ABSTRACT
This article presents themes emerging from semistructured interviews with dementia family caregivers in rural communities who participated in an integrative, cognitive-behavioral and spiritual counseling intervention, and with faith community nurses (FCNs) who delivered the intervention. The primary objectives of the counseling intervention were to ameliorate dementia caregivers' depressive affect and the severity of their self-identified caregiving and self-care problems. The qualitative portion of the study was intended to elicit caregivers' and FCNs' perceptions of the benefits and drawbacks of the intervention. We conducted interviews with seven FCN/caregiver pairs 4 times during the 6-month counseling process, totaling 56 interviews. Themes emerging from the interviews included caregivers' perception of burden and care partners' problem behavior; formation of therapeutic alliance between FCNs and caregivers; problem-solving skills, tools, and resources; caregivers' use of problem-solving strategies; spirituality in caregiving and counseling processes; FCNs' prior professional experience; and caregiver and FCN time constraints.
Subject(s)
Caregivers/psychology , Cognitive Behavioral Therapy/methods , Counseling/methods , Dementia/therapy , Parish Nursing/methods , Spirituality , Adult , Aged , Female , Humans , Interviews as Topic , Male , Middle Aged , Qualitative ResearchABSTRACT
OBJECTIVES: The primary objectives of the present study were: (a) to develop the African American Dementia Caregiver Problem Inventory (DCPI-A) that assesses the types and frequency of problems reported by African American dementia caregivers seeking cognitive-behavioral intervention, (b) to evaluate the intercoder reliability of the DCPI-A, and (c) to measure the perceived severity of common problems reported by this caregiver population. METHOD: The development of the DCPI-A was divided into 3 major steps: (a) creating an initial sample pool of caregiver problems derived from 2 parent randomized clinical trials, (b) formulating a preliminary version of the DCPI-A, and (c) finalizing the development of the DCPI-A that includes 20 problem categories with explicit coding rules, definitions, and illustrative examples. RESULTS: The most commonly reported caregiver problems fell into 5 major categories: (a) communication problems with care recipients, family members, and/or significant others, (b) problems with socialization, recreation, and personal enhancement time; (c) problems with physical health and health maintenance, (d) problems in managing care recipients' activities of daily living; and (e) problems with care recipients' difficult behaviors. Intercoder reliability was moderately high for both percent agreement and Cronbach's kappa. A similar positive pattern of results was obtained for the analysis of coder drift. CONCLUSIONS: The descriptive analysis of the types and frequency of problems of African American dementia caregivers coupled with the outcomes of the psychometric evaluation bode well for the adoption of the DCPI-A in clinical settings. (PsycINFO Database Record
Subject(s)
Alzheimer Disease/ethnology , Alzheimer Disease/psychology , Black or African American/psychology , Caregivers/psychology , Cost of Illness , Psychometrics/statistics & numerical data , Surveys and Questionnaires , Activities of Daily Living/psychology , Adult , Aged , Alzheimer Disease/therapy , Cognitive Behavioral Therapy , Communication , Female , Florida , Humans , Male , Mental Disorders/psychology , Mental Disorders/therapy , Middle Aged , Observer Variation , Recreation , Reproducibility of Results , SocializationABSTRACT
OBJECTIVES: Discuss initial findings of a randomized clinical trial comparing the effects of telephone-based and face-to-face (f-to-f) cognitive-behavioral therapy (CBT) on changes in caregiver (CG) burden, assistance support, depression, and health status for African American (AA) CGs with depression. DESIGN: Pilot study using a prepost, two-group design with 14 enrolled and randomized participants. MEASURES: Subjective Burden subscale of the Caregiver Appraisal Inventory, Assistance Support subscale of the Interpersonal Support Evaluation List, Physical Symptoms subscale of the Caregiver Health and Health Behavior Inventory and the Center for Epidemiologic Studies Depression Scale. RESULTS: Prepost improvements were found on 11 completers across all measures for both telephone and f-to-f CBT. Moderate and similar effects sizes for CG subjective burden and assistance support were found for both the telephone and f-to-f groups. Effect sizes for physical symptoms and depression varied from low to moderate, respectively, with a trend toward smaller improvements in f-to-f CBT than in telephone CBT. Qualitative analysis highlighted CGs' perceptions of the active ingredients of treatment and provided indirect support for similar gains in emotional and psychosocial functioning across the two treatment modalities. CONCLUSIONS: Both telephone-based and f-to-f CBT showed improvements in depression, subjective burden, and assistance support in dementia AA CGs. Replication with a larger sample size (N = 106) is currently in progress. Study limitations and future directions for research are also addressed.
Subject(s)
Alzheimer Disease/psychology , Alzheimer Disease/rehabilitation , Black or African American/psychology , Caregivers/psychology , Cognitive Behavioral Therapy/methods , Depressive Disorder/rehabilitation , Somatoform Disorders/rehabilitation , Telephone , Aged , Cost of Illness , Depressive Disorder/psychology , Female , Florida , Health Status , Humans , Male , Middle Aged , Pilot Projects , Problem Solving , Social Support , Somatoform Disorders/psychology , Stress, Psychological/complicationsABSTRACT
OBJECTIVE: Discuss initial evaluation of a program for training faith community nurses (FCNs) to conduct cognitive-behavioral and spiritual counseling (CBSC) for rural dementia caregivers (CGs), and present 2 case studies on the use of CBSC for treating depression in this population. STUDY DESIGN: Pre-post evaluation of the effectiveness of CBSC training and a case study analysis of the effectiveness of CBSC on CG problem improvement and depression. OUTCOME MEASURES: For FCN training, we used the FCN Counseling Comfort Scale, FCN Counseling Efficacy Scale, and the FCN Counseling Workshop Satisfaction Survey. The Problem Severity Scale and Center for Epidemiologic Studies Depression Scale were used in the case studies. RESULTS: Significant post-training increases in FCN counseling comfort and perceived counseling efficacy were obtained. Case study findings provided evidence of substantial improvement in caregiving problems and reductions in depression. CONCLUSIONS: Preliminary outcomes of FCN training and CBSC for dementia CGs were promising. However, replication across the sample is required to evaluate the overall effectiveness of CBSC for reducing CG depression. Specific competencies and ethical considerations in supervising this form of intervention are also addressed.