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Objective: The purpose of this research was to test an extension of the incentive motivation model of alcohol by examining effects of personality traits on drinking motives and contexts, as mediated by social isolation. Methods: Participants were 1269 adults who resided in the United States (n = 618) or United Kingdom (n = 651) and completed an online questionnaire measuring the traits of negative emotionality and resilience, along with social isolation, drinking motives (coping, social) and drinking contexts (alone, at a party, at a bar/club). Six months later, 70% of the participants returned to complete a similar online questionnaire. Results: Path analysis was used to test the hypothesized models and revealed that negative emotionality had a prospective indirect effect on drinking to cope and drinking alone through increased social isolation over the 6-month period of observation. In contrast, the trait of resilience had a prospective indirect effect on reductions in the drinking to cope motive and reductions in drinking alone, through decreased social isolation. Conclusion: The findings suggest that personality traits that contribute to social isolation may be risk factors for dysfunctional drinking motives and contexts.
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CONTEXT: Many cancer survivors and their informal caregivers experience multiple symptoms during the survivor's treatment. OBJECTIVE: Test relative effectiveness and optimal sequencing of two evidence-based interventions for symptom management. METHODS: In this sequential multiple assignment randomized trial (SMART), survivors of solid tumors with elevated depression or anxiety and their caregivers as dyads were initially randomized after baseline assessment in a 3:1 ratio to the Symptom Management and Survivorship Handbook (SMSH, N = 277 dyads) intervention or SMSH plus 8 weeks of telephone interpersonal counseling (TIPC, N = 97 dyads). After 4 weeks, survivors who were not responding (no improvement or worsening score on depression and/or anxiety item) to SMSH only and their caregivers were re-randomized to continue with SMSH alone (N = 44 dyads) to give it more time or to SMSH + TIPC (N = 44 dyads). Mixed effects and generalized linear models compared severity of depression, anxiety, and a summed index of 16 other symptoms over weeks 1-13 and week 17 between randomized groups and among three dynamic treatment regimes (DTRs). Dyads received SMSH only for 12 weeks (DTR1); SMSH for 12 weeks with 8 weeks of TIPC added from week 1 (DTR2); and SMSH for 4 weeks followed by the combined SMSH + TIPC for 8 weeks if no response at 4 weeks (DTR3). RESULTS: Survivors randomized initially to SMSH alone had significantly lower anxiety over weeks 1-13 compared to those randomized to the combined SMSH + TIPC. In comparing DTRs, survivor's anxiety was significantly lower at week 13 for DTR1 compared to DTR2 with no other main effects for survivors or caregivers. Exploratory moderation analyses indicated a potential benefit of adding TIPC for caregivers of non-responders with elevated baseline symptoms. CONCLUSION: SMSH + TIPC did not result in better symptom outcomes at week 17 than SMSH alone. Lower intensity SMSH may improve depression and anxiety symptoms for most survivors and their caregivers. TRIAL REGISTRATION: Clinicaltrails.gov ID number, NCT03743415; approved and posted on 11/16/2018.
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Ansiedad , Supervivientes de Cáncer , Cuidadores , Depresión , Humanos , Supervivientes de Cáncer/psicología , Cuidadores/psicología , Masculino , Femenino , Persona de Mediana Edad , Ansiedad/etiología , Depresión/etiología , Anciano , Adulto , Neoplasias/psicología , Neoplasias/terapia , Consejo/métodosRESUMEN
CONTEXT: Late or residual symptoms diminish quality of life for many cancer survivors after completion of treatment. OBJECTIVES: Examine risk factors associated with persisting symptom burden after chemotherapy and the lack of symptom improvement over time. METHODS: Survivors who completed curative-intent chemotherapy within two years for solid tumors were enrolled into a symptom management trial. There were 375 survivors with two or more comorbid conditions or one comorbid condition and elevated depressive symptoms (pre-defined risk factors in the trial design) who received interventions and 71 survivors without these risk factors who did not receive interventions. For all survivors, symptoms were assessed at intake, 4, and 13 weeks and categorized as mild, moderate, or severe based on the interference with daily life. The probabilities of moderate or severe symptoms and symptom improvement were analyzed using generalized mixed-effects models in relation to comorbidity, depressive symptoms, age, sex, race/ethnicity, employment, time since chemotherapy completion, and physical function. Multiple symptoms were treated as nested within the survivor. RESULTS: Moderate or severe symptoms at baseline and the lack of improvement over time were associated with younger age and lower physical function over and above a greater number of comorbidities and elevated severity of depressive symptoms. CONCLUSION: Risk factors identified in this research (younger age, lower physical function, greater comorbidity, and higher depressive symptoms) can be used to allocate resources for post-treatment symptom management for cancer survivors in order to relieve symptoms that do not necessarily resolve with time.
