Caregiver Socioeconomic Status Research Articles

The Resilience and Socioeconomic Status of Caregivers and School-Aged Children During the COVID-19 Pandemic

Objectives: Conducted during the height of the COVID-19 pandemic in Ontario, Canada, the purpose of this study was to investigate the relationships between (1) caregiver and child resilience; and (2) socioeconomic status (SES) and the resilience of both caregivers and children. Background: The COVID-19 pandemic introduced many unanticipated challenges for school-aged children and caregivers and navigating them required tremendous resilience. The degree to which the resilience of family members influenced one another or how it was related to economic hardships tied to the pandemic, particularly for members of low SES families, remains poorly understood. Methods: Online surveys were administered to 22 caregivers ( Mage = 40.45 years; SD = 4.55) and 27 children ( Mage = 8.19 years; SD = 1.14) to measure self-reported resilience and SES. Correlational analyses were conducted to assess both objectives. Results: Analyses detected no significant relationships between the resilience of caregivers and children, nor the resilience and SES of these groups. However, trends revealed that caregivers who reported “normal” levels of resilience had a higher average income than those who reported low levels of resilience. Conclusions: There is insufficient evidence to suggest a relationship between the resilience of caregivers and their children, but income levels may play a role in the resilience of caregivers. Implications: Targeting factors that help families with low SES navigate adversities, including those related to income, need to be identified and better understood to ensure a proactive and equitable public health response in future phases of the pandemic or similar situations.

Parenting centers and caregiver mental health: Evidence from a large-scale randomized controlled trial in China.

This study conducts an exploratory analysis of the impacts of a center-based early childhood development intervention on the mental health of caregivers, using data from a cluster-randomized controlled trial of 1664 caregivers (Mage =36.87years old) of 6- to 24-month-old children in 100 villages in rural China. Caregivers and children in 50 villages received individual parenting training, group activities and open play space in village parenting centers. The results show no significant overall change in caregiver-reported mental health symptoms after 1year of intervention. Subgroup analyses reveal heterogeneous effects by caregiver socioeconomic status and identity (mother vs. grandmother). Findings suggest that early childhood development interventions without targeted mental health components may not provide sufficient support to improve caregiver mental health.

Perceived Demographic and Socio-Economic Factors Contributing to Poor Outcome of Neonatal Sepsis at Paediatric Unit Kenyatta National Hospital

Introduction: Globally sepsis is still a known case of high mortality and mobility rates among neonates. This is despite having been advances in healthcare quality. The World Health Organization estimates that more than 40% of deaths occurring among infants aged below five years happen during the neonatal phase and they result in 3.1 infant deaths annually. Objective: This study sought to establish the perceived demographic and socioeconomic status of poor outcomes of neonatal sepsis at Kenyatta national hospital paediatric unit. Methodology: This was a hospital-based descriptive cross-sectional study conducted in the Paediatric Unit of Kenyatta National Hospital. A total of 175 mothers of neonates with neonatal sepsis admitted in KNH selected using consecutive sampling methods were recruited into the study. A validated researcher-administered semi-structured questionnaire was used to collect the data. Descriptive statistics involved the calculation of measures of central tendencies like means, modes and medians between variables. Association between the study variables was estimated using both chi-square and odds ratio statistics at a 95% confidence interval. The study results were presented in tables, graphs and charts, as appropriate. Results: Maternal demographic factors associated with poor outcomes of neonatal sepsis included - younger or advanced maternal age (X2 = 4.735, df = 2, p = 0.031); low education level (X2 = 6.362, df = 1, p = 0.012) and short birth intervals of < 2 years (X2 = 5.108, df = 2, p = 0.023). Maternal socioeconomic factors associated with poor outcomes of neonatal sepsis included - low household income level (X2 = 6.163, df = 1, p = 0.014); large family sizes of ≥5 members (X2 = 4.844, df = 1, p = 0.028) and lack of a health insurance cover (X2 = 5.382, df = 1, p = 0.019). Conclusion: Various maternal demographics, maternal socio-economic were significant perceived determinants of poor outcomes of neonatal sepsis in Kenyatta National Hospital’s Paediatric Unit. Recommendations: The national government with the help of county governments and development partners should invest in community empowerment programs that aim to improve the socioeconomic status of caregivers and their households. In addition, further investments in the health care system are needed to make it more affordable to all and particularly to the low-income group.

