Research On Conceptual Framework And Evaluation Tool Of Perceived Caregiving Benefits Of Caregivers For Patients With Stroke

ObjectivesFirst of all,the aims are to construct conceptual framework of perceived caregiving benefits of caregivers for patients with stroke,then to develop and validate a scale of caregiving benefits based on conceptual framework,and finally to assess the caregiving benefits of stroke survivors' caregivers and to explore its possible contributor factors.MethodsThis study was performed in three parts.The first part:the construction of the conceptual framework of perceived caregiving benefits of caregivers for patients with stroke.The convenience sampling and purpose sampling were used to select 20 caregivers from 2 communities.The semi-structured interview were used to collect data.The strategies of traditional grounded theory from Glaser were used to analyze data.The second part:The development and validation of the scale of perceived caregiving benefits.The first draft were designed based on the conceptual framework of perceived caregiving benefits.The scale of test version was formed after two rounds Delphi technique from 20 national experts.The scale was surveyed three times.The IBM SPSS 21.0 was used to analyze the content validity,item analysis,exploratory factor analysis(EFA)and reliability of the data from 307 caregivers in first time survey and 35 caregivers in second time survey after two weeks.A receiver operating characteristic(ROC)curve was used to predict depression of caregivers.The AMOS 17.0 was used to perform confirmatory factor analysis(CFA)and the values of composite reliability and average variance extracted(AVE)were also calculated using the data from the third time survey of 311 caregivers.The third part:the research on contributor factors of caregiving benefits of stroke caregivers.The scale of perceived caregiving benefits and the measurement of family function and self-efficacy were used to the 311 caregivers in third time survey.The IBM SPSS 21.0 and the PROCESS program were used to perform descriptive statistics,variance analysis,linear regression,moderation model,mediation model and the moderated mediation.ResultsThe results of the first part:the concept of perceived caregiving benefit was all the benefits and gains were perceived from the care process for their loved ones,and caregivers identified their caregiving role and grew healthily in both physical and mental health.The conceptual framework of perceived caregiving benefits included six aspects as following,the enhancement of knowledge and practice,self-esteem and other-esteem,health literacy,positive outlook,harmony family,social resources and benefits.The results of second part:the value of scale-level content validity index(S-CVI)/universal agreement was 0.84,S-CVI/averaging calculation was 0.97,item CVI ranged from 0.83 to 1.00.Four factors were extracted and the cumulative proportion variance was 74.14%,a 26-item and 4-factor(self growth,health promotion,family growth and self-sublimation)perceived caregiving benefits scale was confirmed.The model based internal consistency index of the scale was 0.845,the value of Cronbach alpha coefficient of the four dimensions were 0.885?0.953.The value of split-half reliability was 0.929 and the test-retest reliability was 0.994.The value of criterion-related validity of the positive aspects of cargiving scale was 0.803(P<0.01).ROC curve showed that the score of perceived caregiving benefits scale could predict depression of caregivers,the area under the curve was 0.641,the value of sensitivity was 0.903 and specificity was 0.652,the cut-off score was 101.50.The factor loading of all the items were above 0.5 in CFA and the fitting index including chi-square index/degrees of freedom = 1.254,goodness of fit index(GFI)=0.921,adjusted GFI = 0.901,normal fit index(NFI)= 0.951,incremental fit index(IFI)= 0.990,comparative fit index(CFI)= 0.990,root mean square error of approximation(RMSEA)=0.02 were within the acceptable range.The value of composite reliability were 0.891-0.942 and the value of AVE were 0.621-0.700.The results of third part:the score of caregiving benefits was(102.22±20.32),the closeness between caregivers and stroke survivors(B=5.789,P=0.011),family functions(B=2.171,P<0.001)and self-efficacy(B=0.733,P<0.001)were independent contributor factors.The closeness between caregivers and stroke survivors were the moderator of the relationship between family function and caregiving benefits(B=-2.610,P=0.013).The indirect path from family function to caregiving benefits through self efficacy was significant according to the Bootstrap 95%confidence interval(CI)did not include zero,which indicated self efficacy was the mediator of the relationship between family function and caregiving benefits;the interaction between self efficacy and hours of care per day was found(B=-0.535,P=0.007),and the moderated mediation test was significant(B=-0.211,95%CI[-0.540,-0.038]),which indicated the hours of care per day moderated the mediation.ConclusionsThis research defined the concept of caregivers' perceived benefits and developed a conceptual framework.Based on the framework,the perceived caregiving benefits scale was developed and it had a good reliability and validity,and the psychological assessment indexes were satisfying,and could be used to assess the benefits of caregivers and could predict depression.The closeness between caregivers and stroke survivors were the moderator of the relationship between family function and caregiving benefits,self efficacy was the mediators of the relationship between family function and caregiving benefits;and the hours of care per day moderated the mediation.The finding suggested self efficacy could be the beginning of intervention to caregiving benefits,under the condition of the closeness between caregivers and stroke survivors and the hours of care per day to provide accurate and maximized benefits intervention to caregivers.