Validity Evidence for the Brief Self-Control Scale in the Spanish Adult Population: A Systematic Study.

The Brief Self-Control Scale (BSCS) has been widely studied across languages and populations. However, research examining the Spanish version is scant and limited to the adolescent population. Our aim here was to provide validity evidence for use of the BSCS with Spanish adults by analyzing and comparing the psychometric properties of different versions of the scale (13-item, 10-item, 9-item, 8-item, and 7-item). Confirmatory factor analysis was used to test the internal structure based on one-factor and two-factor models. Results obtained in a sample of 676 Spanish adults showed adequate fit indices for the two-factor structure of the 9-item, 8-item, and 7-item versions of the BSCS, although only the 9-item and 8-item BSCS were found to be invariant across gender. Item homogeneity and reliability of factor scores for these two versions (9-item and 8-item) were satisfactory. We also provide novel validity evidence based on relationships with indicators of psychological adjustment and wellbeing. Scores on the 9-item and 8-item BSCS correlated with life satisfaction, flourishing, self-esteem, distress, depression, and loneliness, and hence both may be suitable for use in mental health assessment contexts.

Measurement invariance of the Facebook intrusion questionnaire across 25 countries.

Facebook is one of the most popular social networking sites. However, Facebook intrusion or addiction is a growing concern as it involves an excessive attachment to Facebook, which disrupts daily functioning. To date, few studies have examined whether cross-cultural differences in the measurement of Facebook addiction exist. The aim of this study was to investigate the cross-cultural validity and measurement invariance of the Facebook Intrusion Questionnaire (FIQ), one of the most widely used measures of Facebook addiction, across 25 countries (N = 12,204, 62.3% female; mean age = 25 years). Multigroup confirmatory factor analyses (MGCFA) assessed cross-cultural validity as well as invariance. Additionally, individual confirmatory factor analyses evaluated the factorial structure and measurement invariance across genders in each country. The FIQ demonstrated partial metric invariance across countries and metric (13 countries), scalar (11 countries) or residual (10 countries) invariance across genders within individual countries. A one-factor model indicated a good fit in 18 countries. Cronbach's alpha for the entire sample was .85. Our findings suggest that the FIQ may provide an adequate assessment of Facebook addiction that is psychometrically equivalent across cultures. Moreover, the questionnaire seems to be universal and suitable for studying different social media in distinct cultural environments. Consequently, this robust tool can be used to explore behaviours related to specific media that are particularly popular in any given country.

Immunomodulatory Effects in Healthy Individuals Following a 4-Week Taoist Qigong Intervention: A Comparative Study.

BACKGROUND Qigong, an ancient health preservation technique forming part of Traditional Chinese Medicine, combines slow body movements, breathing, and meditation. While this meditative movement system has been reported to offer various physical and psychological benefits, studies on the Taoist school of qigong are sparse. This study, therefore, aimed to investigate the effects of Taoist qigong on white blood cells and other immune parameters in healthy individuals. MATERIAL AND METHODS Thirty-eight participants were recruited for the study, with 21 assigned to the experimental group and 17 to the control group. Participants in the experimental group engaged in a four-week Taoist qigong program. Blood samples for immune parameter quantification, including leukocyte count, neutrophil, eosinophil, basophil, lymphocyte, and large unstained cell (LUC) counts, as well as concentrations of IgG, IgA, IgM, C3, and C4, were collected one day before the experiment started and one day after it ended. RESULTS Post-program, the experimental group exhibited significantly lower total leukocyte counts, and reduced numbers of lymphocytes and LUCs. Additionally, a higher percentage of monocytes was noted in this group. CONCLUSIONS Taoist qigong practice induced a distinct immunomodulatory profile, characterized by decreased counts of several white blood cell parameters and increased percentages of certain agranulocytes. This outcome presents intriguing implications from a psychobiological perspective and highlights the need for further research into the immune effects of Taoist mind-body practice.

Cognition in informal caregivers: evidence from an English population study.

