| Objective:This study investigated the current situation of benefit finding and family resilience,caregiver needs,and caregiver readiness among family caregivers of stroke patients in three tertiary-level general hospitals in Shandong Province,using positive psychology as the research perspective and cognitive adaptation theory,and analyzed the interrelationships among the variables,and investigated the pathways of family resilience,caregiver needs,and caregiver readiness on benefit finding,with the aim of informing the development of targeted benefit finding interventions for family caregivers of stroke patients.Methods:This study used convenient sampling method to select 340 family caregivers of stroke patients who met the inclusion and exclusion criteria in three tertiary-level general hospitals in Jinan from February to September 2022 as research objects.Family caregivers of stroke patients were investigated using the General Information Questionnaire,the Chinese simplified version of the Family Resilience Rating Scale,the Caregiver Needs Scale,the Chinese version of the Caregiver Readiness Scale and the Caregiver Benefit Finding Scale.Data were entered in pairs using Excel spreadsheets and analysed using SPSS 26.0 software with mean ± standard deviation,t-test,one-way ANOVA,multiple linear stepwise regression analysis and Pearson’s correlation analysis,where Model 6 in the SPSS macro program PROCESS version 4.0 was used to test for chain mediated model effects.Results:1.The total benefit finding score for family caregivers of stroke patients was(100.13±13.32),with a score range of 26 to 130 and a mean entry score of(3.85±0.51).The mean entry scores for each dimension were,in descending order,family growth,selfimprovement,personal growth and health promotion.The total family resilience score for family caregivers of stroke patients was(96.36±11.14),with a range of 32 to 128 and a mean entry score of(3.01±0.35);the highest to lowest scores for each dimension of the family resilience scale were family communication and problem solving,holding positive views and using social resources;The total score for the Family Communication and Problem Solving dimension was(69.51±8.24),with a range of 23 to 92 and a mean score of(3.02±0.36);the total score for the Positive Perceptions dimension was(17.93±2.56),with a range of 6 to 24 and a mean score of(2.99±0.43);the score for the Utilization of Social Resources dimension ranged from 3 to 12,with a total score of(8.92±1.09)and a mean score of(2.97±0.09).The average entry score was(2.97±0.36).The total caregiver needs score for family caregivers of stroke patients was(12.60±7.01),with a range of 0 to 24 and a mean entry score of(0.29±0.16);the caregiver needs assessment scale dimensions were,in descending order,caregiver-related information needs,medical service needs,human support needs and emotional needs;the total caregiver-related information needs dimension score was(6.78±4.82),with a range of 0 to 9 and a mean entry score of(0.23±0.17).The total score for the caregiver-related information needs dimension was(6.78±4.82),with a range of 0 to 9 and a mean score of(0.23±0.17);the total score for the health care needs dimension was(2.72±1.59),with a range of 0 to 7 and a mean score of(0.39±0.23);the total score for the human support needs dimension was(1.60±1.60),with a range of 0 to 6 and a mean score of(0.27±0.27).The total score for the emotional needs dimension was(1.51±0.82),with a range of 0 to 2 and a mean entry score of(0.75±0.41).Family caregivers of stroke patients had a total score of(10.78±3.21)on the caregiver readiness dimension,with a score range of 0 to 32 and a mean entry score of(1.35±0.40).2.In the general information questionnaire,disease stage of stroke patients,carer’s education level,hours of daily care,monthly household income,mode of medical payment,carer’s perceived health status,experience with similar care,and whether carers were employed were influential factors found to be beneficial for family carers of stroke patients(P<0.05).3.Family resilience of family caregivers of stroke patients was negatively correlated with the caregiver needs score(r= –0.299,P<0.01),positively correlated with the caregiver readiness score(r= 0.454,P<0.01),and positively correlated with the total benefit finding score and its dimensions(r= 0.689,0.576,0.620,0.623,0.499,all P<0.01);the caregiver needs score was negatively correlated with the caregiver readiness score(r= –0.278,P<0.01)and significantly negatively correlated with the total benefit finding score and its dimensions(r= –0.375,–0.300,–0.345,–0.330,–0.297,all P<0.01);the caregiver readiness score was significantly positively correlated with the total benefit finding score and its dimensions.dimension scores(r= 0.492,0.454,0.411,0.439,0.350,all P<0.01).Multiple linear stepwise regression analyses were conducted with benefit finding as the dependent variable and statistically significant variables from the univariate analysis(disease stage of stroke patients,carer’s literacy,hours of daily care,monthly household income,mode of medical payment,carer’s self-perceived health status,experience with similar care,and whether carer was employed),household elasticity,carer’s needs and carer readiness as independent variables.The results