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Supervivientes de Cáncer , Neoplasias , Humanos , Calidad de Vida/psicología , Neoplasias/terapia , Sobrevivientes , ComorbilidadRESUMEN
Recognizing the various negative consequences of overparenting for the child such as poor mental health and relationship quality and delayed transition to full adulthood, this study examined to what extent parents of emerging adults were being responsive and tailoring their parenting practices to meet their child's characteristics, such as need for autonomy and trait autonomy. Survey data from 256 parent-emerging adult child dyads were used for analyses. The results showed that parent-reported overparenting was not associated with child-reported autonomy features. Nevertheless, parents engaged in lower levels of tangible assistance and higher levels of advice/affect management if they perceived their child as high in autonomy need or trait autonomy. Collectively, these findings suggest that parents might practice overparenting out of their own desires and needs rather than taking into account their child's developmental needs and traits. Practical recommendations for family therapists are offered.
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CONTEXT: Social determinants of health (SDOH) impact population health. Leveraging community-level strengths related to SDOH through a social infrastructure perspective can optimize health behaviors and health outcomes to promote health equity. OBJECTIVE: Our aims were to develop, validate, and apply the Connected Community Classification (C3) as comprehensive community-level measure of protective SDOH and structural factors in the Four Corners states region of the United States. DESIGN: C3 was developed using an iterative principal component analysis of publicly available data mapped to 5 SDOH domains. Regional clustering of C3 by zip code tabulation area (ZCTA) was identified using spatial autocorrelation methods. MAIN OUTCOMES: In adjusted spatial autoregressive models, we analyzed the association of C3 with high-risk health behaviors and chronic disease prevalence using publicly available data for population-level estimates of fruit and vegetable intake, physical activity, obesity, smoking, alcohol use, coronary heart disease (CHD), diabetes, and cancer. RESULTS: C3 was found to be reliable and valid; a C3 value of 10 indicates communities with greater connection (high), while a value of 1 indicates communities with greater separation (low) to social infrastructure. Lower connection, as measured by C3, was significantly inversely associated with lower fruit and vegetable intake, lower physical activity, and higher rates of obesity, smoking, CHD, diabetes, and cancer. C3 was significantly positively associated with heavy alcohol use. CONCLUSIONS: These findings demonstrate that communities connected to social infrastructure have better population health outcomes. C3 captures protective community attributes and can be used in future applications to assist health researchers, practitioners, nonprofits, and policymakers to advance social connection and health equity in geographically diverse underserved regions.
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Diabetes Mellitus , Equidad en Salud , Neoplasias , Humanos , Estados Unidos/epidemiología , Promoción de la Salud , Conductas Relacionadas con la Salud , Determinantes Sociales de la Salud , ObesidadRESUMEN
Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.
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Neoplasias , Espiritualidad , Humanos , Calidad de Vida , Cuidadores , SoledadRESUMEN
The goal of this study is to better understand the role of social relationships and traditional gender norms in Latina health. Utilizing Hawkley and Cacioppo's theoretical model of loneliness and health as a framework, loneliness is proposed as a key component in the relationship between the Latina gender norm of marianismo and health. Participants were 178 female adults who identified as Latina (N = 97) or non-Latina White (N = 81), ranging in age from 19-88, who completed measures of loneliness, marianismo, depression, overall health, and health practices. Results indicate that being Latina was associated with family pillar marianismo, which includes characteristics centered on women's roles as the core of the family, that was associated with lower loneliness, and lower loneliness was subsequently associated with better overall health, lower depression, and beneficial health practices. However, being Latina had no association with silencing self to maintain harmony marianismo, that in turn had no association with loneliness, or health outcomes. These results suggest that elements of marianismo can play a protective role in Latina health and well-being, particularly when Latinas endorse the positive aspects of the gender norm that place women at the center of their families. Results also help explain the Latino health paradox by providing more specificity in the links between Latina ethnicity and positive health outcomes.
