Family-centered Care Program Research Articles

Impact of family-centered Care on Parenting Role and Sense of Competence in Parents of Preterm Neonates: a quasi-experimental study

BackgroundImplementing a family-centered care approach can empower parents to care for their premature infants, positively influencing their sense of competence and parenting role. This study aims to investigate the impact of family-centered care within the context of newborn care on the sense of competence and parenting role of parents with preterm infants who were hospitalized in neonatal intensive care units (NICUs) in Iran. MethodsThis quasi-experimental study employed a design with two groups in neonatal intensive care units (NICUs) located in Kerman, Iran. The research sample consisted of 90 parents. The intervention group received training based on the principles of family-centered care and actively participated in caring for their infants in the intensive care unit. Both groups completed the Parenting Sense of Competence Scale and the Parenting Role Tasks Questionnaire before the intervention, seven days after the intervention, and three months after the intervention. ResultsFollowing the implementation of the family-centered care intervention, the experimental group exhibited a relatively higher increase in the sense of competence score (83.42±6.66) compared to the control group (57.60±9.45). Similarly, the experimental group had a higher mean parenting role score (87.95±6.45) than the control group (54.77±11.80). ConclusionThe study findings suggest that implementing the family-centered care program develops training packages based on the principles of family-centered care for nurses working in neonatal intensive care units. This training will help parents of hospitalized infants enhance their sense of competence and improve their parenting role.

Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study

BackgroundTreatment of type 1 diabetes is a process involving not only sick children, but also their caregivers.AimTo assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness.Materials and methodsThe study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used.ResultsIn the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness.ConclusionsThe results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.

Investigating the effect of family-centered care program implementation on fatigue and depression of teenage girls with iron deficiency anemia

Introduction:Today, one of the most common health problems in the world is iron deficiency anemia. The present study was conducted with the aim of determining the effect of family-centered care program implementation on fatigue and depression of teenage girls suffering from iron deficiency anemia. Family-centered care is a method that is controlled through mutually beneficial partnerships between caregivers, patients, and families. Family-centered care is systematically organized so that the dynamics and complexities of different aspects of individuals and families are taken into consideration.
 Methods: The present study is a quasi-experimental study of a practical type that was conducted in 1399 with the selection of 70 adolescent girls with iron deficiency anemia studying in high school in Mahmudabad through non-random sampling. Research tools include Questionnaire. After collecting the information obtained from the pre-intervention stage, the family-centered care program for the sample adolescents in the performance test group. It was performed three month after the intervention. The obtained data were analyzed using Paired-Samples T Test.
 Results: The comparison of the total score of fatigue and depression of adolescent girls with iron deficiency anemia before and after the intervention in the test group showed a significant difference in the direction of decreasing scores (P<0.001), but there was no significant difference in the control group (P> 0.05). Comparison of total fatigue scores of adolescent girls with iron deficiency anemia before and after the intervention in the experimental group showed a significant difference in reducing scores (P < 0.001), but in the control group, there was no significant difference (P = 0.182); Also, comparison of total depression scores of adolescent girls with iron deficiency anemia before and after the intervention in the experimental group showed a significant difference in reducing scores (P < 0.001), but in the control group, there was no significant difference (P=0.667).
 Conclusions: The results showed that the rate of fatigue and depression in adolescent girls with iron deficiency anemia who receive a family-centered care program has decreased compared to the control group.

