| Objectives1.To investigate the current status and influencing factors of informal caregiver care burden in heart failure patients based on social-ecological system theory;to construct an informal caregiver skills intervention program for heart failure based on the caregiver skills program model and based on the findings combined with literature review and recommendations of cardiovascular medicine medical staff.2.To explore the effects of the informal caregiver skills caregiving intervention program for heart failure on caregiving burden,informal caregiver caregiving skills,self-efficacy,family resilience,and social support of informal caregivers with heart failure,and to provide a reference basis for clinical health care professionals to improve the caregiving ability of heart failure caregivers and reduce their caregiving burden.Methods1.Cross section research stage.From October 2021 to May 2022,convenience sampling method was used to investigate heart failure patients and their informal caregivers who met the inclusion and exclusion criteria in the cardiovascular department of three tertiary hospitals(East West District of Yangzhou University Affiliated Hospital and Subei People Hospital)in Yangzhou.Using the self-designed questionnaire for general information of patients and informal caregivers,the Minnesota Heart Failure Quality of Life Questionnaire(MLHFQ),the Chronic Heart Failure Self Care Index(SCHFI),the Caregiver Burden Scale(CZBI),the General Self Efficacy Energy Scale(GSES),the Caregiver Care Ability Scale(FCTI),and the Simplified Chinese version of the Family Resilience Scale(FRAS-C)Conduct a survey using the Social Support Rating Scale(SRSS).After collecting the questionnaire,Epidata was used to input and organize the questionnaire data.Then,SPSS 27.0 was used for statistical analysis using descriptive analysis,one-way ANOVA,correlation analysis,multiple linear regression analysis,and other statistical methods.P<0.05 indicates a statistically significant difference.2.Pre experimental research stage.Based on the research results of the first part,combined with literature research and expert opinions,construct a care skills intervention plan.Select hospitalized patients with heart failure and informal caregivers who meet the inclusion and exclusion criteria for a preliminary experiment,and optimize the intervention plan based on the results of the preliminary experiment.3.Intervention trial stage.From June 2022 to October 2022,103 pairs of heart failure patients and caregivers who were hospitalized in the Cardiovascular Department of Yangzhou University Affiliated Hospital East and West were selected using convenience sampling method for intervention research.The study was divided into groups based on hospitals,with Yangzhou University Affiliated Hospital numbered 1 in the west and 2 in the east.They were randomly divided into an intervention group and a control group by drawing lots.51 patients in the intervention group received routine health education in the hospital,followed the skill intervention plan for heart failure caregivers,while 52 patients in the control group received routine health education in the hospital.Compare the care burden,care ability,self-efficacy,family resilience,and social support scores of the two groups of informal caregivers before and after the intervention.Statistical analysis was conducted using chi square test,two independent sample t-test,and repeated measurement analysis of variance.Results1.Cross section research stage.In this stage of the study,a total of 230 questionnaires were distributed,10 invalid questionnaires were excluded,and 220 valid questionnaires were collected,with an effective recovery rate of 95,8%.The total score range of care burden for 220 informal caregivers with heart failure is 17 to 40 points,with a mean of(27.9±5.29)points,including personal burden(16.63±2.92)points and responsibility burden(6.53±3.65)points.The results of multiple linear regression analysis show that self-care maintenance of heart failure patients,quality of life level of heart failure patients,informal caregiver family communication and problem-solving are factors that affect the total score of caregiver care burden.2.Implementation stage of intervention plan.In this stage of the study,a total of 96 pairs of heart failure patients and informal caregivers were included,with 48 pairs in the intervention group and 48 pairs in the control group.Seven pairs of samples were lost,including 3 pairs in the intervention group and 4 pairs in the control group.There was no statistically significant difference in baseline data between patients with heart failure and informal caregivers before intervention(P>0.05).The problem of caregiver burden is common in both groups,with varying degrees of improvement in scores such as caregiver burden level,caregiver self-efficacy level,care ability,family resilience,and social support after intervention.Among them,the intervention group performed better in most aspects.Result of informal caregiver care burden score:The total score of informal caregiver care burden in the intervention group before intervention was(27.54 ± 4.98)points,while the total score in the control group was(27.56 ± 5.19)points.The total scores of care burden for informal caregivers in the intervention group and control group on the day of intervention were(28.06±3.99)and(28.94±4.45),respectively,with no statistically significant difference(P>0.05);One month after intervention,the scores of care burden in the intervention group and the control group were(24.38±3.83)and(28.31±4.59)respectively,with statistically significant differences(P<0.05);The results of repeated measurement analysis of variance showed that both intra group and interaction effects were statistically significant(P<0.05).By comparing at different time points,the total score of care burden for informal caregivers in the intervention group showed statistical significance compared to baseline on the day after intervention