Analysis Of Caring Ability And Influencing Factors Of Family Caregivers Of Patients With Dysphagia

ObjectiveDysphagia refers to the process that food cannot be safely transported to the stomach,the function of organs such as mandible,double lips,tongue,soft palate,throat and esophagus are damaged.Dysphagia not only impairs the swallowing-feeding function of patients,but can cause aspiration,poor nutrition,psychological problems,social disorders,and even death.Influenced by medical conditions and humanistic attitudes,most patients with dysphagia return home for rehabilitation after a short period of in-hospital treatment.Family caregivers become the primary caregivers,the standerd of care is connected with food safety,living quality,rehabilitation quality.There is no standardized measurement tools for assessing caregiver competence for patients with swallowing disorders.To understand the care status of dysphagia patients who are about to return to family,ensure the safety of patients’ eating after discharge,and reduce complications.This study constructed caregiver competence questionnaire for patients with dysphagia,reliability and validity were tested.Caregivers of patients with dysphagia were investigated,to study the status quo and factors of caring ability.MethodsIn order to evaluate the family care status of patients with dysphagia.Firstly,caregiver competence questionnaire for the patients with dysphagia was constructed.Secondly,conduct a survey,analyze the status of care ability,and explore the influencing factors of care ability.Part Ⅰ methods: According to literature analysis,the dimensions and item pool of the questionnaire were formed under the framework of Farran’s "Model of Caregiver Skill Building/Effectiveness" through literature research,group discussions,brainstorming,and face-to-face communication with experts and caregivers.Two rounds of expert correspondence were completed on the initially formed questionnaire using Delphi method.Analyze expert opinions,calculate expert scores,and the questionnaire on the care ability of caregivers of patients with dysphagia was initially constructed.Between October and December 2019,using convenience sampling,a total of 209 caregivers of patients with dysphagia were investigated,the patients were from two grade A hospitals and a grade B hospital in Wuhan.The obtained data were subjected to item analysis,reliability and validity analysis,etc.The discrete trend method,item distribution method,discrimination analysis,correlation coefficient,Cronbach’s a coefficient method and stepwise regression analysis method were mainly used for item analysis as evaluation indicators.Factor analysis,correlation analysis and content validity index were mainly used for validity analysis.Cronbach’s a coefficient,half-coefficient,test-retest reliability were mainly for reliability analysis as evaluation indicators.Finally,the dimensions and items of the questionnaire were established,and the care ability questionnaire for caregivers of patients with dysphagia was constructed.Part Ⅱ methods: using convenience sampling method,173 dysphagia patients and their family caregivers who were about to be discharged from two grade A hospitals and one grade B hospital in wuhan from december 2019 to september 2020 were investigated using the questionnaire of dysphagia patients’ caregiver care ability.SPSS19.0 software package was used,the mean and standard deviation were applied to analysis the ability to care.Univariate analysis,Pearson correlation analysis,multiple stepwise regression analysis were applied to study the factors affecting caregiving ability.ResultsPart Ⅰ Results: After literature analysis,brainstorming,panel discussion,face-to-face communication with experts and caregivers,a total of 44 items with four dimensions were formed.Two rounds of expert consultation were conducted using the Delphi method.The expert authority coefficient was 0.945,and the expert opinion coordination coefficient was0.283 and 0.206,respectively,forming a test questionnaire with four dimensions and 39 items.A clinical survey of 209 caregivers of patients with dysphagia was conducted,after item analysis,some substandard entries were deleted.Reliability and validity were tested.After four exploratory factor analyses,4 dimensions and 34 items were retained.The correlation coefficient between dimensions were 0.605～0.812,the correlation coefficient between dimensions and questionnaire were 0.768～0.959.The I-CVI ranged from 0.857 to1,S-CVI/UA was 0.824,S-CVI/Ave was 0.975.The total Cronbach’s a coefficient was0.957,the Cronbach’s a coefficient of dimensions were 0.755～0.922.The total half-coefficient was 0.960,the half-coefficient of dimensions were 0.739～0.948.The total retest reliability was 0.886,the retest reliability of dimensions were 0.711～0.828.The finalized questionnaire for the care ability of caregivers of patients with dysphagia had a total of 4-dimensional and 34 items,specifically: the dimension of knowledge related to dysphagia included 7 items,the dimension of daily care skills included 17 items,the dimension of resource utilization included 5 items,and the dimension of self-management included 5 items.Part Ⅱ Results: A clinical survey of 173 family caregivers of patients with dysphagia was conducted,The total score of caring ability was(90.82±12.31),the score rate was60.55%,the daily care skill dimension was as high as 68.03% and that in the knowledge dimension related to dysphagia was as low as 49.25%.Multivariate stepwise regression analysis showed that educational level of caregivers,relevant training or not,self-efficacy,total care time,subjective support,caregiver’s work condition,caregiver’s financial burden,utilization of support were the major effective factors of caregiving ability.ConclusionsIn this study,based on the "Model of Caregiver Skill Building/Effectiveness" of Farran,a caregiver care ability questionnaire for dysphagia patients was developed,which included 4 dimensions and 34 items of dysphagia-related knowledge,daily care skills,resource utilization,self-management.The reliability and validity were tested well.The research showed that the care ability of family caregivers of patients with dysphagia needed to be further improved.Eight independent variables,including the caregiver’s cultural gradation,received relevant training,self-efficacy,total care time,subjective support,the caregiver’s work status,the caregiver’s financial burden,and the utilization of support,were important factors affecting the care ability.Medical staff could refer to the above eight factors to formulate personalized guidance plan.