Primary Family Research Articles

Development of a question prompt list for Indian cancer patients receiving radiation therapy treatment and their primary family caregivers.

We aimed to develop two question prompt lists (QPLs), one for Indian cancer patients undergoing radiation therapy and the second for their primary family caregivers. The study comprised three phases: (1) qualitative interviews with patients (n=65) and PFCs (n=39) to identify their information needs, queries and concerns regarding RT; (2) development of draft QPLs using conventional content analysis and translation into Hindi and Marathi using European Organisation Research and Treatment of Cancer guidelines; and, (3) A readability analysis, and acceptability study with patients (n=22), PFCs (n=26) and Radiation Oncology (RO) staff (n=20) exploring barriers to QPL implementation. Analysis in Phase I identified questions patients and PFCs asked or wanted to ask their physician. A list of 125 and 136 questions were generated for patients and PFCs, respectively. After five iterations, the draft QPLs were finalised, translated, and back-translated from English into Hindi and Marathi (Phase II). In Phase III, most patients and PFCs reported the QPLs were easy to read, they did not find it difficult to ask the questions, and the questions were not emotionally upsetting. Conversely, RO staff reported concerns that patients may find it difficult to discuss the questions with their physician. The study highlights the need to empower patients and PFCs to ask questions and for staff to feel comfortable answering them. Implementing physician-endorsed QPLs could achieve these aims.

数字家长学校助力乡村中小学家庭教育的现状、问题与对策——基于浙江省Q县的实证研究

数字家长学校助力乡村中小学家庭教育的现状、问题与对策——基于浙江省Q县的实证研究

Depression and anxiety among patients attending primary Healthcare in NGHA, Riyadh

Background: Anxiety is a prevalent mental health disorder, affecting approximately 33% of the population, while depression is a leading cause of disability worldwide. This study aims to investigate the prevalence and associated factors of anxiety and depression among patients attending primary health clinics. Methods: A cohort cross-sectional study was conducted on patients at Primary Health Care and Family Medicine clinics in National Guard Health Affairs, Riyadh. The data were collected using a self-administered questionnaire. Non-probability consecutive sampling was used. Data were analyzed using Statistical Package for the Social Sciences. Results: Regarding mental health, 48.1% of patients showed no signs of depression, while the remaining 51.9% displayed varying degrees of depression. Mild depression was the most prevalent (32.4%). For anxiety, 40.7% showed signs of anxiety. Females had a higher depression rate (61.9%) compared to males (44.5%), and age played a role, with the highest depression rate observed among patients aged 21-40 years (70.9%). Marital status also influenced depression, with widowed individuals showing a 100.0% depression rate, followed by divorced (56.3%), single (73.9%), and married (39.2%) individuals. Similarly, gender significantly affected anxiety, with females (46.6%) experiencing higher rates than males (36.3%). Patients aged 21-40 years had the highest anxiety rate (56.1%). Conclusion: This study sheds light on the health factors and their impact on depression and anxiety among primary health clinic attendees. It highlights the importance of considering these factors while assessing mental health issues in a clinical setting. Further understanding of these associations can aid healthcare providers in identifying vulnerable populations and tailoring appropriate interventions to address mental health concerns effectively.

Frequency And Determinants Of Chronic Lower Back Pain Among Patients Presenting To Primary Care Clinics In Pakistan: A Cross-Sectional Analysis

Objective: To ascertain the determinants of chronic lower back pain among patients presenting in primary care clinics. Methods: 300 participants from 18 to 75 years of age were enrolled from Primary Care Clinics, Primary Health Center, Sikanderabad and Family Medicine Health Center, Clifton, for a Cross-sectional study that was done from December 1, 2020, to June 30, 2021. Consultant family physicians took informed consent and then asked relevant history questions and performed a relevant physical examination, such as a straight leg raise on the patients. Results: The frequency of chronic lower back pain came out to be 16.7%(50). The median age was 31.99+15.7 years. For those who had chronic back pain, the majority were regularly taking Cholecalciferol supplements ( 20.8% p-value 0.05). The effect of depression increases the chances (0.688) of chronic lower back pain. (p-value 0.006) Conclusion: In our study, we concluded that lower back pain, especially chronic in duration, is very rampant in the community with male predominance. The majority reported a dull type of pain. Depressed people are more vulnerable to developing chronic back pain. Keywords: LBP (lower back pain), magnitude, restricted mobility, S.I. joint (Sacroiliac joint), community..

