Study Of Quality Of Life And Factors Influencing Caregivers Of Patients With Diabetic Foot Ulcer Amputation

Objective A comprehensive exploration of the quality of life of primary caregivers of patients with diabetic foot ulcer amputations through semi-structured interviews.A quantitative study was conducted to investigate the factors influencing the quality of life of primary caregivers of patients with diabetic foot ulcer amputation through quantitative studies,to reveal the current status of caregiver burden,positive aspect of caregiving,mutuality and quality of life levels and the correlation between the variables,and to analyze the moderating effect of mutuality on caregiver burden,the positive aspect of caregiving and mental health.MethodsThe first part was a qualitative study.From July 2021 to September 2021,Semi-structured interviews were conducted with 15 primary caregivers of patients with diabetic foot ulcer amputation selected using purposive sampling method.NVivo 11.0 software was applied to code and analyze the interview data,and Colaizzi analysis in phenomenological analysis was used for thematic generalization to provide a comprehensive understanding of the quality of life and psychological experiences of primary caregivers of patients with diabetic foot ulcer amputation.The second part is a quantitative study.From September 2021 to July 2022,247 primary caregivers of patients with diabetic foot ulcer amputations were selected using a convenience sampling method.A questionnaire survey was conducted using the general information questionnaire,Zarit Caregiver Burden Interview(ZBI),Positive Aspect of Caregiving(PAC),the Mutuality Scale,and 12-item short-form health survey Version-2(SF-12 v2).SPSS 25.0 software was applied for data processing and statistical analysis:descriptive analysis of general information(percentages,means ± standard deviations);differences in scores of variables in different subgroups of sociodemographic information(Independent samples t-test,One-way ANOVA or Kruskal-Wallis test);correlations among variables(Pearson correlation analysis);moderating effects of mutuality between caregiver burden,positive aspect of caregiving and mental health(Hierarchical regression analysis);specific mechanisms of moderating effects of mutuality(Simple slope analysis).ResultsThe qualitative interview identified four themes: perception of multiple pressures,changes in life status,understanding of role significance,and access to multiple resources.The score of caregiver burden of the primary caregivers of patients with diabetic foot ulcer amputations was(37.55±11.81),including(18.82±5.97)for personal burden and(11.57±4.94)for responsibility burden.Significant differences were in the caregiver’s marital status,education level,relationship with the patient,cohabitation,total caregiving hours,daily caregiving hours,co-caregiving,insomnia symptoms,age,the number of concomitant diseases,and the way of medical expenses(P<0.05).The total score of the positive aspect of caregiving was(34.59±4.75).Including(23.76±3.00)for the self-affirmation dimension and(10.83±2.27)for the life outlook dimension.Statistically significant in different groups of caregivers’ working status,caregivers’ monthly income,caregivers’ education level,residence,physical exercise,insomnia symptoms,the number of concomitant diseases,and the way of paying medical expenses(P<0.05).The score of mutuality of caregivers was(2.52±0.67),including for love and affection(2.92±0.70),for joy sharing(2.48±0.74),shared values(2.46±0.68),and reciprocity(2.37±0.82).The score of mutuality was significantly different in different groups of caregiver’s age,caregiver’s marital status,caregiver’s work status,residence,relationship with the patient,cohabitation,daily care time,patient’s gender,patient’s age,and the number of concomitant diseases(P<0.05).The total caregivers’ mental health score was(47.20±7.34).The total score of physical health was(47.99±6.08),of which physical functioning was(50.59±6.71),role-physical was(50.59±6.71),bodily pain was(50.72±8.61),general health was(33.66±8.69),vitality was(54.31±8.46),social functioning was(46.80±8.73),role-emotional was(43.42±7.99),and mental health was(49.73±8.93).There were significant differences in the mental health scores of primary caregivers in different groups of caregiver’s gender,marital status,physical exercise,patient’s gender,patient’s age,the number of concomitant diseases,and the way of paying medical expenses(P<0.05).There were significant differences in physical health scores of primary caregivers among different groups of caregiver’s age,caregiver’s marital status,caregiver’s work status,caregiver’s monthly income,education level,residence,relationship with patients,physical exercise,and patient’s age(P<0.05).Caregiver burden was negatively correlated with the positive aspect of caregiving(r=-0.271,P<0.05),mutuality(r=-0.132,P<0.05),and mental health(r=-0.347,P<0.05).The positive aspect of caregiving was positively correlated with mutuality(r=0.331,P<0.05)and mental health(r=0.282,P<0.05).Furthermore,mutuality was positively correlated with mental health(r=0.212,P<0.05),and physical health was positively correlated with mental health(r=0.214,P<0.05).There was no significant correlation between caregiver burden,a positive aspect of caregiving,and mutuality.Hierarchical regression analysis showed that mutuality moderates the relationship between caregiver burden and mental health(β=0.117,P<0.05).The negative effect of caregiver burden on mental health was weakened with the increase of mutuality score.The caregiver burden negatively affected mental health when the mutuality score was lower than 2.87.The moderating effect of mutuality between the positive aspect of caregiving and mental health was significant(β=-0.393,P<0.05).The positive effect of caregiving on mental health weakened with the increase in mutuality score.When the mutuality score was lower than 2.39,the positive aspect of caregiving had a positive predictive effect on mental health.Conclusions1.Multiple aspects of quality of life for primary caregivers of patients with diabetic foot ulcer amputation are affected by caregiving,but caregivers simultaneously appreciate the meaning of the caregiving role and the support of different resources.2.Caregiving burden,positive aspect of caregiving,mutuality and mental health of primary caregivers of patients with diabetic foot ulcer amputation were bivariately correlated,and physical health was only significantly correlated with mental health.3.Mutuality of primary caregivers of patients with diabetic foot ulcer amputation has a moderating effect between caregiving burden,positive aspect of caregiving and mental health.