysis was to investigate the determinants of dental care visits among young, low-income African-American children. Trained researchers interviewed a representative sample of low-income black families (caregivers and children aged 0 through 5 years) in Detroit to assess their dental visit history, dental insurance status and oral health behaviors. Dental examinations were conducted using the International Caries Diagnosis Assessment System (ICDAS). Of the 1,021 families who completed an interview and examination, a subset of the 552 children aged 3 to 5 years (and their primary caregivers) was the focus of this analysis. Children with private dental insurance had four times higher odds of having visited a dentist compared with those who had no dental insurance, and the odds for children receiving Medicaid were about 1.5 times higher. A child's age and a caregiver's educational attainment were positive and significant determinants of child dental visits. Caregivers who visited a dentist for preventive reasons were five times more likely to have taken their children to visit the dentist. Visiting a dentist was associated with an increased mean number of filled or missing tooth surfaces, but it was not significantly associated with the mean number of untreated decayed teeth. Children's dental insurance status was a significant determinant of their having visited a dentist. Even after the authors accounted for insurance status and other risk indicators, they found that children of caregivers who reported visiting a dentist for preventive care had a higher number of dental care visits. Determinants of caregivers' preventive dental visits must be identified and encouraged to improve the percentage of low-income children who visit dentists.

Biological Bases of Maternal Attachment

In recent years, there has been growing interest in investigating the processes affecting caregiving behavior. Recent studies of human and nonhuman primates have suggested that hormones can account, at least in part, for changes in caregiving motivation during pregnancy and the postpartum period and for variability in caregiving motivation and behavior among individuals. Although hormones may not be the primary determinants of caregiving, future research cannot afford to overlook the contribution that biological processes can make to normative and pathological attachment and parenting.

Beijing Families: The Behavior and Sentiment of Caregiving

The context in which caring and caregiving takes place is dominated by the cultural conditions and social realities of the time. This ethnographic study explored the perceptions and moral determinants of caregiving from the personal accounts of primary caregivers in 10 Beijing families. Analysis generated themes of labor and routines of caregiving, restricted resources, health, and illness, linked by the sentiment of establishing a connection, family time, personal time, gendered time, and reciprocity. For these Beijing families, caregivers accorded and enacted caregiving based on diffuse sentimental and behavioral as well as cultural guidelines drawing on the nature and quality of the relationship, past patterns of exchange, and a clear sense of who was most able to provide care and why. Implicationsfor the provision of health care tofamilies in China are outlined.

Stroke: The Perspective of Family Caregivers

We studied the family caregivers of elderly stroke patients, focusing on perceptions of the positive and negative aspects of caregiving and the resources used by caregivers to meet its demands. Most caregivers were women and either spouses of daughters. The majority were satisfied with their roles as caregivers and would do it again if faced with that decision. They relied on family and friends for help with caregiving, but not on formal services. Greater understanding of the determinants of caregivers' heterogeneous responses to the demands of caregiving is needed.