Primary Care Family Physicians’ Experiences with Clinical Integration: A Scoping Review of Qualitative and Mixed Reviews

Background: Clinical (service) integration in primary care settings describes how healthcare services are coordinated over time across healthcare contexts to meet patient care needs. Promoting integrated care with interventions that lack systematic approaches can unintentionally increase the complexity and fragmentation of the healthcare system. To improve care integration and healthcare service planning, a systematic approach to understanding its many influencing factors is paramount. This phase I study aims to generate a comprehensive map of family physician (FP) perceived factors, across diseases and patient demographics, influencing how services are integrated for patients. 
 Methods: The protocol development is guided by Arksey and O’Malley’s scoping review methodology framework. Keywords and MeSH terms were contributed by a multidisciplinary team of healthcare professionals, researchers, and patient representatives through an iterative discussion. An Information Specialist with clinical research expertise tested keywords and MeSH terms to build a search strategy using MEDLINE. The strategy was then adjusted for the EMBASE and CINAHL databases. All identified articles were imported into Covidence platform, and 228 duplicates were removed. Two independent reviewers screened 1,771 studies by their titles and abstracts. Of them, 264 studies were reviewed in full text against the selection criteria and their references were hand-searched. A total of 91 articles were included, and over 2,800 factors were extracted. The factors are being or will be coded into themes the Clinical Integration Framework, a merging of two existing models identified from literature and modified. Within each theme, similar codes are clustered together as a subtheme. 
 Discussion: The identified factors will help develop a survey in Phase II study to ascertain high impact factors for intervention(s), as well as thematic and evidence gaps to guide future research. The study findings will be shared with stakeholders to promote awareness of clinical integration issues through multiple channels: publications and conferences for researchers and care providers, an executive summary for clinical leaders and policy makers, and social media for the public.

Physiotherapy In Primary Care: Piloting of A New Integrated Service 

Introduction: In recent years, the prevalence of osteoarticular pain in our society has been following an unstoppable upward curve, with a medium-term forecast that points to it as one of the major causes of disability. The approach to the treatment of these ailments from an exclusively biomedical model, far from resolving them, saturates the health services themselves and fails to add value to the health/disease experience of those who suffer from them.
 Objectives: To evaluate the implementation of a Physiotherapy service in Osakidetza Primary Care centers for the management of people suffering from osteoarticular pain.
 Material And Methods: As part of the corporative strategy delineated by Osakidetza for Pirmary Care, the aim was to introduce a new approach to osteoarticular pain based in an integral model using exercise as the instrument to maintain health and prevent relapses, empowering the person in the management of their process, in connection with the municipal sports services. Specifically, it is intended to refer patients from primary care family medicine professionals to physiotherapy, under an agreed treatment protocol and in coordination with the Rehabilitation Service. This process is based on a fundamentally educational approach, consisting in 10 sessions of 1 hour of duration, in groups of 8-10 people, carried out over 2 weeks each group, with specific exercises adapted to their pathology. The piloted evaluation of the program was conducted in 2 gyms located in 2 health centers serving the entire regional population of 312,000 inhabitants, between November 2018 to December 2021. 
 Results: The number of people assessed by 4 physiotherapists during the evaluation period was 4,175. Of these, 3,294 (79%)performed the treatment, 4% were referred to the hospital rehabilitation service after the assessment, 3% of the patients were returned to their Family Doctor due to inadequate referral and 17% refused treatment, in all cases due to the impossibility of reconciling work-family life. In accordance with the available evidence, the most frequent reason for consultation was back pain, in 72% of the cases. In 76% of the cases, the waiting time from the physical therapist's evaluation to access to the treatment was less than 1 month, being in all cases less than 2 months. After participation in the program, 81% of the users treated showed improvement in pain and/or functionality. Regarding satisfaction, 95% found the treatment useful and 100% would recommend the treatment to others, with an average satisfaction of 9.3 out of 10.
 Conclusions: The approach to non-specific back and shoulder pain in the context of primary care offers a service to the affectd citizens closer in time and space, with an effective resolution of the symptomatology and a highly valued patient experience. The physiotherapist, in addition to leading the whole process, is a key figure of integration between the two levels of care of Primary and Specialized Care. By resolving non-complex pathology in the primary care setting, more space is given to address more complex pathology in the hospital setting.