Effect of Family-Centered Care on Maternal Caring Burden in Premature Infants Admitted to Intensive Care Unit

Background: Birth of a preterm newborn profoundly challenges the mother to play her parenting role. The care burden of the mother affects the entire family system. This study aimed to identify the impact of family centered care on the care burden of mothers with preterm newborns hospitalized in neonatal intensive care unit (NICU).
 Methods: In this quasi-experimental study, 59 mothers of preterm newborns hospitalized in the NICU of the Hafiz hospital in Shiraz,Iran, were assessed. A four-stage family-centered care program was implemented in the first seven days of the infant's hospitalization. The control group received routine care. The amount of care burden of the mothers was measured using Caregiver Burden Scale (CBS). The control and experimental groups filled out the questionnaire at the baseline (third day after admission) and the seventh day after hospitalization.
 Results: After the intervention, the mean score of care burden in mothers in the control and experimental groups were 62.73 ± 7.44 and 58.13 ± 8.17, respectively. The mean score of care burden in mothers in the experimental group was significantly lower than before the intervention. The results of the univariate analysis of covariance (ANCOVA) showed a significant difference in mean scores of care burden and their subscales in two groups (P=0.04).
 Conclusion: Family-centered care reduces the care burden of mothers of preterm newborns by emphasizing the helpful presence of the other family members, especially fathers in the NICUs. The family-centered care approach is effective and it has positive effect on parental involvement in the care of the newborn on the process of recovery.

Factors associated with family involvement in a family-centered care program among incarcerated French adolescents with conduct disorder.

This study aims to identify the patient characteristics that may influence family involvement in a family-centered care program during detention. Little is known about the needs of incarcerated adolescents and their families. This exploratory study used a cross-sectional design to collect data from incarcerated adolescents with conduct disorder followed in a French outpatient psychiatric department. Logistic regression models were used to identify the sociodemographic, clinical and family characteristics of these incarcerated adolescents that could predict family involvement in their care. Among 44 adolescents with conduct disorder, the probability of family involvement during the adolescent's detention was 9.6 times greater (95% CI 1.2-14.4, p = 0.03) for adolescents with no than for those with cannabis substance use disorder, and family involvement decreased with the age of the adolescent (OR = 0.22, 95% CI 0.1-0.9, p = 0.04). Increased knowledge of the characteristics of these adolescents and their families is needed to develop programs that will increase family interventions by specialty treatment services during detention. No study has yet been published on French incarcerated adolescents with conduct disorder. As conduct disorder is one of the most important mental health disorders among delinquent adolescents, this study provides knowledge about these adolescents and the need to involve their parents in their care to prevent the further escalation of problem behaviors.

Neonatal Continuing Education That Powers Family-Centered Care Like Never Before.

Families in the NICU struggle on a daily basis and they are at high risk for mental health challenges ongoing due to the trauma inflicted at birth and during the NICU and beyond. Starting parents down a path of psychosocial support is key at bedside and can have a major impact on that infant and family's long-term outcomes. This is the most powerful family-centered care program in existence thanks to the collaboration of three well-respected organizations-National Perinatal Association, NICU Parent Network, and Patient + Family Care.

The Effect of a Multifaceted Family Participation Program in an Adult Cardiovascular Surgery ICU.

To develop and implement a patient- and family-centered care program for patients in a cardiovascular surgery ICU. Prospective, pre- and postintervention evaluations were conducted. The cardiovascular surgery ICU was located in a tertiary hospital. Participants included 56 family members of patients in cardiovascular surgery ICU between May and July 2019. Providing personalized treatment plans for patients by: 1) providing an ICU diary, 2) communicating with the medical staff, 3) providing personal care using ICU visitation kit, and 4) guiding bedside range of motion exercises. The experimental group received a guided ICU diary and education program from a nurse, including the application of a family participation visitation program. Family members were provided with customized information from the ICU diary and communicated with the medical staff for approximately 10 minutes. Family members were instructed on how to perform personal care using an "ICU visitation kit" during visitation hours when permitted to participate in bedside activities for approximately 10-minute intervals. Scores for satisfaction with the provided care and information increased significantly for the experimental group compared with the control group (t = 8.62; p < 0.001). Anxiety levels decreased significantly after intervention in both groups (t = -7.05; p < 0.001 and t = -12.94; p < 0.001) with a significant association observed between group and time point (F = 20.50; p < 0.001). However, no significant change was observed in satisfaction with decision-making following intervention in either group, and no significant association was noted between groups and time points for this variable (F = 0.24; p = 0.626). This set of implemented family participation processes significantly improved satisfaction and reduced anxiety in family members of critically ill patients.