BACKGROUND AND OBJECTIVES: The relationship between caregiving and cognition remains unclear. We investigate this association comparing four cognitive tasks and exploring the role of potential explanatory pathways such as healthy behaviours (healthy caregiver hypothesis) and depression (stress process model). RESEARCH DESIGN AND METHODS: Respondents were from English Longitudinal Study of Ageing (ELSA) (N = 8910). Cognitive tasks included immediate and delayed word recall, verbal fluency and serial 7 subtraction. Series of hierarchical linear regressions were performed. Adjustments included socio-demographics, health related variables, health behaviours and depression. RESULTS: Being a caregiver was positively associated with immediate and delayed recall, verbal fluency but not with serial 7. For immediate and delayed recall, these associations were partially attenuated when adjusting for health behaviours, and depression. For verbal fluency, associations were partially attenuated when adjusting for depression but fully attenuated when adjusting for health behaviours. No associations were found for serial 7. DISCUSSION AND IMPLICATIONS: Our findings show that caregivers have higher level of memory and executive function compared to non-caregivers. For memory, we found that although health behaviours and depression can have a role in this association, they do not fully explain it. However, health behaviours seem to have a clear role in the association with executive function. Public health and policy do not need to target specifically cognitive function but other areas as the promotion of healthy behaviours and psychological adjustment such as preventing depression and promoting physical activity in caregivers.

Prevalence of Child Contact Sexual Abuse in the Spanish Region of Andalusia.

The aim of this study was to analyze the prevalence and characteristics of child sexual abuse (CSA) in Andalusia, Spain's most populated region. A sample of 817 adults (281 male; M age = 34.7; SD = 13.86) completed the Child Sexual Abuse Experiences Questionnaire. Because the sample was unbalanced, we performed post-stratification by gender, resulting in 562 participants (50% male). Overall, 38.8% of the sample reported at least one type of contact abuse experience, with prevalence ranging from 22% for being fondled to 3.9% for being forced to perform a sexual act involving penetration. The first episode of CSA most commonly occurred between age 6 and 11 years, except for penetration. The majority of reported experiences were repeated and perpetrated by a male. More than half of the victims did not label their experience as sexual abuse, and this apparent lack of awareness about what constitutes abuse was particularly evident among male victims. The prevalence of CSA in Andalusia is higher than for Spain as a whole, highlighting the need to raise public awareness through prevention programs.

The role of character strengths in predicting gains in informal caregivers of dementia.

OBJECTIVES: Although providing care to a person with dementia can have a negative impact, caregivers may also perceive certain benefits and gains through the tasks they perform. Our aim here was to study caregiver gains within the framework of positive psychology, exploring the predictive power of character strengths, while controlling for sociodemographic variables and variables related to the dementia and caring. METHODS: A sample of 105 main caregivers of people diagnosed with dementia completed a sociodemographic questionnaire, the Gain in Alzheimer care Instrument and the Values in Action Inventory of Strengths. Correlational analysis and hierarchical regression were conducted. RESULTS: Eighteen character strengths were positively and significantly correlated with gain scores. Regression analysis indicated that level of education was negatively related to gain scores. In addition, hope was the character strength which best predicted the gain score, such that caregivers who scored higher on hope tended to perceive greater benefits from their role. CONCLUSION: The results suggest that hope may play an important role in relation to the perceived gains of caregiving. Intervention programmes based on positive psychology and aimed at enhancing character strengths, especially hope, could help caregivers to identify the positive aspects of their caring role.

Measurement invariance of the Phubbing Scale across 20 countries.

Mobile phone addiction is a robust phenomenon observed throughout the world. The social aspect of mobile phone use is crucial; therefore, phubbing is a part of the mobile phone addiction phenomenon. Phubbing is defined as ignoring an interlocutor by glancing at one's mobile phone during a face-to-face conversation. The main aim of this study was to investigate how the Phubbing Scale (containing 10 items) might vary across countries, and between genders. Data were collected in 20 countries: Belarus, Brazil, China, Croatia, Ecuador, India, Israel, Italy, Netherlands, Pakistan, Poland, Portugal, Serbia, Slovakia, Slovenia, Spain, Turkey, UK, Ukraine and USA. The mean age across the sample (N = 7696, 65.8% women, 34.2% men) was 25.32 years (SD = 9.50). The cross-cultural invariance of the scale was investigated using multigroup confirmatory factor analyses (MGCFA) as well as the invariance analyses. Additionally, data from each country were assessed individually via confirmatory factor analyses (CFAs). We obtained two factors, based on only eight of the items: (a) communication disturbances and (b) phone obsession. The 8 items Phubbing Scale.

Effect of variance ratio on ANOVA robustness: Might 1.5 be the limit?