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OBJECTIVE: This study compared three ethnic/racial groups of informal cancer caregivers on social determinants of health and tested social determinants of health as predictors of psychological distress and caregiver burden. METHODS: This study was a secondary analysis of baseline data of a sequential multiple assignment randomized trial (SMART) testing symptom management interventions with caregiver-survivor dyads. Caregivers completed baseline measures of social determinants of health (SDoH), functional limitations, psychological distress, and caregiver burden. Hispanic, non-Hispanic White, and non-Hispanic other races caregivers were compared on these variables. Multivariate tests of associations between SDoH and caregiver burden and psychological distress were conducted in structural equation modeling with caregiver burden and psychological distress as latent variables. RESULTS: Hispanic caregivers reported significantly higher caregiver burden, specifically for finances, family, and schedules. Caregiver burden was significantly predicted by having income barely or not meeting needs, being female, socially isolated, married, Hispanic, and having poor physical functioning. Significant predictors of caregivers' psychological distress: being female, being socially isolated, and having poor physical functioning. CONCLUSION: Hispanic caregivers experience significant challenges associated with caregiver burden, especially if they are female, socially isolated, and have poor physical functioning. Assessment of these SDoH is important in caregiver health to provide supportive care during caregiving. CLINICAL TRIAL REGISTRATION NUMBER: NCT03743415 www.clinicaltrials.gov.
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Among Latino/as, informal caregiving duties are often deemed a family responsibility. Understanding psychological outcomes tied to caregivers of Latina breast cancer survivors is important to identify the impacts of cancer. Secondary analysis of baseline data collected in a randomized clinical trial (RCT) from 230 Latina breast cancer survivor-caregiver dyads. Characteristics of caregivers residing in rural/underserved and urban areas were compared using t- or chi-square tests. General linear models were used to analyze depressive symptoms in relation to residence, survivor-caregiver relationship, acculturation, obligation, reciprocity, and comorbidities. Urban residence was significantly associated with higher levels of depression controlling for survivor-caregiver relationship acculturation, obligation, reciprocity, and comorbidities. Mother caregivers had significantly higher levels of depression than other caregivers. Depression among Latino/a caregiver's providing care to an adult child is an important consideration as Latino/as are less likely to seek out/have access to mental health services than other groups.
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OBJECTIVE: Neighborhood disadvantage has been documented as a risk factor for problem drinking. The specific aim of this investigation is to test a model of neighborhood disadvantage, psychological distress, and problem drinking in a demographically and socioeconomically diverse sample. METHOD: A sample of 618 adults (21-65-year-olds; Mage = 30.80, SD = 9.81; 58% female) who reported drinking alcohol at least once in the past 6 months, completed an online questionnaire with questions about psychological distress (depression, stress, social isolation) and problem drinking (drinking problems, drinking to cope, binge drinking) twice over the course of 6 months. Their data were merged with the American Community Survey data from the U.S. Census Bureau to form an index of neighborhood disadvantage (median income, % residents with less than high school education, % living in poverty, % receiving income assistance). RESULTS: A structural equation modeling analysis showed that neighborhood disadvantage was associated with increases in psychological distress during the T1-T2 interval. Psychological distress was also positively associated with problem drinking at both T1 and T2. There was an indirect effect of neighborhood disadvantage on problem drinking through increased psychological distress. However, there was no direct effect of neighborhood disadvantage on problem drinking in this sample. CONCLUSIONS: Increased psychological distress may be a key mechanism that links living in disadvantaged neighborhoods and problem drinking. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Alcoholismo , Distrés Psicológico , Adulto , Humanos , Femenino , Masculino , Pobreza/psicología , Factores de Riesgo , Características de la Residencia , Etanol , Características del VecindarioRESUMEN
CONTEXT: Many cancer survivors experience a lingering symptom burden after chemotherapy. OBJECTIVES: In this sequential multiple assignment randomized trial, we tested optimal sequencing of two evidence-based interventions for symptom management. METHODS: Survivors of solid tumors (N = 451) were interviewed at baseline and stratified as high or low need for symptom management based on comorbidity and depressive symptoms. High need survivors were randomized initially to the 12-week Symptom Management and Survivorship Handbook (SMSH, N = 282) or 12-week SMSH with eight weeks of Telephone Interpersonal Counseling (TIPC, N = 93) added during weeks one to eight. After four weeks of the SMSH alone, non-responders on depression were re-randomized to continue with SMSH alone (N = 30) or add TIPC (N = 31). Severity of depression and summed severity index of 17 other symptoms over weeks one to13 were compared between randomized groups and among three dynamic treatment regimes (DTRs): 1) SMSH for 12 weeks; 2) SMSH for 12 weeks with eight weeks of TIPC from week one; 3) SMSH for four weeks followed by SMSH+TIPC for eight weeks if no response to the SMSH alone on depression at week four. RESULTS: There were no main effects for randomized arms or DTRs, but there was a significant interaction of trial arm with baseline depression favoring SMSH alone during weeks one to four in the first randomization and SMSH+TIPC in the second randomization. CONCLUSION: The SMSH may represent a simple effective option for symptom management, adding TIPC only when there is no response to SMSH alone for people with elevated depression and multiple co-morbidities.