Provision of DMPA-SC for self-administration in different practice settings during the COVID-19 pandemic: Data from providers across the United States

ObjectivesDepot medroxyprogesterone acetate-subcutaneous (DMPA-SC) can be prescribed through telemedicine and self-administered, but data about availability, particularly during the COVID-19 pandemic, are limited. This study assessed changes in the availability of DMPA-SC for self-administration during the pandemic. Study designThis study used survey data from a convenience sample of US providers engaged in contraceptive care and participating in a Continuing Medical Education-accredited contraceptive training (April 2020–April 2022; n = 849). Providers were recruited from across 503 clinics, including primary care and family planning clinics, public health departments, college and school-based health centers, independent abortion care clinics, and outpatient clinics in hospital settings. Measures included the availability of DMPA-SC for self-administration before and during the pandemic and the use of telemedicine. We used Poisson regression models and cluster-robust errors by clinic, adjusting for region, time of survey, and clinic size, to assess clinic availability of DMPA-SC for self-administration by practice setting. ResultsCompared to the prepandemic period (4%), the availability of DMPA-SC for self-administration increased significantly during the pandemic (14%) (adjusted prevalence ratios [aPR] 3.43, 95% CI [2.43–4.85]). During the pandemic, independent abortion clinics were more likely to offer DMPA-SC for self-administration compared to primary care clinics (aPR 2.44, 95% CI [1.10–5.41]). Clinics receiving Title X funds were also more likely to provide DMPA-SC for self-administration during the pandemic compared to other clinics (aPR 2.32, 95% CI [1.57–3.43]), and more likely to offer DMPA-SC for self-administration through telemedicine (aPR 2.35, 95% CI [1.52–3.63]). Compared to the early pandemic period (April–September 2022), telemedicine access to DMPA-SC for self-administration was highest during the later pandemic time period (October 2021–April 2022) (aPR 2.10, 95% CI [1.06–4.17]). ConclusionsThe availability of DMPA-SC for self-administration significantly increased during the pandemic with differences by practice setting and Title X funding. However, overall method availability remains persistently low. ImplicationsDespite increased availability of DMPA-SC for self-administration among US contraceptive providers during the COVID-19 pandemic, there remains a need to train providers, educate patients, and remove barriers to ensure broader availability of this method across different practice settings.

The personality traits of family caregivers of individuals with dementia: The effects of social anxiety, social phobia, and caregiving hours

Background and Aim of Study: Caring for individuals afflicted with dementia engenders substantial demands and responsibilities for caregivers, encompassing the extensive time allocation devoted to the care recipient on a daily basis. Furthermore, the psychological attributes inherent in informal caregivers, encompassing traits like social anxiety and social phobia, can exert an influence on the evolution of their personal dynamics over time. This phenomenon potentially yields repercussions for how caregivers offer guidance and assistance to elderly individuals grappling with dementia, particularly in relation to their fundamental daily activities and instrumental tasks. The aim of the study: to analyze the predictive effect of social anxiety and social phobia as psychological characteristics of caregivers, along with the impact of caregiving hours as caregiving-related characteristics, on caregivers’ personality. Material and Methods: This observational and cross-sectional study comprised a sample of 97 participants serving as primary family caregivers completed a sociodemographic questionnaire, the Big Five Inventory, the Anxiety Scale in Social Interaction Situations, and the Social Phobia Scale. Results: The findings revealed that social phobia demonstrated significant predictive power for Openness (β=-0.199; p=0.016) and Extraversion (β=-0.136; p=0.024), whereas the daily caregiving hours negatively affected Conscientiousness (β=-0.145; p=0.011), Agreeableness (β=-0.137; p=0.040), Openness (β=-0.210; p=0.011), and Extraversion (β=-0.175; p=0.003). Conversely, social anxiety did not prove to be a significant variable. Conclusions: The presence of social phobia or higher hours devoted to caregiving for individuals with dementia are factors that impact personality functioning and should be considered in the planning of support programs for family caregivers.