Effect of Strengthening Family Coping Resources on Emotion Regulation of Family Caregivers of Patients with Schizophrenia

Background: Strengthening the coping resources as an instruction for anxiety-regulation may affect the emotion-regulation of families. Regarding the significant role of families in health of these patients, it seems that interference in strengthening coping resources affects their emotion-regulation. Aim: This study aimed to determine the effect of strengthening family coping resources on the emotion-regulation of schizophrenic patients' caregivers. Method: This quasi-experimental research was conducted on families with hospitalized schizophrenic patients in one of the most prominent psychiatric centers in the Northeast of Iran in 2018. The participants were assigned to intervention (n=29) and control (n=31) groups. A short revised form of Emotion-Regulation Questionnaire was utilized as data collection tool. The intervention based on strengthening family coping resources (SFCR) was administered in three modules and 15 group sessions (groups of 6-8 individuals) according to the instructions of the multi-family model of Kisser et al. On the other hand, the controls received routine cares in hospital wards.The data were analyzed in SPSS software version (16) using independent and paired t-tests. Results: The groups were homogenous in terms of demographic characteristics. The result of independent t-test demonstrated a significant difference in the mean score of revaluation (P=0.001) and suppression (p=0.001) in the intervention group, compared to the control group, after the intervention. Implications for Practice: This intervention can guide clinicians on how to implement a family-centered care program to reduce the burden of caring schizophrenic patients through gaining family support in the efficient care of these patients.

The effect of family-centered care on adherence to treatment in patients with type 2 diabetes

Background and Aim: The family can play an important role in adapting patients with diabetes to lifestyle changes, so that the family, as the most essential pillar of society, is responsible for the proper care of the patient with diabetes; Therefore, the present study was conducted to determine the effect of family-centered care on the adherence to treatment of patients with type 2 diabetes. Materials and Methods: In this quasi-experimental study, 80 patients with type 2 diabetes and one member of their family were selected by convenience sampling method and randomly assigned to two of intervention and control groups. Adherence to treatment was assessed using a researcher-made questionnaire and laboratory values before and 3 months after the intervention. Data were analyzed using the Kolmogorov-Smirnov, Independent t-test, paired t-test, and Chi-square test. Results: After the implementation of the family-centered care program, increased mean scores for patient adherence to treatment in the intervention group compared to the control group, this increase was statistically significant (p=0.0001). The results showed a decrease in the mean score of fasting blood glucose, random blood glucose and glycosylated hemoglobin in the intervention group compared to the control group. This decrease was statistically significant (P = 0.0001). Conclusion: Family-centered care can increase adherence to treatment, and decrease fasting blood glucose, random blood glucose and hemoglobin glycosylated levels. Therefore, it is recommended that family pay more attention to diabetic members. Key Words: Adherence to Treatment; Blood glucose; Family-Centered Nursing; Type 2 Diabetes Mellitus

The effect of family-centered care on adherence to treatment in patients with type 2 diabetes

Background and Aim: The family can play an important role in adapting patients with diabetes to lifestyle changes, so that the family, as the most essential pillar of society, is responsible for the proper care of the patient with diabetes; Therefore, the present study was conducted to determine the effect of family-centered care on the adherence to treatment of patients with type 2 diabetes. Materials and Methods: In this quasi-experimental study, 80 patients with type 2 diabetes and one member of their family were selected by convenience sampling method and randomly assigned to two of intervention and control groups. Adherence to treatment was assessed using a researcher-made questionnaire and laboratory values before and 3 months after the intervention. Data were analyzed using the Kolmogorov-Smirnov, Independent t-test, paired t-test, and Chi-square test. Results: After the implementation of the family-centered care program, increased mean scores for patient adherence to treatment in the intervention group compared to the control group, this increase was statistically significant (p=0.0001). The results showed a decrease in the mean score of fasting blood glucose, random blood glucose and glycosylated hemoglobin in the intervention group compared to the control group. This decrease was statistically significant (P = 0.0001). Conclusion: Family-centered care can increase adherence to treatment, and decrease fasting blood glucose, random blood glucose and hemoglobin glycosylated levels. Therefore, it is recommended that family pay more attention to diabetic members. Key Words: Adherence to Treatment; Blood glucose; Family-Centered Nursing; Type 2 Diabetes Mellitus