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Neoplasias , Humanos , Neoplasias/tratamiento farmacológico , Neoplasias/psicología , Comorbilidad , Cuidados Paliativos , Resultado del TratamientoRESUMEN
BACKGROUND: Cancer survivors (defined as individuals from diagnosis to the end of life) in treatment experience multiple physical and psychological symptoms (e.g., fatigue, pain, depression, anxiety, disturbed sleep) that influence their well-being and treatment outcomes. Underrepresented cancer survivors may disproportionately experience greater symptom burden (number of symptoms, symptom severity, depression, anxiety). OBJECTIVES: The aim of this study was to examine the relationships of social determinants of health, including age, ethnicity, education, income and whether income meets the survivor's needs, neighborhood (rural vs. urban), access to healthcare (e.g., insurance), and social isolation, with symptom burden in cancer survivors. METHODS: This secondary analysis included baseline data from 400 cancer survivors of solid tumor cancers undergoing chemotherapy or targeted therapy who participated in a larger randomized trial of symptom management interventions. Symptom burden was measured by the Center for Epidemiological Studies-Depression scale for depression and Patient-Reported Outcomes Measurement Information System scores for anxiety and social isolation, summed severity index of 16 symptoms from the General Symptom Distress Scale, and the total number of symptoms. Self-reported comorbid conditions were measured using the Bayliss tool. General linear models were used to relate symptom measures (one at a time) to age, number of comorbid conditions, level of education, marital status, income meeting needs, and size of metropolitan neighborhood. Additional covariates included site of cancer, its treatment, and whether the cancer was metastatic. RESULTS: Non-Hispanic White survivors ( n = 191) were older and had more comorbid conditions, a higher proportion of metastatic cancers, and higher levels of education and income compared with Hispanic survivors ( n = 168) and non-Hispanic survivors of other races ( n = 41). Compared with the other two groups, Hispanic survivors had the lowest rate of health insurance availability, and non-Hispanic survivors of other races had the lowest social isolation. Age, number of comorbid conditions, and social isolation were significantly associated with number of symptoms, symptom severity, and depression. Age and social isolation were associated with anxiety. In addition, the symptom severity of non-Hispanic White survivors was lower than that of Hispanic survivors and non-Hispanic survivors of other races. DISCUSSION: These findings highlight the health disparities in symptom burden experienced among cancer survivors when considering their social determinants of health. Assessing these may help clinicians address health disparities in cancer care.
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Depresión , Neoplasias , Humanos , Depresión/epidemiología , Depresión/terapia , Etnicidad , Hispánicos o Latinos , Neoplasias/terapia , Neoplasias/psicología , Calidad de Vida/psicología , Determinantes Sociales de la Salud , Costo de EnfermedadRESUMEN
Research shows that overparenting (a.k.a. helicopter parenting) is associated with many child issues, among which disrupted mental health is one of the most consistently observed. The present study aims to examine if open family communication and child trait autonomy alter the associations between overparenting and emerging adult children's general self-efficacy, environmental mastery, anxiety, and depression. Cross-sectional data were collected from college students (N = 442, M age = 20.28 years, SD = 1.48) in the United States. Results showed that open family communication strengthened the negative association between overparenting and environmental mastery, and trait autonomy weakened the negative association between overparenting and general self-efficacy. None of these two moderators altered the associations between overparenting and child anxiety and depression. The effects of open family communication and trait autonomy in a controlling context are discussed. Overall, notwithstanding the moderation effects observed from open family communication and trait autonomy, the findings suggest that the effects of overparenting might be difficult to buffer.