Assistive technologies and aging in place for people with dementia and disabilities: a proof-of-concept study with in-home passive remote monitoring with interactive communication functions

Purpose Can assistive technologies (ATs) support aging in place for people with dementia and disability? In seeking to go beyond the persistent institutional care delivery paradigm, this proof-of-concept study tested the feasibility of home care delivery using sensors and remote communication devices. This article reports the collaborative efforts among care professionals, care recipients and family caregivers in their private home environment and the impact of in-home passive remote monitoring (PRM) system on the users. The purpose of this study was to investigate the usability and impact of a PRM system combining in-house passive remote monitoring and an interactive communication function. Methods In order to realize AT-supported, person-centered aging in place, a new care delivery model was designed, developed and tested for the duration of 12 weeks. The study was conducted with 5 older people (1 with severe disability and 4 with dementia), their primary family carers with 15 care professionals as users. Results The findings indicate that there were some technical issues. However, the overall assessment of the system performance was positive, and the users expressed favorable views regarding its preventive and interactive nature. The importance of team-based care delivery, adjusted to fit the PRM equipment, was also highlighted. Faced with the challenge of meeting the increasing demand for person-centered care with limited resources, there will be a greater need for better integration of improved ATs. The study indicates ATs’ potential for enhancing the quality of life for those involved in caregiving, while stressing the significance of stakeholders’ engagement, skills and teamwork.

VISUALIZING VETERANS’ CARE: UNDERSTANDING THE BREADTH OF OLDER VETERANS’ PAID AND FAMILY SUPPORT NETWORKS

Abstract Many older veterans rely on a complex network of paid and unpaid caregivers to age safely at home. Medical records often only capture a primary family caregiver, giving medical teams a limited picture of veterans’ supports at home as well as plans for contingency care. We tested a novel visual tool, care mapping, to better understand the scope of veterans’ formal and informal support. We created collaborative care maps with 10 dyads/triads of veterans age 65+ eligible for VA-paid home care and their primary paid and family caregivers. We compared the maps to veterans’ electronic medical records (EMRs) to explore care network structure, function and adequacy. Care maps identified substantially more care partners than EMRs, including functional, medical, socioemotional and spiritual supports such as family, paid aides, neighbors, Veterans’ groups, faith communities, local businesses (pharmacies, food delivery), and social media. Veterans, family and paid caregivers described working together closely, with aides serving as a “third arm” to fill care gaps. Care was often mutual, as veterans described financial and emotional support they provided to family members, aides and their families, and friends. Participants also described these networks as dynamic and fluid, changing based on care needs and care partners’ availability and skills. Identifying the range of support Veterans receive from family, paid aides, and their community may better help medical teams understand often overlooked community supports and relationships, identify care gaps and tailor home and community-based services where they are most effective and needed.

GRAY FOR A DAY: A SIMULATION ACTIVITY IMPACTS PARTICIPANTS IN COMMUNITY-BASED HEALTH EDUCATION

Abstract Nearly 80% of older adults own their own homes; approximately two-thirds live within 25 miles of relatives; and most prefer to age-in-place, without access to geriatric-specific care. They rely on primary care clinics and family, friends, and other local support to meet their health needs. The healthcare workforce and lay public need to better understand age-related functional decline. Simulation activities can increase one’s understanding of new concepts or perspectives. One such activity, “Gray for a Day,” offers a didactic presentation and simulations of functional decline. In 2022, 10 Mississippi State University Cooperative Extension agents offered the “Gray for a Day” training to 550 individuals across 35 sessions in community colleges, high school career and technical education classes, and hospitals and nursing home food service departments. Participant evaluations were collected to assess learning outcomes and empathy development. Process evaluation data and descriptive statistics are reported. Nearly all (98%) of the participants reported increases in knowledge of age-related sensory and functional decline and increases in understanding how age-related sensory and functional decline can impact one’s daily life; and 95% reported an increase in considering how they can better interact with older adults experiencing functional decline. Understanding challenges facing older adults is essential to empathy and important both in a home environment and in the workplace. The “Gray for a Day” simulation activity is feasible for implementation in multiple settings and has the potential to increase knowledge, understanding, and possibly empathy for older adults experiencing functional decline.