Association of Antiretroviral Drug Regimen With Viral Suppression in HIV-positive Children on Antiretroviral Therapy in Eswatini.

Global pediatric treatment goals are for 90% of known children living with HIV to be on antiretroviral therapy (ART), with 90% having viral suppression. We used enrollment data from a study evaluating a family-centered HIV care program in Eswatini to describe the ART histories and virologic outcomes of enrolled children living with HIV and identify factors associated with viral suppression (<1000 RNA copies/mL) and undetectability (<400 RNA copies/mL). Factors associated with viral suppression and undetectability were identified using Pearson χ for categorical variables and Wilcoxon rank sum tests for continuous variables. Three hundred seventy-seven children were enrolled, median age 8.5 years. Median age at HIV diagnosis was 2.1 years; at ART initiation, 2.6 years; and ART duration at enrollment, 4.1 years. Ninety-nine percent were receiving ART; 95.2% were on first-line ART and 4.8% on second-line ART. Most children (43.1%) were receiving nevirapine-based ART (median age 9.2 years), with 31.3% on lopinavir-ritonavir-based (median age 5.4 years) and 25.5%, efavirenz-based ART (median age 10.3 years). Viral suppression (<1000 copies/mL) was observed in 77.9% and undetectability (<400 copies/mL) in 73.5% of children. The only factor significantly associated with viral suppression was ART regimen, with 72.1% of children on nevirapine-based ART versus 86.7% on efavirenz-based ART virally suppressed. Although 99% of children enrolled in the study were receiving ART, viral suppression was observed in only 77.9%, with lowest rates among children receiving nevirapine-based ART. These findings highlight the critical importance of monitoring treatment regimen for optimizing treatment outcomes for pediatric HIV.

A program of family-centered care for adolescents in short-term stay groups of juvenile justice institutions.

BackgroundTo provide successful treatment to detained adolescents, staff in juvenile justice institutions need to work in family-centered ways. As juvenile justice institutions struggled to involve parents in their child’s treatment, we developed a program for family-centered care.MethodsThe program was developed in close collaboration with staff from the two juvenile justice institutions participating in the Dutch Academic Workplace Forensic Care for Youth. To achieve an attainable program, we chose a bottom-up approach in which ideas for family-centered care were detailed and discussed by workgroups consisting of group leaders, family therapists, psychologists, other staff, researchers, and a parent.ResultsThe family-centered care program distinguishes four categories of parental participation: (a) informing parents, (b) parents meeting their child, (c) parents meeting staff, and (d) parents taking part in the treatment program. Additionally, the family-centered care program includes the option to start family therapy during detention of the youths, to be continued after discharge from the juvenile justice institutions. Training and coaching of staff are core components of the family-centered care program.ConclusionsThe combination of training and the identification of attainable ways for staff to promote parental involvement makes the family-centered care program valuable for practice. Because the program builds on suggestions from previous research and on the theoretical background of evidence-based family therapies, it has potential to improve care for detained adolescents and their parents. Further research is required to confirm if this assumption is correct.