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BACKGROUND: Latino cancer caregivers are at risk of physical, mental, and emotional health issues. Sociocultural factors such as informational support, Anglo orientation, and spiritual practice may compound or protect against these risks. OBJECTIVE: The purpose of this research project was to examine self-efficacy as a mediator between sociocultural factors and health outcomes in Latino cancer caregivers. METHODS: This is a secondary analysis of baseline caregiver data from an experimental study testing two psychoeducational interventions in Latina individuals with breast cancer and their caregivers. Caregivers (N = 233) completed items assessing self-efficacy, informational support, Anglo orientation, spiritual practice, depression, and global health. Caregiver data were analyzed using hierarchical linear regression and mediation analysis. RESULTS: Spiritual well-being was not significantly associated with health outcomes or self-efficacy. In regression analysis, both informational support ( b = 0.32; 95% confidence interval [CI], 0.20 to 0.45; P < .001) and Anglo orientation ( b = 0.15; 95% CI, 0.11 to 2.48; P < .05) were significant predictors of global health, but informational support ( b = -0.43; 95% CI, -0.55 to -0.30; P < .001) was the only significant predictor of depression. There were indirect relationships through self-efficacy for symptom management for both informational support and Anglo orientation and health outcomes. CONCLUSIONS: Informational support and Anglo orientation were significantly related to health outcomes directly and indirectly through self-efficacy in Latino cancer caregivers. IMPLICATIONS FOR PRACTICE: Informational support through the health system and community, when provided with attention to culture and Spanish language translation, can increase Latino cancer caregivers' self-efficacy to care for themselves and improve health outcomes.
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Neoplasias de la Mama , Cuidadores , Hispánicos o Latinos , Autoeficacia , Femenino , Humanos , Acceso a la Información/psicología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/terapia , Cuidadores/psicología , Cultura , Hispánicos o Latinos/psicología , Salud Mental , Factores Sociales , Apoyo SocialRESUMEN
An online survey of 528 people who lost someone close to them in the last 5 years was used to test associations between having final conversations (FCs) and depression. The direct effect was nonsignificant, but there were two significant moderation effects. Time since bereavement moderated the FC-depression relationship; there was a negative relationship between FCs and depression shortly following bereavement, but no relationship after more time had passed. The age of the deceased also moderated this relationship; there was a negative relationship between FCs and depression when the deceased was older, but no relationship when the deceased was younger.
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Aflicción , Depresión , Humanos , Pesar , ComunicaciónRESUMEN
The current study utilizes Hawkley, Cacioppo, and colleagues' model of loneliness and health to examine the influence of parent-child relationships on the health of incarcerated women. Participants were 121 incarcerated female adults who have at least one child, and who completed a questionnaire with measures of parental involvement, parent-child closeness, loneliness, overall health, physical functioning, depression, and anxiety. Results reveal that among incarcerated women, perceptions of close and involved relationships with their children were associated with less loneliness, and less loneliness was associated with better overall health and physical functioning, as well as lower depression and anxiety. Findings highlight the importance of including loneliness in studies that examine the impact of parent-child relationships on health, especially for this vulnerable population, and suggest that it is worthwhile to engage in efforts to help incarcerated women maintain close and involved relationships with their children through high-quality communication.
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Madres , Prisioneros , Adulto , Humanos , Femenino , Soledad , Relaciones Padres-Hijo , PadresRESUMEN
PURPOSE: The purpose was to determine predictors of scheduled and unscheduled health services use by cancer survivors undergoing treatment and their informal caregivers. METHODS: English- or Spanish-speaking adult cancer survivors undergoing chemotherapy or targeted therapy for a solid tumor cancer identified a caregiver (N = 380 dyads). Health services use over 2 months was self-reported by survivors and caregivers. Logistic regression models were used to relate the likelihood of service use (hospitalizations, emergency department [ED] or urgent care visits, primary care, specialty care) to social determinants of health (age, sex, ethnicity, level of education, availability of health insurance), and number of comorbid conditions. Co-habitation with the other member of the dyad and other member's health services use were considered as additional explanatory variables. RESULTS: Number of comorbid conditions was predictive of the likelihood of scheduled health services use, both primary care and specialty care among caregivers, and primary care among survivors. Greater probability of specialty care use was associated with a higher level of education among survivors. Younger age and availability of health insurance were associated with greater unscheduled health services use (hospitalizations among survivors and urgent care or ED visits among caregivers). Unscheduled health services use of one member of the dyad was predictive of use by the other. CONCLUSIONS: These findings inform efforts to optimize health care use by encouraging greater use of scheduled and less use of unscheduled health services. These educational efforts need to be directed especially at younger survivors and caregivers.
