Preparation of the Japanese Version of the Diabetes Caregiver Activity and Support Scale and Verification of Its Reliability and Validity.

PURPOSE: The purpose of the study was to adapt and psychometrically evaluate a Japanese language version of the Diabetes Caregiver Activity and Support Scale (D-CASS-J) to be culturally relevant for people with diabetes living in Japan. METHODS: A Japanese translation of the original version of the D-CASS was prepared, corrected, and back-translated. Family caregivers of patients with diabetes mellitus ages ≥65 years who visited the outpatient diabetes clinic of Ise Red Cross Hospital were included. Cronbach's α coefficients were calculated as an assessment of internal consistency. Exploratory factor analyses were performed to verify construct validity. Hierarchical multiple regression analyses were performed using depression as the dependent variable and D-CASS-J and other variables as explanatory variables. Pearson's correlation coefficients between D-CASS-J scores and the support burden scale scores were calculated to verify criterion-related validity. RESULTS: This analysis included 268 subjects. Cronbach's α coefficient was .86. Factor analyses showed the same single-factor structure as the original version of the D-CASS. Hierarchical multiple regression analyses based on the conceptual model demonstrated construct validity. D-CASS-J scores were significantly correlated with support burden scale scores. CONCLUSIONS: For family caregivers of elderly patients with diabetes in Japan, D-CASS-J can be used as a tool to evaluate difficulties experienced while providing support to patients.

Effects of Dignity Therapy on Family Members: A Systematic Review.

Dignity therapy (DT) provides, for patients with a serious illness, a guided sharable life review through a protocolized interview and the creation of a legacy document. Evidence is mounting in support of the use of DT for patients with a serious illness; however, it is unclear whether DT has effects on family members. The purpose of this article was to provide a systematic literature review of the effects DT has on family members of patients who receive DT. Using a PubMed search with key terms of "Chochinov," "family," and "dignity care," a total of 18 articles published between January 2000 and July 2016 were identified and included in this review. This systematic review was helpful in identifying the strength of the evidence and gaps in the literature focused on DT and expected or actual effects on the DT recipient or family members. Findings identify the need to conduct further research related to the feasibility, acceptability, and effects of DT for family members. Future research should focus on understanding whether and how family members may benefit from receiving the legacy document and whether the timing of family member involvement plays a role in the outcomes of DT.

Development and Psychometric Testing of the Diabetes Caregiver Activity and Support Scale.

Purpose The purpose of this study was to develop and psychometrically test the Diabetes Caregiver Activity and Support Scale (D-CASS), a measure of how difficult or easy caregiver activity and supportive behaviors are for family caregivers of persons with type 2 diabetes (T2DM). Methods Internal consistency reliability, test-retest reliability, criterion-related validity, and construct validity were examined in 101 family caregivers of persons with T2DM. Participants were recruited using study brochures distributed at a large hospital in the Midwest and at statewide American Indian Pow Wows. Additionally, study brochures were available via a link on Facebook. Data collection occurred by telephone, face-to-face, or through Facebook using measures with evidence of reliability and validity. Family caregivers were predominately female (82.2%), spouses (50.2%), and American Indian (17%), African American (24%), or white (55%). Data were analyzed using descriptive statistics and psychometric analyses. Results The psychometric analyses resulted in an 11-item D-CASS with evidence of internal consistency reliability (alpha = .82) and test-retest reliability. Evidence of construct validity was obtained using 3 hierarchical multiple regressions guided by a conceptual model. Factor analysis supported the unidimensionality of the D-CASS. Conclusion The 11-item D-CASS is a brief and easy to administer instrument that has evidence of reliability and validity in family caregivers of persons with T2DM.

Emotional and Behavioral Aspects of Diabetes in American Indians/Alaska Natives.

American Indians and Alaska Natives (AI/ANs) bear a disproportionate burden of diabetes and associated long-term complications. Behavioral interventions play a vital role in promoting diabetes medical and psychological outcomes, yet the development of interventions for AI/AN communities has been limited. A systematic review was conducted of studies focused on the psychosocial and behavioral aspects of diagnosed diabetes among AI/ANs. Ovid and PubMed databases and published reference lists were searched for articles published between 1987 and 2014 that related to the psychosocial and behavioral aspects of type 1 or type 2 diabetes in the AI/AN population. Twenty studies were identified that met the inclusion criteria. Nineteen studies were observational and one study was intervention based. Two of the studies used community-based participatory research methodology. Of the 20 studies, 2 discussed cultural influences associated with diabetes self-management and 10 identified the specific tribes that participated in the study. Tribal affiliations among the studies were broad with the number of AI/AN participants in each study ranging from 30 to 23,529 participants. Emotional and behavioral topics found in the literature were adherence ( n = 2), depression ( n = 9), physical activity ( n = 3), psychosocial barriers ( n = 1), social support ( n = 3), and stress ( n = 2). Relatively few studies were identified using AI/AN populations over a 27-year period. This is in stark contrast to what is known about the prevalence and burden that type 1 and type 2 diabetes mellitus place on AI/AN communities. Future research should promote community engagement through the use of community-based participatory research methodologies, seek to further understand and describe the emotional and behavioral context for diabetes self-management in this population, and develop and test innovative interventions to promote the best possible diabetes outcomes.