Inconsistencies in the research findings on F-test robustness to variance heterogeneity could be related to the lack of a standard criterion to assess robustness or to the different measures used to quantify heterogeneity. In the present paper we use Monte Carlo simulation to systematically examine the Type I error rate of F-test under heterogeneity. One-way, balanced, and unbalanced designs with monotonic patterns of variance were considered. Variance ratio (VR) was used as a measure of heterogeneity (1.5, 1.6, 1.7, 1.8, 2, 3, 5, and 9), the coefficient of sample size variation as a measure of inequality between group sizes (0.16, 0.33, and 0.50), and the correlation between variance and group size as an indicator of the pairing between them (1, .50, 0, -.50, and -1). Overall, the results suggest that in terms of Type I error a VR above 1.5 may be established as a rule of thumb for considering a potential threat to F-test robustness under heterogeneity with unequal sample sizes.

Sphericity estimation bias for repeated measures designs in simulation studies.

In this study, we explored the accuracy of sphericity estimation and analyzed how the sphericity of covariance matrices may be affected when the latter are derived from simulated data. We analyzed the consequences that normal and nonnormal data generated from an unstructured population covariance matrix-with low (ε = .57) and high (ε = .75) sphericity-can have on the sphericity of the matrix that is fitted to these data. To this end, data were generated for four types of distributions (normal, slightly skewed, moderately skewed, and severely skewed or log-normal), four sample sizes (very small, small, medium, and large), and four values of the within-subjects factor (K = 4, 6, 8, and 10). Normal data were generated using the Cholesky decomposition of the correlation matrix, whereas the Vale-Maurelli method was used to generate nonnormal data. The results indicate the extent to which sphericity is altered by recalculating the covariance matrix on the basis of simulated data. We concluded that bias is greater with spherical covariance matrices, nonnormal distributions, and small sample sizes, and that it increases in line with the value of K. An interaction was also observed between sample size and K: With very small samples, the observed bias was greater as the value of K increased.

Psychometric properties of the Depression Anxiety Stress Scales (DASS-21) in women with breast cancer.

Breast cancer impacts the psychological well-being of women, leaving them at risk of developing depression, anxiety, and other stress-related disorders. The Depression Anxiety Stress Scales (DASS-21) is a widely used measure, although empirical evidence regarding its psychometric properties in the breast cancer population is limited. The purpose of this study was to conduct an exhaustive analysis of the psychometric properties of the DASS-21 in a sample of Spanish women diagnosed with breast cancer. Participants were 289 breast cancer patients who completed the DASS-21 and other questionnaires measuring life satisfaction, positive and negative affect, flourishing, perceived stress, and breast cancer-specific stressors. In terms of validity evidence based on the internal structure of the DASS-21, adequate fit indices were obtained for the model based on three first-order factors (depression, anxiety, stress) and one second-order factor (general psychological distress). Reliability coefficients (McDonald's omega) ranged from .84 to .95. Validity evidence based on relationships with other variables was also provided by moderate and strong correlations with well-being indicators and stress measures. The results support the use of the DASS-21 for measuring general psychological distress in the breast cancer context, where it may provide useful information for the design of psychological interventions with patients.

The Flourishing Scale: Psychometric Properties in Breast Cancer Patients.

BACKGROUND/OBJECTIVE: Promoting well-being is a key goal of cancer care, and it needs to be assessed using appropriate instruments. Flourishing is considered part of psychological well-being and it is commonly assessed with the Flourishing Scale (FS). To our knowledge, no studies have analyzed the psychometric properties of the FS in breast cancer patients. Our aim here was to provide validity evidence for use of the FS in this context. METHOD: Participants were 217 Spanish women with breast cancer who completed the FS and other scales assessing positive psychology constructs (life satisfaction, positive affect, resilience, self-esteem, optimism) and indicators of psychological maladjustment (negative affect, depression, anxiety, and stress). The internal structure of the FS was analyzed using confirmatory factor analysis (CFA). We calculated the average variance extracted (AVE) to evaluate convergent validity, and both McDonald's omega and Cronbach's alpha coefficients to estimate reliability. Item analysis was performed by computing corrected item-total correlations. Validity evidence based on relationships with other variables was obtained through Pearson correlation analysis, controlling for age and cancer stage. RESULTS: The CFA supported a single-factor structure, with adequate goodness-of-fit indices (CFI = 0.997, NNFI = 0.996, RMSEA = 0.069, and SRMR = 0.047) and standardized factor loadings ranging from 0.70 to 0.87. The value of the AVE was 0.63, and the reliability coefficient obtained with both procedures was 0.91. Corrected item-total correlations ranged from .62 to .78. Correlation analysis showed direct and strong associations between the FS score and scores on positive psychology constructs (range from 0.43 to 0.74), the strongest correlations being with positive affect and life satisfaction. The FS score was inversely correlated with scores on depression, anxiety, stress, negative affect, and pessimism (range from -0.14 to -0.52), the strongest association being with stress. DISCUSSION: The FS is a useful tool for exploring well-being in the breast cancer context, providing useful information for psychological assessment.