and one month after intervention(P<0.05).Result of informal caregiver care ability score:The total score of informal caregiver care ability in the intervention group before intervention was(18.23±3.88)points,while the total score in the control group was(18.38±3.28)points.The total scores of care ability in the intervention group and control group on the day after intervention were(5.13 ±1.68)and(10.08 ±1.90),respectively.The total scores of care ability one month after intervention were(7.29±1.29)and(13.23 ± 1.17),with statistical significance(P<0.05);In addition,there was a statistically significant difference in scores between the two groups of caregivers in the three dimensions of "response and assistance","handling personal emotional needs",and"evaluating family and community resources" on the day of intervention and one month after intervention(P<0.05);The scores for the three dimensions of the intervention group on the day of intervention were(1.13±0.84)points,(0.90±0.69)points,and(0.50±0.65)points,respectively.At one month after intervention,the scores for the three dimensions were(1.56±0.71)points,(1.94±0.60)points,and(1.48±0.85)points,respectively;The scores of the three dimensions in the control group on the day of intervention were(2.13±0.73)points,(2.35±0.53)points,and(1.88±0.94)points,respectively.At one month after intervention,the scores of the three dimensions were(3.13±0.53)points,(4.27 ± 0.57)points,and(3.46±0.62)points,respectively.Repeated measurement analysis of variance showed statistically significant differences in scores between the intervention group and the control group in terms of inter group,intra group,and interaction effects(P<0.05).The research results showed that there was no statistically significant difference in the scores of the "adaptive caregiver role" dimension between informal caregivers in the intervention group on the day after intervention and one month after intervention.The scores of other dimensions,including total scores,were compared at different time points and showed statistical differences(P<0.05).Self efficacy score results:The self-efficacy score of informal caregivers in the intervention group before intervention was(28.19±3.92)points,while the control group was(27.17±3.96)points;On the day after intervention,the scores of the two groups of informal caregivers were(32.25± 2.38)and(28.08±3.11),respectively,with statistically significant differences(P<0.05);The results of repeated measurement analysis of variance showed that both intra group and interaction effects were statistically significant(P<0.05).The scores of the two groups of informal caregivers on the day of intervention compared to baseline,and the scores on the day of intervention compared to one month after intervention were statistically significant(P<0.05).Result of family resilience score:The total score of family resilience of informal caregivers in the intervention group before intervention was(96.69 ± 6.91)points,while the total score of the control group was(96.71 ±6.54)points;One month after intervention,there was a statistically significant difference in the two groups of caregivers’ scores in the dimensions of"utilizing social resources" and "maintaining a positive attitude",as well as the total score(P<0.05).The intervention group scored(9.40±1.43)points and(19.9±2.02)points in both dimensions,while the control group scored(8.88 ± 1.12)points and(18.83 ± 1.23)points,respectively.The results of repeated measurement analysis of variance showed statistically significant intra group and interaction effects(P<0.05).Comparing the scores of informal caregivers in the intervention group at different time points in various dimensions,it was found that the dimensions of "utilizing social resources","maintaining a positive attitude",and the total score were statistically significant at different time points(P<0.05).Social support:The total score of social support for informal caregivers in the intervention group before intervention was(29.17± 5.00)points,while the total score for the control group was(27.15 ± 5.63)points.On the day after intervention,the scores of each dimension in the intervention group and control group were:subjective support(11.00±1.71)points and(9.79 ± 1.50)points,respectively;Objective support scores(12.56 ± 2.30)and(11.19±3.16);Support utilization(9.17±1.67)points,(8.19±1.79)points;The scores of each dimension in the intervention group and control group after one month of intervention completion were:subjective support(11.52±1.32)points and(9.35 ± 1.59)points,respectively;Objective support scores of(13.13±2.31)and(11.19 ± 3.16);Support utilization(10.02 ± 1.45)points and(8.13±1.89)points.The results of repeated measurement analysis of variance showed statistically significant inter group,intra group,and interaction effects(P<0.05).There was a statistically significant difference in social support scores between the two groups of informal caregivers on the day after intervention and one month after intervention(P<0.05);Pairwise comparison at different time points showed that the scores of informal caregivers in the intervention group on the day after intervention and one month after intervention were statistically significant compared to baseline,and the scores on the day after intervention and one month after intervention were statistically significant(P<0.05).Conclusions1.The total graphical level of caregiving burden for informal caregivers of heart failure in Yangzhou area was at a mild burden.Patient self-care ability,quality of life,monthly per capita household income,caregiver gender,relationship with the patient,monthly per capita household income,and communication and problem-solving dimensions were all influential factors of caregiver burden.2.Caregiver skills intervention programs for patients with heart failure can reduce caregiver burden improve caregiver capacity,self-efficacy,family resilience,and social support. |
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