Comparing treatment fidelity between study arms of a randomized controlled clinical trial for stroke family caregivers.

OBJECTIVE: To compare treatment fidelity among treatment arms in the Telephone Assessment and Skill-Building Kit study for stroke caregivers (TASK II) with respect to: 1) protocol adherence; 2) intervention dosage and 3) nurse intervener perspectives. DESIGN: A randomized controlled clinical trial design. SETTING: Urban, community, midwestern United States. SUBJECTS: A total of 254 stroke caregivers (mean ±SD age, 54.4 ±11.8 years), 55 (22.0%) males and 199 (78.4%) females) randomized to the TASK II intervention (n=123) or an Information, Support, and Referral comparison group (n=131). INTERVENTIONS: TASK II participants received the TASK II Resource Guide; Information, Support, and Referral participants received a standard caregiver brochure. At approximately 8 weeks after discharge, both groups received 8 weekly calls from a nurse, with a booster call 4 weeks later. MEASURES: Protocol adherence was evaluated with the TASK II Checklist for Monitoring Adherence. Intervention dosage was measured by the number of minutes caregivers spent reading materials and talking with the nurse. Nurse intervener perspectives were obtained through focus groups. RESULTS: Protocol adherence was 80% for the TASK II and 92% for the Information, Support, and Referral. As expected, intervention dosage differed between TASK II and Information, Support, and Referral with respect to caregiver time spent reading materials (t=-6.49; P<.001) and talking with the nurse (t=-7.38; P<.001). Focus groups with nurses yielded further evidence for treatment fidelity and recommendations for future trials. CONCLUSIONS: These findings substantiate treatment fidelity in both study arms of the TASK II stroke caregiver intervention trial (NIH R01NR010388; ClinicalTrials.govNCT01275495).

Needs and Concerns of Family Caregivers of American Indians, African Americans, and Caucasians With Type 2 Diabetes.

Although type 2 diabetes is a chronic illness affecting the entire family, scant literature exists in this area. This study's purpose was to identify needs of family caregivers of persons with type 2 diabetes across cultures. Using a semi-structured interview guide with open-ended questions, a convenience sample of 33 family caregivers of American Indians (n = 14), African Americans (n = 11), and Caucasians (n = 8) with type 2 diabetes were interviewed by telephone. Qualitative content analysis was conducted based on five pre-determined categories derived from an existing conceptual model. Results were similar across groups and provided support for the conceptual model with themes emerging within the five pre-determined categories: (a) information about type 2 diabetes, (b) managing emotions and behaviors, (c) physical care, (d) instrumental care, and (e) personal responses to caregiving. No additional themes emerged. Although small and exploratory, findings provide information that may be useful to the future development of culturally based interventions.

Needs and Concerns of Family Caregivers of Persons With Type 2 Diabetes: An Integrated Review of Cross-cultural Literature With Implications for the American Indian Population.

PURPOSE: The purposes of this review were to identify the needs and concerns of family caregivers of persons with type 2 diabetes and to develop recommendations for future research on family caregivers of American Indians with type 2 diabetes. Searching the Cumulative Index to Nursing and Allied Health, Ovid, and PubMed, an extensive literature review was conducted using 10 search terms for articles published from 1990 to 2013. References of retrieved studies were also searched. CONCLUSIONS: On the basis of the search criteria, 6 studies exploring the needs and concerns of family caregivers of persons with type 2 diabetes were identified. Findings were placed in 5 predetermined categories derived from Bakas et al's needs and concerns framework: (1) finding information and resources related to type 2 diabetes, (2) dealing with the emotions and behaviors of the care recipient, (3) providing physical care, (4) providing instrumental care, and (5) dealing with one's own personal responses to caregiving. The cross-cultural literature helped identify common ground and specific literature about the experiences of American Indian caregivers. Further research is needed on the needs of caregivers of persons with type 2 diabetes, particularly those in the Native American and other minority populations. Findings can be used to develop interventions to improve outcomes for these caregivers.