The effect of skewness and kurtosis on the robustness of linear mixed models.

This study analyzes the robustness of the linear mixed model (LMM) with the Kenward-Roger (KR) procedure to violations of normality and sphericity when used in split-plot designs with small sample sizes. Specifically, it explores the independent effect of skewness and kurtosis on KR robustness for the values of skewness and kurtosis coefficients that are most frequently found in psychological and educational research data. To this end, a Monte Carlo simulation study was designed, considering a split-plot design with three levels of the between-subjects grouping factor and four levels of the within-subjects factor. Robustness is assessed in terms of the probability of type I error. The results showed that (1) the robustness of the KR procedure does not differ as a function of the violation or satisfaction of the sphericity assumption when small samples are used; (2) the LMM with KR can be a good option for analyzing total sample sizes of 45 or larger when their distributions are normal, slightly or moderately skewed, and with different degrees of kurtosis violation; (3) the effect of skewness on the robustness of the LMM with KR is greater than the corresponding effect of kurtosis for common values; and (4) when data are not normal and the total sample size is 30, the procedure is not robust. Alternative analyses should be performed when the total sample size is 30.

Life Satisfaction and Character Strengths in Women With Breast Cancer: Zest and Hope as Predictors.

BACKGROUND: Empirical evidence shows that life satisfaction is positively related to character strengths, and although this association has been observed in different populations, it is scarce in breast cancer patients. This study analyzes the relationship between character strengths and life satisfaction in Spanish women diagnosed with breast cancer. METHODS: A sample of 117 women completed the Satisfaction with Life Scale (SWLS) and the Spanish version of the VIA Inventory of Strengths (VIA-IS). Correlation analysis and regression modeling were performed to determine which strengths predict life satisfaction. RESULTS: The results of the correlation analysis showed that 15 strengths were positively and significantly associated with life satisfaction, with the highest correlations corresponding to zest, hope, curiosity, social intelligence, love, gratitude, and judgment. Regression modeling indicated that of these, zest and hope were key strengths for predicting life satisfaction. CONCLUSIONS: These findings suggest that intervention programs based on the development of zest and hope could help to improve life satisfaction and, therefore, the psychological well-being of women with breast cancer.

Psychometric properties of the perceived stress scale (pss-10) with breast cancer patients.

Breast cancer diagnosis is one of the most difficult events that a woman can experience during her life and it usually produces high levels of stress. Global measures of perceived stress are useful for screening and for comparing stress levels between cancer patients and other clinical and nonclinical populations. One such instrument that is widely used is the Perceived Stress Scale (pss-10), but its psychometric properties have scarcely been analysed with breast cancer patients. The aim of this study was to provide validity evidence regarding the use of the 10-item version of the pss-10 as a tool for measuring perceived stress in this context. Participants were 215 Spanish breast cancer patients who completed the PSS-10 and the DASS-21, a measure of affective distress (depression, anxiety, and stress). The internal structure of the PSS-10 was examined through confirmatory factor analysis (CFA), and the reliability of test scores was estimated using McDonald's omega coefficient. Validity evidence based on relationships with other variables was also obtained using correlation analysis. The CFA supported a correlated two-factor structure: perceived helplessness (six negatively worded items) and perceived self-efficacy (four positively worded items). Reliability coefficients for scores on these two factors were 0.87 and 0.73, respectively. Scores on affective distress (DASS-21) were strongly and positively correlated with perceived helplessness and moderately and negatively correlated with perceived self-efficacy. The PSS-10 is an adequate tool for measuring perceived stress in the breast cancer context and it may be useful for identifying women at risk of psychological maladjustment.

