Model Predicting Positive Aspects of Caregiving Among Family Cares of Persons With Dementia: A Longitudinal Cohort Study.
Objective: Positive aspects of caregiving among family carers of persons living with dementia not only benefit the carers' health, but also enhance the quality and sustainability of invaluable informal care resources. To better inform the development of carer support intervention to optimise positive aspects of caregiving, this paper tested the integrative theoretical model based on stress coping and meaning-making paradigms.
Methods: Longitudinal exploratory study. Methods: From January 2018 to August 2021, 390 Chinese family carers of persons living with dementia were recruited from the geriatric clinics in Hong Kong. The criterion variable was measured by the Positive Aspect of Caregiving Scale at baseline and 6 months thereafter. The predictors were measured using the Dementia Management Strategies Scale, the Caregiving Self-Efficacy Scale, the Meaning-Focused Coping Scale, the Medical Outcome Study Social Support Survey, the Duke University Religion Index, the Positive Affect Index and the Intrinsic Motivations to Care. Path analysis tested the hypothesised model.
Results: The carers aged 56.2 (SD = 12.2); about two-thirds being female and adult-child caregivers. The hypothesised model showed an unsatisfactory model fit. The model was optimised by modification index with consideration of the theoretical plausibility in making the changes (CFI = 0.971, RMSEA = 0.057, SRMR = 0.027). After adjusting the baseline PAC, the 6-month PAC was predicted by self-efficacy in controlling upsetting thoughts and obtaining respite as well as meaning-focused coping. Various contextual factors strengthened the self-efficacy and meaning-focused coping, indirectly increasing PAC. Whereas carers' intrinsic motivation towards care and good dyadic relationships increased the carer's self-efficacy in emotional regulation, social support and religiosity played indispensable roles to facilitate meaning-focused coping.
Conclusions: PAC in dementia context is evolved from an integration of stress coping and existential meaning-making paradigms. Enhancing emotion and role regulation as well as meaning-focused coping are crucial to enhance the positive experience of the family carers. This project has generated a theory-driven and evidence-based predictive model to explain the manifestation of positive aspects of caregiving in dementia caregiving. The findings provide precise directions on how to empower family caregivers to create a fulfilling and meaningful caregiving adventure. Conclusions: Substantial evidence indicates the role of positive aspects of caregiving in enhancing the carers' health outcomes in the context of dementia. However, inadequate theorization of this phenomenon delimits the momentum to develop proactive strategies to optimise such a positive caregiving experience. This longitudinal study indicated that positive aspects of caregiving are evolved from an integrative stress coping and existential meaning-making paradigm. More specifically, a sense of self-efficacy in emotional and role regulation as well as the use of meaning-making coping predict a higher level of positive aspects of caregiving. A context, which is characterised by high religiosity, good intrinsic motivation of care and a good dyadic relationship, also favours the cultivation of this positive experience during life adversity. This study facilitates a paradigm shift in supporting family carers in a dementia context and advances the theorization of positive human experience in facing life adversity. The reporting method complies with the STROBE, stands for observational study. Family carers of persons with dementia actively shared their experience in family caregiving.