The Association between Nutritional Knowledge, Socio-Economic Status of Caregivers and Stunting of Children under 5 Years in Kwale County of Kenya: A Baseline Survey

Background: In Low- and Middle-Income Countries (LMIC), including Kenya, undernutrition has been the most significant contributor to child morbidity and mortality. Knowledge and practices of mothers/caregivers have been identified as a key sustainable factor for consideration in determining the nutritional status of children. The study aim was to determine how caregiver knowledge and socio-economic status will impact on nutritional status of children under 5 years. Methods: This study was conducted in Kwale County, Kenya, to assess baseline maternal and child parameters. Seven hundred pairs; children and their primary caregivers were sampled at baseline. Results: A total of 681 households comprised of caregiver and index child pair participated in the survey from the sampled 700. Knowledge scores of food functions, breastfeeding and complementary feeding were combined to assess caregivers’ nutritional knowledge with a maximum score of 24. The median score was 11 (IQR: 9-12) and ranged from 0 to 24. Those with scores of 12 and above (50% plus) were 230 (33.2%). Stunting was 29.8% and the level of under-weight was 16.4%. No significant association was found between nutritional knowledge of the caregivers and nutritional indicators of children under 5 years, but there were significant differences (P= 0.002) in the Knowledge score of caregivers between the five wealth quintiles. Conclusion: Most of the caregivers did not have any nutritional knowledge which was assessed as knowledge of food groups and sources and functions of different foods as well as knowledge in breastfeeding and complementary feeding.

The Association between Nutritional Knowledge, Socio-Economic Status of Caregivers and Stunting of Children Under 5 Years in Kwale County of Kenya: A Baseline Survey

Background: In Low and Middle Income Countries (LMIC), including Kenya, undernutrition has been the most significant contributor to child morbidity and mortality. Knowledge and practices of mothers/caregivers have been identified as a key sustainable factor for consideration in determining the nutritional status of children. The study aim was to determine how caregiver knowledge and socio-economic status will impact on nutritional status of children under 5 years. Methods: This study was conducted in Kwale County, Kenya to assess at baseline maternal and child parameters. Seven hundred pairs; children and their primary caregivers were sampled at baseline. Results: A total of 681 households comprised of caregiver and index child pair, participated in the survey from the sampled 700. Knowledge scores of food functions, breastfeeding and complementary feeding were combined to assess caregivers nutritional knowledge with a maximum score of 24. The median score was 11 (IQR: 9 – 12) and ranged from 0 to 24. Those with scores of 12 and above (50% plus) were 230 (33.2%). Stunting was 29.8% and the level of under-weight was 16.4%. No significant association was found between nutritional knowledge of the caregivers and nutitional indicators of children under 5 years but there was significant differences (P= 0.002.) in the Knowledge score of caregivers between the five wealth quintiles. Conclusion: Most of the caregivers did not have any nutritional knowledge which was assessed as knowledge of food groups and sources and functions of different foods as well as knowledge in breastfeeding and complementary feeding.

Poor parenting behaviours and dental caries experience in 6- To 7-year-old children.

ObjectivesThe association between poor parenting and dental caries in children remains unclear. We investigated the association of poor parenting with dental caries and oral health behaviour among children aged 6‐7 years in Japan.MethodsTwo waves of repeated cross‐sectional surveys on children and their caregivers in Adachi City, Tokyo, were analysed. Questionnaires on parenting behaviour and the child's oral health behaviour were distributed through schools and completed by 8499 caregivers (response rate = 80.8%). The number of decayed or filled primary teeth (dft) at school dental health check‐ups was linked to the survey data (N for complete case analysis = 6309). Factor analysis was performed to identify types of poor parenting: poor involvement, child abuse and lack of supervision of a child's health behaviours. The association between factor scores (z‐score), the number of dft and oral health behaviour (not brushing teeth twice a day, not controlling snack eating habits and drinking juice every day) was evaluated by Poisson's regressions adjusted for covariates, including caregiver's socioeconomic status.ResultsPoor involvement and lack of supervision of a child's health behaviours were positively associated with dft (mean ratio, MR [95% confidence interval, CI] =1.05 [1.03, 1.07] and 1.18 [1.16, 1.21], respectively) and unhealthy oral health behaviours. Child abuse was not associated with dft (MR = 0.99 [0.96, 1.01]) but was associated with all three unhealthy oral health behaviours (prevalence ratio, PR [95% CI] were 1.11 [1.06, 1.16], 1.11 [1.06, 1.16] and 1.06 [1.00, 1.11] for not brushing teeth, not controlling snack eating and drinking juice, respectively).ConclusionsPoor involvement and lack of supervision of a child's health behaviours were associated with dental caries, and any type of poor parenting was associated with poor oral health behaviour among children.

