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Title: Bibliotherapy for improving caregiving appraisal of informal caregivers of people with dementia: a pilot randomized controlled trial
Authors: Wang, Shanshan
Degree: Ph.D.
Issue Date: 2020
Abstract: Background: Informal caregivers are the backbone of dementia care. Cultivating caregiving appraisal is needed because it influences the caregivers' health. The caregiving appraisal of informal caregivers of people with dementia in China was found to be unsatisfactory. However, there is a lack of interventional studies. With the lack of professional support for informal caregivers, self-help interventions have shown advantages. Bibliotherapy, a self-help intervention requiring minimal professional support, has the potential to improve caregiving appraisal. However, it has not been used in Chinese informal caregivers. The feasibility and efficacy among dementia caregivers have also not been explored. Objectives: To develop an evidence-based bibliotherapy protocol and explore the feasibility and efficacy of bibliotherapy on improving caregiving appraisal among informal caregivers of people with dementia. Design: A two-arm pilot randomized controlled trial. Methods: Sixty informal caregivers were randomized to either the intervention group, receiving eight weekly bibliotherapy sessions at home without withdrawing from usual care; or the control group, receiving usual care from the community health centers. Caregiving appraisal, coping, psychological well-being, knowledge of dementia, and attitude toward dementia were assessed both at baseline and immediately after the intervention. Assessors were blinded to group allocation. Individual interviews among intervention group participants were conducted to explore their acceptance of the intervention. Descriptive statistics, Chi-square test, Mann Whitney U test, independent t-test, generalized estimating equation, and content analysis were used for data analysis.
Results: The feasibility of bibliotherapy was confirmed by the acceptable recruitment rate (69.8%), the high response rate of measurement tools (83.3%), and the high retention rate (83.3%). Four themes were identified from the individual interviews after the intervention, which have confirmed the acceptability of the intervention. No adverse event was found. Compared to the control group, caregivers in the intervention group had more significant improvements on caregiving appraisal (Wald X2=16.51, p<.001), coping (Wald X2=8.91, p=.003), knowledge of dementia (Wald X2=5.71, p=.017), and attitude toward dementia (Wald X2=41.39, p<.001) across time. However, the group- by-time interaction effect on the passive coping subscale was not significant (Wald X2=2.85, p=.091), and the effect on psychological well-being was only significant on the personal growth subscale (Wald X2=5.04, p= .025). The effect sizes on improving caregiving appraisal (d=0.49-0.80), coping (d=0.52-1.09), knowledge of dementia (d=0.63), and attitude toward dementia (d=0.65-1.15) were moderate to high; while the effect sizes on improving psychological well-being were low (d=0.05-0.40). Conclusions: The feasibility and acceptability of bibliotherapy were supported by the findings. Bibliotherapy had significant effects on improving caregiving appraisal, active coping, knowledge of dementia, and attitude toward dementia in this preliminary investigation. The effects on passive coping and psychological well-being were still limited. Randomized controlled trials with larger sample sizes and long-term follow-ups are encouraged in the future. Contributions to the body of knowledge: This study contributed to the body of knowledge in three aspects: updated the current theoretical models of caregiving appraisal with new findings from empirical studies, developed a culturally specific bibliotherapy protocol, and tested the novel intervention among informal caregivers of people with dementia.
Subjects: Caregivers
Dementia -- Patients -- Care
Hong Kong Polytechnic University -- Dissertations
Pages: xxi, 335 pages
Appears in Collections:Thesis

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