DEPRESSIVE COGNITIONS AND SYMPTOMS IN CAREGIVING GRANDMOTHERS: TESTING GROWTH CURVE MODEL STABILITY

Abstract Grandmothers caring for grandchildren have elevated depressive symptoms levels compared to grandmothers who do not provide care. Depressive symptoms are state-like in nature and describe recent depressive symptoms. The Depressive Cognition Scale© captures changes in negative thinking patterns that often precede depressive symptoms. Depressive cognitions, according to Beck’s theory of depression, are the first depressive symptoms to appear and typically lead to more serious symptoms of depression. Previously diagnosed depression may also contribute to current levels of depressive cognitions and depressive symptoms. Data were collected on 342 participants in a longitudinal nationwide online research study of caregiving grandmothers. A latent growth curve model of how previously diagnosed depression and depressive cognitions impacted the trajectory of depressive symptoms at four time points (baseline, 2 weeks, 12 weeks, and 24 weeks) was tested. The model fit the data well (Chi Square=24.301.; df=12; p=.019; TLI=.977; CFI=.987; RMSEA=.055). This model was submitted to 6 separate multigroup nested model tests (levels of income, education, age, employment, number of children, and primary vs. multigeneration families) to provide evidence supporting generalizability of the model. All models fit the data well (TLI=.960-.991; CFI=.973-.992; RMSEA=.051-.025). Total invariance/stability, based on nonsignificant changes in chi square and CFI<.01, was supported in the multigroup analyses across all levels testing equality in measurement and regression weights and residual variances. This lack of change in the model across 6 different grandmother scenarios provides further evidence supporting the need for interventions to address diagnosed depression and depressive cognitions for reducing depressive symptoms in grandmother caregivers.

Predictors of live-in migrant caregiver employment for people with dementia in Taiwan.

With the increasing number of individuals with dementia, families have hired an increasing number of live-in migrant caregivers (LIMCs). Currently, limited evidence is available regarding the influence of long-term care resource utilization on the hiring of LIMCs for caring for individuals with dementia in Taiwan. We recruited individuals with dementia who did not hire LIMCs and their primary family caregivers from nine hospitals in Taiwan as baseline. Multivariable logistic regression was used to evaluate the utilization of long-term care resources for individuals with dementia and other factors that may affect the decision to hire LIMCs. The users of non-long-term care resources had the highest likelihood of hiring LIMCs (odds ratio [OR] = 4.24, 95% CI, 2.30-7.84). Compared with spouses, nonimmediate family caregivers (OR = 3.40, 95% CI, 1.16-9.90) were significantly more likely to hire LIMCs. A higher likelihood of hiring LIMCs was observed for those with Lewy body dementia compared with other individuals (OR = 2.31, 95% CI, 1.03-5.14). Compared with individuals who did not hire LIMCs, those who hired LIMCs exhibited higher scores on the Neuropsychiatric Inventory (NPI) and higher severity of individual NPI items. Hiring LIMCs is strongly correlated with the utilization of non-long-term care resources and is influenced by the dynamics between individuals with dementia and their primary family caregivers. A higher likelihood of hiring LIMCs was observed for individuals with Lewy body dementia and individuals with elevated NPI scores compared with their counterparts. Given these observations, various support strategies and interventions should be tailored to the specific requirements of individuals with dementia and their families.

Extending Classroom Learning Borders

Through the provision of education and training, the Caregiver Training Workshop (CTW) pilot study aimed to advance knowledge about in-person educational interventions for primary family caregivers aiding ill adults (18 years of age and over) at home. The target population was community-dwelling chronic disease caregivers, fourteen of whom participated in the workshop/pilot study in September and October 2019. The sessions were offered once a week, over five weeks—each session lasting two hours. The goal of the CTW pilot study was to measure any relationship between caregiver burden levels and the study’s multi-component curriculum and course design, and to obtain participant feedback about the content and structure. Curricular topics were selected based on a review of the literature. The methodology selected was mixed-methods and convergent pretest–posttest design. Data was collected at three points in time. The pre-workshop data collection instruments consisted of the Burden Scale for Family Caregivers (BSFC) in long form and a mixed demographics form. Post-workshop instruments consisted of the BSFC (second time) and open-ended questions evaluating the program. Three-months post workshop conclusion, the instruments consisted of the BSFC (final time) and a mixed questionnaire regarding the program’s impact. The reduction in caregiver burden was not statistically significant; however, burden scores from three of the 14 caregivers improved over the study period. Analyzing the qualitative data, as well as viewing caregiver burden through self-efficacy theory, offer insights as to why. Many caregivers expressed interest in maintaining contact with each other post workshop completion. This supports research indicating that some caregivers are interested in maintaining social connections throughout their care recipients’ illness trajectories.