Repeated measures ANOVA and adjusted F-tests when sphericity is violated: which procedure is best?

Introduction: One-way repeated measures ANOVA requires sphericity. Research indicates that violation of this assumption has an important impact on Type I error. Although more advanced alternative procedures exist, most classical texts recommend the use of adjusted F-tests, which are frequently employed because they are intuitive, easy to apply, and available in most statistical software. Adjusted F-tests differ in the procedure used to estimate the corrective factor ε, the most common being the Greenhouse-Geisser (F-GG) and Huynh-Feldt (F-HF) adjustments. Although numerous studies have analyzed the robustness of these procedures, the results are inconsistent, thus highlighting the need for further research. Methods: The aim of this simulation study was to analyze the performance of the F-statistic, F-GG, and F-HF in terms of Type I error and power in one-way designs with normal data under a variety of conditions that may be encountered in real research practice. Values of ε were fixed according to the Greenhouse-Geisser procedure (ε^). We manipulated the number of repeated measures (3, 4, and 6) and sample size (from 10 to 300), with ε^ values ranging from the lower to its upper limit. Results: Overall, the results showed that the F-statistic becomes more liberal as sphericity violation increases, whereas both F-HF and F-GG control Type I error; of the two, F-GG is more conservative, especially with large values of ε^ and small samples. Discussion: If different statistical conclusions follow from application of the two tests, we recommend using F-GG for ε^ values below 0.60, and F-HF for ε^ values equal to or above 0.60.

Non-normal Data in Repeated Measures ANOVA: Impact on Type I Error and Power.

BACKGROUND: Repeated measures designs are commonly used in health and social sciences research. Although there are other, more advanced, statistical analyses, the F-statistic of repeated measures analysis of variance (RM-ANOVA) remains the most widely used procedure for analyzing differences in means. The impact of the violation of normality has been extensively studied for between-subjects ANOVA, but this is not the case for RM-ANOVA. Therefore, studies that extensively and systematically analyze the robustness of RM-ANOVA under the violation of normality are needed. This paper reports the results of two simulation studies aimed at analyzing the Type I error and power of RM-ANOVA when the normality assumption is violated but sphericity is fulfilled. METHOD: Study 1 considered 20 distributions, both known and unknown, and we manipulated the number of repeated measures (3, 4, 6, and 8) and sample size (from 10 to 300). Study 2 involved unequal distributions in each repeated measure. The distributions analyzed represent slight, moderate, and severe deviation from normality. RESULTS: Overall, the results show that the Type I error and power of the F-statistic are not altered by the violation of normality. CONCLUSIONS: RM-ANOVA is generally robust to non-normality when the sphericity assumption is met.

Development and psychometric properties of the Stressors in Breast Cancer Scale.

Background: A diagnosis of breast cancer generates psychological stress, due not only to treatment and its side effects but also to the impact on different areas of the patient's daily life. Although there are instruments for measuring psychological stress in the cancer context, there is currently no tool for assessing stressors specific to breast cancer. Aims: The aim of this study was to develop the Stressors in Breast Cancer Scale (SBCS). Method: A panel of experts evaluated the clarity and relevance of scale items, providing validity evidence based on test content. Psychometric properties of the scale were then analyzed. Results: Validity evidence based on the internal structure of the SBCS was obtained through exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), following a cross-validation strategy. The CFA supported a second-order factor model with five dimensions: physical appearance and sex strains, health and daily difficulties, interpersonal relationship strains, healthcare strains, and worries and concerns about the future. This structure was invariant across two groups distinguished by time from cancer diagnosis (less than 3 and 3 years or more from diagnosis). Reliability, based on McDonald's omega and Cronbach's alpha coefficients, ranged from 0.83 to 0.89 for factor scores, and reached 0.95 for total scores. Validity evidence was also provided by correlations with depression, anxiety, perceived stress, and perceived health and quality of life. Discussion: The results support the use of the SBCS for measuring stress as a stimulus in the breast cancer context. Implications for clinical practice and research are discussed.

Using the linear mixed model to analyze nonnormal data distributions in longitudinal designs.