Perspectives and impediment to eye care in caregivers of children with childhood glaucoma

Purpose:To study the perceptions, attitude, knowledge of the disease, and impediments to seeking early eye care in caregivers of children with childhood glaucoma.Methods:The study included new and old children diagnosed with childhood glaucoma (which included congenital glaucoma and developmental glaucoma) at a tertiary hospital of east India. The caregivers were administered a video-based questionnaire through open-ended questions intended to collect demographic and other personal details such as caregiver's socioeconomic status, knowledge, attitude towards eye health, and other social barriers. The responses were analyzed using thematic analysis technique into different buckets such as social status, knowledge/attitude, and sociocultural beliefs while individual responses in each bucket were analyzed.Results:Of a total of 43 patients included, >75% of patients came from places >200 km from the eye care centre with >50% coming from >300 km. Most patients presented either <1 year (42%, n = 18) or >3 years (52%, n = 22) with only 2% (n = 3) presenting between 1–3 years of age. The mother was the first person of contact to diagnose the eye abnormality in >45% of patients. Comparing differences among children who presented within 1 year of first diagnosis and those that presented later, caregivers hailing from long-distance >200 km from an eye care center, monthly income <5000 INR, and those with social/cultural taboos (like children's eyes should not be operated) were more likely to seek delayed eye care for congenital glaucoma, P < 0.001.Conclusion:Impediments in seeking early eye care for blinding diseases in children (including distance from the nearest hospital, low socioeconomic constraints, and sociocultural beliefs/taboos) mandate serious policies towards improving education about eye disease and eye health among caregivers.

Iodine Status and Its Determinants among Adolescent School Girls in Rural Tanzania

Iodine deficiency is still one of the most serious public health problems in developing countries in the world. The high rates of adolescent pregnancies in Tanzania exacerbate the vicious cycle of maternal child malnutrition including iodine deficiency. It has been well‐documented that maintaining adequate iodine supply during pregnancy is essential for maternal healthy thyroid function and fetal neurological development. Increased iodine requirements for pregnancy and a high demand for nutrients for growth in adolescent make them vulnerable to inadequate iodine status. However, few studies have reported determinants of iodine status in rural areas of Tanzania. We aimed to assess iodine status and identify its determinants among adolescent schoolgirls in rural Tanzania. Four secondary day schools in Iringa region in Tanzania were randomly selected for this cross‐sectional study during the lean season (January–March) in 2016. A total of 208 adolescent girls aged 12–19 years were surveyed with a questionnaire on general and socioeconomic characteristics of themselves and their caregivers; dietary intakes; and use of iodized salt in cooking at home, and single spot urine samples. Multivariable logistic regressions were performed to identify determinants of iodine status, while controlling for covariates. Based on UICs from urine samples, iodine status of the adolescent girls was adequate (median UIC: 227.1 μg/L) and the prevalence estimate of UIC &lt;50 μg/L was 16.4% among adolescent girls in rural Tanzania. Adolescent girls in the lowest tertile of UIC tended to live in a smaller household and have their caregivers having a low level of education and working as blue‐collar employees (peasant farmers) than those in the highest tertile of UIC. Adolescent girls living in semi‐urban were more likely to be at risks for UIC &lt;50 μg/L (adjusted odds ratio [AOR]=16.32, 95% confidence interval [CI]: 4.92–54.11, P &lt;0.01), compared to those living in rural area. Adolescent girls who have caregivers working as peasant farmers had a lower risk of UIC &lt;50 μg/L, than those who have caregivers working as a white‐collar employee such as educator, health professionals, and business person (AOR=0.17, 95% CI:0.03–0.97, P &lt;0.05). The present study provides the evidences that socioeconomic status of caregivers was important determinants of adolescent girls' iodine status. Therefore, nutrition education for adolescents' caregiver should be emphasized to combat nutritional inadequacies. Further investigations longitudinally designed with large samples are warranted to identify risk factors of iodine deficiency among adolescent girls of childbearing age in Tanzania.Support or Funding InformationThis study was conducted by the generous financial support of a USAID‐funded Food Security Project, Innovative Agricultural Research Initiative (iAGRI) in Tanzania.