Better Respiratory Education and Treatment Help Empower (BREATHE) study: Methodology and baseline characteristics of a randomized controlled trial testing a transitional care program to improve patient-centered care delivery among chronic obstructive pulmonary disease patients

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a leading cause of hospitalizations. Interventional studies focusing on the hospital-to-home transition for COPD patients are few. In the BREATHE (Better Respiratory Education and Treatment Help Empower) study, we developed and tested a patient and family-centered transitional care program that helps prepare hospitalized COPD patients and their family caregivers to manage COPD at home. MethodsIn the study's initial phase, we co-developed the BREATHE transitional care program with COPD patients, family-caregivers, and stakeholders. The program offers tailored services to address individual patients' needs and priorities at the hospital and for 3months post discharge. We tested the program in a single-blinded RCT with 240 COPD patients who were randomized to receive the program or ‘usual care’. Program participants were offered the opportunity to invite a family caregiver, if available, to enroll with them into the study. The primary outcomes were the combined number of COPD-related hospitalizations and Emergency Department (ED) visits per participant at 6months post discharge, and the change in health-related quality of life over the 6months study period. Other measures include ‘all cause’ hospitalizations and ED visits; patient activation; self-efficacy; and, self-care behaviors. DiscussionUnlike 1month transitional care programs that focus on patients' post-acute care needs, the BREATHE program helps hospitalized COPD patients manage the post discharge period as well as prepare them for long term self-management of COPD. If proven effective, this program may offer a timely solution for hospitals in their attempts to reduce COPD rehospitalizations.

The Effect of Family-centered Care Program on Maternal Attachment in Mothers of Premature Infants

BACKGROUND AND OBJECTIVE: The birth of a premature infant is associated with long - term hospitalization and separation from family. Hospitalization of the infant affects the attachment between the infant and mother and affects the quality of care given to the infant by mother and increases the risk of delayed behavioral problems. Therefore, the present study aims to analyze the effect of family-centered care program on maternal attachment in mothers of premature infants. METHODS: In this clinical trial, 60 mothers of premature infants with gestational age of 30 to 36 weeks, hospitalized in neonatal intensive care unit of Motahari Hospital were selected using convenient non-probability sampling and were randomly divided into two groups of control and intervention (30 mothers in each group). The family-centered care program was performed on intervention group in three steps: In the beginning of infant care, before the fourth day of hospitalization and before discharge, while the control group was only under the usual care. The level of maternal attachment was measured using Avant's mother-infant attachment behavior questionnaire and each dimension of attachment behavior was scored from 0 to maximum based on care (45), proximity (45) and emotional (37) behavior (IRCT: 2017021914454N3) FINDINGS: The total score of maternal attachment increased from 34.3±5.1 to 61.6±4.5 in intervention group and increased from 33.1±4.2 to 37.8±3.7 in control group. There is a significant difference between the two groups in terms of total score of attachment between mother and premature infant (p<0.001). CONCLUSION: Results of the study demonstrated that implementation of family-centered care program increases the attachment between mother and infant more than common infant-care methods. © 2017, Babol University of Medical Sciences. All rights reserved.

Family-Centered Care in Juvenile Justice Institutions: A Mixed Methods Study Protocol.