Caregiver Knowledge About Palliative Care in King Abdullah Medical City, Makkah, Saudi Arabia: A Cross-Sectional Study (2023).

Background Understandingpalliative care (PC) can hinderaccess to it. To address this, further research into the factors influencing knowledge and awareness of PC is required to develop effective public health campaigns. This study aimed to estimate the knowledge and awareness of PC among primary family caregivers of patients present to the palliative department at King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia (KSA), in 2023, and to determine the factors affecting the family caregiver's awareness about PC. Materials and methods This cross-sectional study was conducted in 2023 among patients' family caregivers in the palliative department of King Abdullah Medical City, Makkah, KSA. The patient was evaluated by palliative service as an inpatient or outpatient presentation. A score, namely "caregivers' general knowledge of palliative care," was used as a study variable. Each of the questions was converted to points and calculated using a simple additive method. The total score was converted to a categorical variable. To discard the null hypothesis, a conventional p-value <0.05 was used. Results The 378 family primary caregivers completed the self-administered questionnaire. The majority (73.8%) were unaware of PC until their family member was admitted to the hospital. The mean score of caregivers' general knowledge is 2.75+0.9, indicating that they have limited knowledge about PC. Age, employment status, relation to the patient, and duration of receiving PC are significantly associated with their knowledge. No associations were found on gender, level of education, and tumor site. Participants aged 26-35 years old (p<0.001), those who are students (p=0.002), who are brother/sister of the patient (p<0.001), and less than one year of PC (p<0.001) significantly related to caregivers' knowledge. Conclusion A low knowledge mean score was found in this study. This indicated that participants had limited knowledge of PC. This study suggested that effective PC education programs and increasing specialized facilities be developed to raise the awareness of both caregivers and patients.

Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship.

Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life. The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas. Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent. Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.

General practice focussed strategies to increase participation in lung cancer screening – a systematic review protocol

Background Lung cancer is the leading cause of cancer-related mortality worldwide. Despite this, the uptake of lung cancer screening (LCS) using low-dose CT is substantially low in comparison to established cancer screening programmes. Additionally, those at higher risk of the disease are the least likely to participate in screening, including current smokers and those experiencing socioeconomic deprivation. General practice (which may be referred to as primary care or family medicine depending on location) plays a vital role in screening through the identification of eligible individuals, overcoming participation barriers, and facilitating shared decision-making. Given the low rates of participation, it is important to understand which, if any, strategies from general practice could improve the effectiveness of a national programme. Objectives To assess and quantify the effects of strategies implemented in general practice to increase participation in LCS. Method A systematic review and meta-analysis, where possible, will be conducted following PRISMA reporting guidelines. Searches of PubMed, Embase, CINAHL, Cochrane Library, Web of Science, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform will be conducted. All randomised trials, non-randomised studies, and quantitative descriptive studies that report recruitment strategies based in general practice and LCS outcomes will be eligible. Screening and data extraction will be conducted independently by two reviewers. The risk of bias and overall certainty of findings will be assessed using the MMAT and GRADE tools, respectively. The Template for Intervention Description and Replication (TIDieR) checklist will be used for data extraction and the Behavioural Change Techniques (BCT) Taxonomy for data analysis of the components of interventions. Conclusion This review will provide data on the most effective general practice-based recruitment strategies aimed at improving LCS participation. Understanding the most effective and equitable strategies is important in the development of successful LCS and ensuring individuals at the greatest risk can participate.

P109: The role of family caregivers’ emotional complexity in their relationship with the person with dementia and their emotional well-being and distress.