Racial and ethnic differences in psychotropic medication use among community-dwelling persons with dementia in the United States

ABSTRACTObjectives: Little is known about the patterns of psychotropic medication use in community-dwelling minority persons with dementia (PWD). The purpose of this study was to investigate racial/ethnic differences in psychotropic medication use across a diverse population of community-dwelling PWD and to examine the extent to which caregiver characteristics influence this use.Method: Data were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Generalized linear models were used to identify racial/ethnic differences in psychotropic medication use. Akaike Information Criterion (AIC) model selection was used to evaluate possible explanations for observed differences across racial/ethnic group.Results: Differences in anxiolytic and antipsychotic medication use were observed across racial/ethnic groups; however, race/ethnicity alone was not sufficient to explain those differences. Perceptions of caregiving and caregiver socioeconomic status were important predictors of anxiolytic use while PWD characteristics, including cognitive impairment, functional impairment, problem behavior frequency, pain, relationship to the caregiver, sex, and age were important for antipsychotic use.Conclusion: Racial/ethnic differences in psychotropic medication use among community-dwelling PWD cannot be explained by race/ethnicity alone. The importance of caregiver characteristics in predicting anxiolytic medication use suggest that interventions aimed at caregivers may hold promise as an effective alternative to pharmacotherapy.

ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia.

Continuous insurance coverage is an important component of effective health care. Evaluation of insurance gaps in pediatric cancer care is an understudied area. We conducted a retrospective analysis of payer data from outpatient oncology encounters at Primary Children's Hospital (Salt Lake City, UT) over the first 2 years of therapy for pediatric patients with acute lymphoblastic leukemia diagnosed from 1998 to 2010 (N = 380). Using logistic regression, we evaluated demographic and clinical predictors (age at diagnosis, sex, ethnicity, high/standard acute lymphoblastic leukemia risk, and rural/urban county of residence at diagnosis) of a gap in health insurance. The median age at diagnosis was 4 years (interquartile range, 3 to 8 years), and 172 patients (45%) were girls. In the first 2 years of treatment, 45 patients (12%) experienced a gap in health insurance. The odds of having a gap in insurance coverage decreased by 16% each year from 1998 to 2010 (odds ratio, 0.84; 95% CI, 0.76 to 0.93; test for trend, P = .001). Public insurance at diagnosis was associated with a four-fold increased likelihood of experiencing an insurance gap (odds ratio, 4.09; 95% CI, 1.98 to 8.44; P < .001) compared with patients with private insurance at diagnosis. Gaps in insurance coverage during pediatric cancer treatment are not uncommon, which highlights the importance of discussing insurance status at diagnosis and throughout a patient's treatment course to help patients and their families prepare for any changes and avoid unnecessary financial burden. Future research should focus on examining the effect of insurance gaps on patient outcomes and evaluating likelihood of gaps in insurance after health care reform.

The Relationship between Emotional Intelligence and Socioeconomic status of caregivers on the Quality of Life in patient’s with Alzheimer’s dementia

Dementia of Alzheimer’s type (DAT) is the most common cause of dementia in the older people. The importance of Emotional Intelligence is in equipping caregivers to deal efficiently with Alzheimer patients. The current study seeks to evaluate the role played by Emotional Intelligence and Socio-economic Status of caregivers of Alzheimer patients on the Quality of Life of Alzheimer patients. The total numbers of participants in the study were 60 caregivers of Alzheimer patients who were given tests of Emotional Intelligence scale and Alzheimer’s disease Related Quality of Life (ADRQoL). The data was analysed using appropriate statistical methods. The Emotional Intelligence and the socioeconomic status of caregivers of Alzheimer patients had no significant effect on the Quality of Life of Alzheimer patients and major statistical significance was noted. Further enquiry into other factors affecting the Quality of Life of Alzheimer patients is warranted.