BackgroundTreatment and rehabilitation interventions in juvenile justice institutions aim to prevent criminal reoffending by adolescents and to enhance their prospects of successful social reintegration. There is evidence that these goals are best achieved when the institution adopts a family-centered approach, involving the parents of the adolescents. The Academic Workplace Forensic Care for Youth has developed two programs for family-centered care for youth detained in groups for short-term and long-term stay, respectively.ObjectiveThe overall aim of our study is to evaluate the family-centered care program in the first two years after the first steps of its implementation in short-term stay groups of two juvenile justice institutions in the Netherlands. The current paper discusses our study design.MethodsBased on a quantitative pilot study, we opted for a study with an explanatory sequential mixed methods design. This pilot is considered the first stage of our study. The second stage of our study includes concurrent quantitative and qualitative approaches. The quantitative part of our study is a pre-post quasi-experimental comparison of family-centered care with usual care in short-term stay groups. The qualitative part of our study involves in-depth interviews with adolescents, parents, and group workers to elaborate on the preceding quantitative pilot study and to help interpret the outcomes of the quasi-experimental quantitative part of the study.ResultsWe believe that our study will result in the following findings. In the quantitative comparison of usual care with family-centered care, we assume that in the latter group, parents will be more involved with their child and with the institution, and that parents and adolescents will be more motivated to take part in therapy. In addition, we expect family-centered care to improve family interactions, to decrease parenting stress, and to reduce problem behavior among the adolescents. Finally, we assume that adolescents, parents, and the staff of the institutions will be more satisfied with family-centered care than with usual care. In the qualitative part of our study, we will identify the needs and expectations in family-centered care as well as factors influencing parental participation. Insight in these factors will help to further improve our program of family-centered care and its implementation in practice. Our study results will be published over the coming years.ConclusionsA juvenile justice institution is a difficult setting to evaluate care programs. A combination of practice-based research methods is needed to address all major implementation issues. The study described here takes on the challenge by means of practice-based research. We expect the results of our study to contribute to the improvement of care for adolescents detained in juvenile justice institutions, and for their families.

Investigating the effects of a family-centered care program on stroke patients’ adherence to their therapeutic regimens

Background: Stroke survivors have residual neurological impairment, which requires long-term support and care. In this situation family involvement in care process is necessary. However, as the family caregivers of stroke survivors are not necessarily supported by the health-care professionals, and they often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. Aim: The aim of this study was to investigate the effects of a family-centered care program on stroke patients’ adherence to their therapeutic regimens. Methods: This is a posttest-only randomized controlled trial study, conducted on stroke patients and their family caregivers. The control group (N = 30) received only routine hospital services and the experimental group (N = 30) received routine hospital services plus a family-centered care program consisting of four steps; need assessment, educating families based on patients’ needs, follow-ups by short phone interviews, and referral service. The data were collected via a demographic data form and ‘Adherence to the Therapeutic Regimens (ATR)’ questionnaire between July 2011 and March 2012 and lasted 2 months for each subject. Data were assessed and analyzed with SPSS version 18. Findings: Study findings showed that the levels of adherence to the different components of the therapeutic regimens, including rehabilitations, medications and dietary regimen are significantly higher in the experimental group compared to the control group (P  0.001). Conclusion: By empowering patients’ families and improving their ATRs, family-centered care programs will be able to play an important role in management of physical and mental health of stroke patients.

Investigating the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens.

Abstract Background: Stroke survivors have residual neurological impairment, which requires long-term support and care. In this situation family involvement in care process is necessary. However, as the family caregivers of stroke survivors are not necessarily supported by the health-care professionals, and they often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. Aim: The aim of this study was to investigate the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens. Methods: This is a posttest-only randomized controlled trial study, conducted on stroke patients and their family care-givers. The control group (n = 30) received only routine hospital services and the experimental group (n = 30) received routine hospital services plus a family-centered care program consisting of four steps; need assessment, educating families based on patients' needs, follow-ups by short phone interviews, and referral service. The data were collected via a demographic data form and "Adherence to the therapeutic regimens" Questionnaire between July 2011 to March 2012 and lasted two months for each subject. Data were assessed and analyzed with SPSS version 18. Findings: Study findings showed that the levels of adherence to the different components of the therapeutic regimens, including rehabilitations, medications and dietary regimen are significantly higher in the experimental group compared to the control group (P value< 0.001). Conclusion: By empowering patients' families and improving their adherence to the therapeutic regimens, family-centered care programs will be able to play an important role in management of physical and mental health of stroke patients.

Investigating the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens.