Objective:Research in informal dementia caregiving has focused on the negative outcomes it implies as a chronic stress situation, even though positive feelings derived from the caregiving experience are also reported. This co-occurrence of positive and negative experiences is a form of emotional complexity that has barely been explored in caregivers although it could be relevant for understanding caregivers' vulnerability to distress. To explore this emotional complexity, profiles of caregivers according to their levels of positive and negative affect were created and compared with regard to their reported anxiety, ambivalence feelings, experiential avoidance, quality of the actual relationship, thoughts of institutionalizing the person with dementia (PWD), and social support.Methods:363 primary family caregivers were distributed in groups based on their reported depressive feelings and positive emotions related to caregiving and the PWD. Four groups were identified: (1) flat (low negative affect, low positive affect), (2) negative (high negative affect, low positive affect), (3) positive (low negative affect, high positive affect), (4) mixed (high negative affect, high positive affect). ANOVAS were performed to explore differences between groups.Results:Caregivers in the positive and mixed profiles reported better actual relationships with the PWD and higher experiential avoidance. Caregivers with both negative and mixed profile showed higher anxiety than the other profiles, and the negative profile also reported higher thoughts about institutionalizing the care-recipient and more ambivalence. Caregivers in the positive group reported the highest social support.Conclusion:The obtained findings converge in the idea that caregivers ́ positive emotions towards the PWD are closely related to the quality of the relationship, and may be involved in a delayed decision to institutionalize her/him. The presence of negative affect (depressive feelings) is associated with anxiety symptoms, even when positive emotions are reported, supporting the high prevalence of anxiety-depressive comorbidity in this population. Finally, the negative profile (low positive and high negative affect) is the one that reports more ambivalence. Taken together, these findings suggest that caregiving for PWD should be considered an emotionally complex situation with positive affect derived from the caregiving being key in understanding caregivers’ well-being and distress.

Coexisting with anomie: Experiences of persons living with early-stage dementia: A grounded theory study.

Individuals in the early stages of dementia often endure elevated levels of stress and anxiety, which can hinder their ability to adapt to the progression of dementia. To mitigate the negative impacts of dementia more effectively, it is necessary to explore the trajectory of the adaptation process of persons living with dementia. This study aimed to construct a theoretical framework for the adaptation process of individuals in the early stages of dementia. Participants were dyads of persons diagnosed with mild dementia or mild cognitive impairment (≥ 60 years of age) and their primary family caregivers. This longitudinal study used a grounded theory approach to explore the adaptation trajectory changes in persons with mild dementia over a 3-year period. Data were collected from dyads with face-to-face interviews. Analysis of the interview data revealed the core category was 'Coexisting with anomie: Progressive disappointment and striving', which was comprised of three categories: awareness of alienation, unsettled feelings, and restorative avoidance coping. Categories changed depending on levels of cognition and constituted progressive and cyclical dynamic processes. Four contextual factors positively or negatively influenced adaptation: level of insight about dementia, personal traits, caregiving style of the caregiver, and level of social interactions. These findings provide a new perspective about the mental health of persons in early-stage dementia. Understanding coexisting with anomie and related influencing factors could facilitate the development of support interventions by mental health nursing staff, which could improve emotional safety, promote psychological well-being, and increase quality of life for persons living with dementia.

Relationships among self-esteem, ego-resilience, and caregiver burden among families of children with hematologic and oncologic disease: A cross-sectional study

BackgroundPediatric hematology and oncology disease is a physically and emotionally demanding health condition for families. High self-esteem and ego-resilience among caregivers, which have recently gained increased recognition, might help ease caregiver burdens. Few studies, however, have simultaneously investigated the relationships between self-esteem, ego-resilience, and caregiver burden among caregivers of children with hematologic and oncologic disease. ObjectiveThe purpose of this study is to investigate the relationships between caregiver burden, self-esteem, and ego-resilience and examine whether ego-resilience plays a role in mediating the relationship between self-esteem and caregiver burden among family caregivers of children with hematologic and oncologic disease. DesignDescriptive correlational study. SettingThe outpatient clinic of the department of pediatric hematology and oncology at a flagship university hospital in a metropolitan city in South Korea. ParticipantsThe sample comprised 109 primary family caregivers of children with hematologic and oncologic disease. Convenience sampling method was used. MethodsThe participants completed the Ego-Resiliency Scale, Rosenberg Self-Esteem Scale, and Family Burden Questionnaire. One-way analysis of variance, independent t-tests, and correlation analyses were conducted using IBM SPSS 25.0. The mediating effect of ego-resilience was estimated using the PROCESS macro and bootstrap method in SPSS. ResultsCaregiver burden showed significant negative associations with self-esteem and ego-resilience, with moderate effect sizes (r = −.391 and −0.361, respectively, p = .001). Ego-resilience mediated the relationship between self-esteem and caregiver burden (b = −0.019; 95 % bias-corrected bootstrap confidence interval −0.035 and −0.001). ConclusionsSelf-esteem and ego-resilience may lessen caregiver burden among families of children with hematologic and oncologic disease, and self-esteem of caregivers tends to promote their ego-resilience. Therefore, self-esteem and ego-resilience should be improved among family caregivers to reduce their caregiver burden.