Using a Monte Carlo simulation and the Kenward-Roger (KR) correction for degrees of freedom, in this article we analyzed the application of the linear mixed model (LMM) to a mixed repeated measures design. The LMM was first used to select the covariance structure with three types of data distribution: normal, exponential, and log-normal. This showed that, with homogeneous between-groups covariance and when the distribution was normal, the covariance structure with the best fit was the unstructured population matrix. However, with heterogeneous between-groups covariance and when the pairing between covariance matrices and group sizes was null, the best fit was shown by the between-subjects heterogeneous unstructured population matrix, which was the case for all of the distributions analyzed. By contrast, with positive or negative pairings, the within-subjects and between-subjects heterogeneous first-order autoregressive structure produced the best fit. In the second stage of the study, the robustness of the LMM was tested. This showed that the KR method provided adequate control of Type I error rates for the time effect with normally distributed data. However, as skewness increased-as occurs, for example, in the log-normal distribution-the robustness of KR was null, especially when the assumption of sphericity was violated. As regards the influence of kurtosis, the analysis showed that the degree of robustness increased in line with the amount of kurtosis.

Assessing Satisfaction With Online Courses: Spanish Version of the Learner Satisfaction Survey.

The aim of this study was to develop a Spanish version of the Learner Satisfaction Survey (LSS-S) and to analyze its psychometric properties. The questionnaire was administered to a sample of 1,194 university students. Validity evidence based on the instrument's internal structure and on relationships with other variables (personality and motivation) were analyzed. In addition, reliability of test scores and differences by gender and area of knowledge were examined. The results revealed a factor structure with adequate fit indices based on five first-order factors (learner-content, learner-instructor, learner-learner, and learner-technology interactions, and general satisfaction) and one second-order factor (total score for academic satisfaction). Scores on the LSS-S were positively correlated with scores on conscientiousness, intrinsic motivation, and identified regulation, and negatively correlated with scores on neuroticism and amotivation. Although the magnitude of correlations with personality traits was small, those with motivational factors were moderate or strong. Reliability of LSS-S factor scores may be considered satisfactory, with McDonald's omega ranging from 0.80 to 0.86. These results indicate that the LSS-S has satisfactory psychometric properties and that it is an adequate tool for measuring satisfaction with online courses among Spanish learners in higher education.

Life satisfaction and the mediating role of character strengths and gains in informal caregivers.

WHAT IS KNOWN ON THE SUBJECT?: The role of informal caregiver can have both negative and positive consequences for a person's well-being. The main theoretical framework for explaining these consequences is the stress process model, which considers contextual variables, stressors and mediating/moderating factors. The latter are psychosocial factors such as coping strategies, personal mastery, social support or beliefs and values which may influence caregiver well-being. The perception of gains in caregiving has also been proposed as a mediating variable since it may act as a coping strategy. However, few studies have examined values and perceived gains as mediating variables with life satisfaction as the outcome. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study explores the role of character strengths and caregiver gains as mediators between stressors and life satisfaction in informal caregivers of persons with dementia. The results identify hope as a key character strength, its lack being one pathway through which stress may lead to low life satisfaction and low perceived gains from caregiving. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Caregivers who experience a lack of hope may be less able to generate goals and be less motivated to achieve them. Our findings are relevant to gerontological nursing based on the Senses Framework as they confirm the importance of the senses of purpose and achievement. Nursing and care staff can play an active role in helping informal caregivers to meet their goals by promoting these two senses, thereby fostering a more positive caregiving experience. ABSTRACT: Introduction Being an informal caregiver can have both negative and positive consequences for well-being. Within the framework of the stress process model, few studies have examined values and perceived gains of caregiving as mediating variables of life satisfaction. Aim To explore the role of character strengths and perceived gains as mediators in the association between life satisfaction and primary and secondary stressors in informal caregivers of persons with dementia. Method Participants were 112 informal caregivers. Hierarchical regression, correlation and mediation analyses were performed. Results Lower life satisfaction was associated with being female, unmarried, caring for someone with greater cognitive impairment, a higher level of stress, having restricted leisure time and perceiving financial difficulties. Hope mediated the associations between perceived stress and both life satisfaction and perceived gains of caregiving. Discussion Hope is a key strength and its lack is one pathway through which stress may cause low satisfaction and low perceived gains from caregiving. Implications for practice Without hope, it is difficult for caregivers to generate goals and be motivated to achieve them. Nursing and care staff should aim to promote a sense of purpose and achievement among informal caregivers so as to foster a more positive caring experience.