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Supervivientes de Cáncer , Neoplasias , Adulto , Atención Ambulatoria , Cuidadores , Humanos , Neoplasias/terapia , Autoinforme , SobrevivientesRESUMEN
In Erikson's model of development, intimacy and isolation denote polar outcomes of psychosocial crisis in young adulthood. Drawing on this model, the present study used three-wave longitudinal data to examine patterns of the success and lack of success in the resolution of Eriksonian crisis in relation to romantic loneliness as a negative outcome of the intimacy crisis, and compared across Poland and the United States. The data were collected from Polish and U.S. individuals aged 18-40 for Wave 1 (N = 763). Four patterns of the Eriksonian intimacy crisis were identified: (a) stable partnered status; (b) stable single status; (c) transition from single to partnered status; (d) transition from partnered to single status. In both countries, transition from single to partnered status was related to decreased romantic loneliness. Greater initial romantic loneliness was observed among Polish single adults who transited to partnered status in contrast to stable single adults. In turn, the U.S. partnered adults who transited to single status initially experienced lower romantic loneliness than stable single adults. Bivariate latent growth curve models pairing romantic loneliness with relationship satisfaction revealed that higher initial relationship satisfaction was associated with lower initial romantic loneliness, and a greater increase in relationship satisfaction was associated with smaller increases in romantic loneliness. The findings highlight that different resolutions of the intimacy crisis are related to diverse romantic loneliness and relationship satisfaction trajectories and these associations also appear to differ as a function of various marital and loneliness contexts in Poland and the United States. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Soledad , Parejas Sexuales , Adulto , Humanos , Satisfacción Personal , Polonia , Conducta Sexual/psicología , Parejas Sexuales/psicología , Estados Unidos , Adulto JovenRESUMEN
INTRODUCTION: Asthma is an incurable, lifelong condition that places children at increased risk for exacerbation, hospitalisation and school absences. Most paediatric asthma interventions target parents alone and are overly prescriptive. Improving Asthma Care Together (IMPACT) is a novel shared management system comprised of a mobile health (mHealth) application, symptom watch and tailored health intervention that pairs parent and child together as an asthma management team. IMPACT helps families monitor asthma status, tailor asthma management strategies and facilitate intentional transition of asthma management to the child. The purpose of this study is to determine the feasibility, acceptability and preliminary efficacy of the IMPACT intervention. METHODS AND ANALYSIS: This pilot randomised controlled trial will recruit 60 children with asthma (7-11 years) and one parent. All parent-child dyads will complete data collection sessions at baseline, postintervention and follow-up. Dyads randomised to the intervention group (IMPACT) will complete the 8-week intervention comprised of weekly activities including symptom monitoring, goal setting and progress monitoring. Dyads randomised to the control group will receive usual care but then be provided access to IMPACT at the end of the study. Feasibility will be measured by the proportion of eligible dyads enrolled and retained. Acceptability of IMPACT will be assessed using the Acceptability of Intervention Measure, the System Usability Scale and a semistructured interview. Preliminary efficacy is determined based on change in primary outcomes, parent-reported and child-reported asthma responsibility and asthma self-efficacy scores, from baseline. ETHICS AND DISSEMINATION: This study has been approved by the University of Washington Institutional Review Board; study ID: STUDY00010461. Participants gave informed consent to participate in the study before taking part. Study results will be disseminated in peer-reviewed journals and scientific conferences. A lay summary will be provided to study participants. TRIAL REGISTRATION NUMBER: NCT04908384 (ClinicalTrials.gov identifier).
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Asma , Aplicaciones Móviles , Telemedicina , Asma/terapia , Humanos , Padres , Proyectos Piloto , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation-Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes' approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b = - .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b = - .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.