of this study showed that family resilience,caregiver readiness,patient stage of illness,experience as a caregiver,hours of daily care,monthly household income,and caregiver needs,together explained 59.1% of the total variance found for the benefit.The variance inflation factors(VIFs)for the independent variables were all>1 and<10,and there were no issues of multicollinearity.Regression equation established:benefit finding for family carers of stroke patients = 26.288+0.622 family elasticity+0.754 carer readiness+2.703 patient stage of illness–3.590 experience of similar care+1.340 hours of care per day+1.483 monthly family income–0.218 Caregiver needs.The variance showed this regression to be statistically significant(F=71.021,P<0.001).4.A mediating effects analysis was conducted using Model 4 in PROCESS version 4.0,with family elasticity as the independent variable,caregiver need and caregiver preparation as the mediating factors,and benefit finding as the dependent variable,while controlling for demographic data.The results showed that the coefficients of family resilience to caregiver demand(path a)and caregiver demand to benefit finding(path b)in the indirect path were respectively –0.188(95% CI: –0.253,–0.124;P<0.001)and –0.353(95% CI: –0.503,–0.203;P<0.001),and the indirect effect(path a × path b)was 0.066,with a 95% confidence interval of(0.028,0.122),excluding 0,indicating that the mediating role of caregiver demand between family resilience and benefit finding holds;the coefficients of family resilience on caregiver readiness(path a)and caregiver readiness on benefit discovery(path b)in the indirect path were 0.131(95% CI: 0.104,0.159;P<0.001),0.937(95% CI: 0.590,1.284;P<0.001),and the indirect effect(path a × path b)was 0.123 with a 95% confidence interval of(0.058,0.198),which did not contain 0,indicating that the mediating role of caregiver readiness between family resilience and benefit finding mediating role holds.5.A mediating effects analysis was conducted using Model 6 in PROCESS version 4.0,with family elasticity as the independent variable,caregiver need and caregiver readiness as mediating variables,and benefit finding as the dependent variable,while controlling for demographic data.The results showed that the coefficients for family resilience to caregiver need(path a),caregiver need to caregiver readiness(path b),family resilience to caregiver readiness(path f),caregiver readiness to benefit finding(path c),and caregiver need to benefit finding(path e)in the indirect path were respectively –0.188(95%CI: –0.253,–0.124;P<0.001),–0.072(95%CI: –0.117,–0.026;P<0.001),0.118(95%CI: 0.089,0.146;P<0.001),0.822(95%CI: 0.477,1.167;P<0.001),–0.294(95%CI : –0.441,–0.146;P<0.001),an indirect effect(path a × path b × path c)of 0.011,and a Bootstrap test 95% confidence interval of(0.003,0.024)excluding 0,indicating that the chain mediating role of caregiver need,caregiver readiness in family elasticity and benefit finding holds.The indirect effect(path a × path e)was 0.055 with a Bootstrap test 95% confidence interval of(0.019,0.111),excluding 0,indicating that the mediating role of caregiver need holds.The indirect effect(path f × path c)was 0.097,with a Bootstrap test 95% confidence interval of(0.039,0.168),excluding 0,indicating that the mediating role of caregiver readiness holds.Conclusions:1.Family caregivers of stroke patients had a moderate level of benefit finding,with the lowest score for the health promotion dimension;family resilience of family caregivers of stroke patients was at a moderate level,with the lowest score for the use of social resources dimension;family caregivers of stroke patients had fewer needs,with higher scores for carerelated information needs;and family caregiver readiness of stroke patients was at a moderate to low level.Multiple linear stepwise regression analysis showed that patient’s disease stage,caregiver’s daily caregiving hours,monthly household income,caregiver experience,family resilience,caregiver readiness,and caregiver needs were important influences on the finding of benefits for family caregivers of stroke patients.2.Family resilience of family caregivers of stroke patients was positively associated with caregiver readiness,caregiver readiness with benefit finding,and family resilience with benefit finding;family resilience was negatively associated with caregiver needs,caregiver needs with caregiver readiness,and caregiver needs with benefit finding.3.Family resilience and caregiver readiness of family caregivers of stroke patients were positive predictors of benefit finding,and caregiver needs were negative predictors of benefit finding.It is suggested that clinical caregivers could enhance benefit finding by increasing family resilience,meeting caregiver needs,and improving caregiver readiness among family caregivers of stroke patients.4.There were multiple mediating effects of caregiver needs and caregiver readiness between the family resilience of family caregivers of stroke patients and benefit finding.Family resilience can influence benefit finding either through the separate mediating role of caregiver needs or caregiver readiness,or through the chain mediating role of caregiver needs and caregiver readiness. |
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