Factors associated with depression and burden in Spanish speaking caregivers of individuals with traumatic brain injury

To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. Prospective. Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). Generalized linear models revealed that patient language problems and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers' perception of patient depression was the only factor associated with both caregiver burden and depression. Caregivers' perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed.

Social services utilization by adults with intellectual disabilities and their families

In this study, we used Andersen's Behavioral Model with the family as a unit of analysis to examine the patterns of awareness and utilization of social services by families with at least one adult with intellectual disabilities. Face-to-face interview questionnaires were conducted with primary family caregivers in Hsinchu City, Taiwan in 2004. Data were collected on adults' and caregivers' predisposing, enabling, and need variables as well as awareness and utilization of formal social services. A total of 792 interviews were completed, making a response rate of 94.2%. Multivariate logistic regression analysis was used to identify potential predictors of social service awareness and utilization. We found awareness and utilization to be mostly associated with predisposing and enabling variables including caregiver's socioeconomic status, family connection with social networks, and family participation in related groups or associations. Younger caregivers were more likely to access formal assistance, while adults whose families were more connected into social networks were more likely to be aware of in-kind and voucher services, e.g., in-home services including respite and home care, and vocational services such as sheltered workshops, and bus voucher services.

The Association of Caregiver's Socioeconomic Factors and Infants Health and Weaning Practices from Korean National Health and Nutrition Survey

The objective of this study was to examine the association of caregiver's socioeconomic factors such as residential area, level of education and income and infants weaning practices. The Korean National Health and Nutrition Survey was conducted on a stratified random sample (n = 9,968) in 2001. This study analyzed data of female (n = 245) aged between 20–49 years old living with infants aged between 0–2 years old. Data of birth height, birth weight, choice of breast feeding or formula feeding, duration of breast feeding, timing of milk supplement and complementary feeding and related issues were examined. The residential areas were divided such as metropolitan (46.9%), urban (36.7%), rural area (16.3%). The educational status was mostly junior college (61.6%) or college (34.3%) graduates. The levels of income were divided into low (33.8%), medium (45.3%), and high (20.1%). There were significant differences in birth height among residential area (p = 0.0038). The average heights of infants living in metropolitan area, urban and rural were 50.4 cm, 49.2 cm and 43.8 cm. There were significant differences in birth height between high and low level of income (p = 0.0292). The durations of breast feeding were different by level of income. Other factors related infant weaning practices were not different by residential area and level of income. These results suggest that caregiver's socioeconomic status appear to have influences on the anthropometry of infants and weaning practices.

Update on the Family Strain Questionnaire: A Tool for the General Screening of Caregiving-Related Problems

The growing prevalence of chronic diseases and home-based treatments has led to the introduction of a large number of instruments for assessing the caregiving-related problems associated with specific diseases, but our Family Strain Questionnaire (FSQ) was designed to provide a basis for general screening and comparison regardless of the disease. We here describe the final validation of its psychometric characteristics. The FSQ consists of a brief semi-structured interview and 44 dichotomic items, and has now been administered to 811 caregivers (285 were simultaneously administered other questionnaires assessing anxiety and depressive symptoms). After a factorial analysis confirmed the 5-factor structure identified in previous studies (emotional burden, problems in social involvement, need for knowledge about the disease, satisfaction with family relationships, and thoughts about death), we undertook correlation and reliability analyses, and a receiver operating characteristics curve analysis designed to determine the cut-off point for the emotional problems identified by the first factor. Finally, univariate ANOVA with Bonferroni's post-hoc test was used to compare the disease-specific scores. The validity and reliability of the FSQ is good, and its factorial structure refers to areas that are internationally considered as being of general importance. The semi-structured interview collects information concerning the socio-economic status of caregivers and their convictions/interpretations concerning the diseases of their patients. The FSQ can be used as a single instrument for the general assessment of caregiving-related problems regardless of the reference disease. This makes it possible to reduce administration and analysis times, and compare the problems experienced by the caregivers of patients with different diseases.