Abstract Background: Stroke survivors have residual neurological impairment, which requires long-term support and care. In this situation family involvement in care process is necessary. However, as the family caregivers of stroke survivors are not necessarily supported by the health-care professionals, and they often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. The aim of this study was to investigate the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens. This is a posttest-only randomized controlled trial study, conducted on stroke patients and their family caregivers. The control group (N = 30) received only routine hospital services and the experimental group (N = 30) received routine hospital services plus a family-centered care program consisting of four steps; need assessment, educating families based on patients' needs, follow-ups by short phone interviews, and referral service. The data were collected via a demographic data form and 'Adherence to the Therapeutic Regimens (ATR)' questionnaire between July 2011 and March 2012 and lasted 2 months for each subject. Data were assessed and analyzed with SPSS version 18. Study findings showed that the levels of adherence to the different components of the therapeutic regimens, including rehabilitations, medications and dietary regimen are significantly higher in the experimental group compared to the control group (P < 0.001). By empowering patients' families and improving their ATRs, family-centered care programs will be able to play an important role in management of physical and mental health of stroke patients.

Social support, perceived stigma, and quality of life among HIV-positive caregivers and adult relatives of pediatric HIV index cases in Kinshasa, Democratic Republic of Congo

Psychosocial support services are essential for effective HIV care, yet this area remains under-researched in sub-Saharan settings where the HIV epidemic is the most devastating. We explored the relationships between social support, perceived stigma, and quality of life (QOL) in HIV-positive adults participating in a family-centered pediatric HIV care and treatment program in Kinshasa, Democratic Republic of Congo (DRC). Baseline interviews were conducted with 275 HIV-positive adults who were caregivers or first-line relatives of enrolled HIV-positive children. Associations between variables were examined using Pearson correlation coefficients. Hierarchical multiple regression was used to test the hypothesis that the relationship of social support to QOL was moderated by perceived stigma. We examined psychological status, which overlaps with symptoms of depression and is one of the six domains in the World Health Organization (WHO) QOL measure, separately and as part of overall QOL. Our sample was 84% female and largely mothers with relatively little formal education. There was a positive association between social support and psychological status (r = 0.42(224), p < 0.001) and a negative association between perceived stigma and psychological status (r = –0.31(226), p < 0.001). The relationship of social support to psychological status was moderated by perceived stigma (β = 0.191, p < 0.05) such that the association between social support and psychological status was positive and stronger for patients reporting high stigma than for patients reporting low stigma. The relationship of social support to overall QOL was not moderated by perceived stigma (β = 0.089, p = 0.397). These results highlight the importance of assessing multiple QOL domains. By examining psychological status separately, we found support for our hypothesis which we would not have found if only overall QOL had been examined. Enhancing social support may be particularly important for those reporting high stigma in improving QOL. As access to antiretroviral therapy increases, so does the relevance of modifiable predictors of QOL.

The role of religion in HIV-positive women's disclosure experiences and coping strategies in Kinshasa, Democratic Republic of Congo

Literature from the U.S. has documented the importance of spirituality on the psychological health of people living with HIV/AIDS; however there is little published data on the ways in which people living with HIV/AIDS in Africa turn to religion for support. We conducted 40 in-depth interviews with HIV-positive women who were pregnant or had recently given birth in Kinshasa, Democratic Republic of Congo to inform the development of a comprehensive family-centered HIV treatment and care program. Women described how they relied upon their faith and turned to church leaders when they were diagnosed with HIV and prepared to share their diagnosis with others. The women used prayer to overcome the initial shock, sadness and anger of learning their HIV diagnosis. They turned to their church leaders to help them prepare for disclosing their diagnosis to others, including their partners. Church leaders were also important targets for disclosure by some women. Women's faith played an important role in their long-term coping strategies. Conceptualizing their infection as a path chosen by God, and believing that God has the power to cure their infection comforted women and provided them with hope. In settings like the Democratic Republic of the Congo, where there is a strong foundation of faith, we need to recognize how individuals draw upon their different health belief systems in order to develop and implement coherent and effective prevention, treatment and care strategies.