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Journal of Public Health

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15-01-2022 | Care | Original Article

Does a one-week health program promote well-being among caregiving parents? A quasiexperimental intervention study in Germany

Authors: Christian Hetzel, Torsten Alles, Michael Holzer, Erich Koch, Ingo Froböse

Published in: Journal of Public Health | Issue 8/2023

Abstract

Background

Burden of care and negative health consequences are evident in informal caregiving. Intervention studies, if any, are largely limited to the field of adult or elderly care although there are specific needs for parents of chronically ill and disabled children, for example, lack of acceptance, special life course problems, and supply deficits.

Aim

The effect of a legally funded, one-week health program offered by the Social Insurance for Agriculture, Forestry, and Horticulture (SVLFG) on the well-being of the participating parents of children with a high level of care is determined. Secondary outcome measures are stress and behavior theory-based characteristics.

Subject and methods

In a controlled panel study (intervention group n = 23, comparison group n = 33, allocation not randomized) well-being (WHO-5 index) and other measures (subjective burden, acceptance of the care situation, institutional and social support, recreational and care-related behavior) were collected at several measurement points. Statistical methods are fixed effects panel regressions under control of time-varying characteristics (external conditions, period effects).

Results

At the start of the intervention, 70% of the intervention group (83% mothers, 73% at least 51 years old) are at the threshold of clinically relevant depressiveness. After a very clear initial effect, the level remains above the baseline level for up to 15 weeks after the intervention (under stable conditions). A sinking below the initial level is prevented until at least 26 weeks even with significantly increasing external conditions. The main drivers appear to be sustained increases in acceptance of the care situation, institutional support, and recreational behavior.

Conclusion

Given the high initial burden of the participants, the sustainability of the prevention-oriented intervention is considerable. Nevertheless low-threshold interventions such as telephone or online counselling could be useful after approximately 25 weeks. The intervention is unique for the social insurance system in Germany. The design allows a causal interpretation of the treatment effects despite the small number of cases. Further studies should particularly address effect heterogeneity.

The terms “informal care,” “family members providing care,” and “home care” are used synonymously here. This refers to persons who provide nursing, medical, and psychosocial care for a person recognized as being in need of care in the home environment and not on a gainful basis.

Frequency of sports/exercise, relaxation exercises, pursuing hobbies, spending free time with others.

Frequency of care provided by professionals (e.g., outpatient service, day care, short-term care), care provided by family, friends, or neighbors, and meetings, phone calls, or other contacts with other caregivers.

Has your child’s need for assistance increased, and if so, how significantly? Have the circumstances for care worsened and if so how significantly? Has something happened that has put a lot of emotional strain on you, and if so, how severe was it?

Such comparisons are bias-free only if there is randomized group assignment or, in the case of nonexperimental designs, only if certain conditions are met (e.g., Hausman test).

For reference, at the last measurement point, the 50% and 75% quantiles of ext. are 23 and 58 points, respectively. Figure 2 shows the coefficients b (filled/unfilled points for p < 0.05/p < 0.10) from the fixed effects panel regression (model 5 for different trajectories of the external conditions)

Due to the different centering of ext., only the main effects of the measurement time points change; all other model parameters are identical to model 5 in Table 2. The initial effect at the end of the intervention is identical for all manifestations of ext. because no change in the external conditions can be assumed for the one-week intervention period and these were therefore not surveyed. The values (b/s.e./p) for ext. = 25 (5 weeks: 7.58/4.65/0.105; 15 weeks: 9.44/3.99/0.019; 26 weeks: 4.98/3.98/0.213) and for ext. = 50 (5 weeks: 1.09/8.86/0.902; 15 weeks: 3.47/4.64/0.456, 26 weeks: 4.67/4.52/0.303).

Allison PD (2009) Fixed effects regression models. Sage, Thousand OaksCrossRef

Ausserhofer D, Mantovan F, Pirhofer R et al (2009) The burden of parents caring for their children and adolescents with severe disabilities in South Tyrol. Pflege 22:184–195. https://doi.org/10.1024/1012-5302.22.3.184CrossRefPubMed

Barre F, Epping J (2018) Changes in the use of health insurance services before and after a father-child measure. Gesundheitswesen 80:1048–1054. https://doi.org/10.1055/s-0043-104214CrossRefPubMed

Bech P, Olsen RL, Kjoller M et al (2003) Measuring well-being rather than the absence of distress symptoms: a comparison of the SF-36 mental health subscale and the WHO-five well-being scale. Int J Methods Psychiatr Res 12:85–91. https://doi.org/10.1002/mpr.145CrossRefPubMed

Bech P (2012) Subjective positive well-being. World Psychiatry 11:105–106. https://doi.org/10.1016/j.wpsyc.2012.05.021CrossRefPubMedPubMedCentral

Berglund E, Lytsy P, Westerling R (2015) Health and wellbeing in informal caregivers and non-caregivers: a comparative cross-sectional study of the Swedish general population. Health Qual Life Outcomes 13:109. https://doi.org/10.1186/s12955-015-0309-2CrossRefPubMedPubMedCentral

BMG (2020) Soziale Pflegeversicherung Leistungsempfänger nach Altersgruppen und Pflegegraden am 31.12.2019, https://www.bundesgesundheitsministerium.de/themen/pflege/pflegeversicherung-zahlen-und-fakten.html. Accessed 05 Jan 2021

Brähler E, Mühlan H, Albani C et al (2007) Testing and standardization of the German version of the EUROHIS-QOL and WHO-5 quality-of life-indices. Diagnostica 53:83–96. https://doi.org/10.1026/0012-1924.53.2.83CrossRef

Brehaut JC, Garner RE, Miller AR et al (2011) Changes over time in the health of caregivers of children with health problems: growth-curve findings from a 10-year Canadian population-based study. Am J Public Health 101(12):2308–2316. https://doi.org/10.2105/AJPH.2011.300298CrossRefPubMedPubMedCentral

Brüderl J, Ludwig V (2015) Fixed-effects panel regression. In: Best H, Wolf C, editors. The Sage handbook of regression analysis and causal inference. Sage, Los Angeles, pp 327–357

Calvo-Perxas L, Vilalta-Franch J, Litwin H et al (2018) What seems to matter in public policy and the health of informal caregivers? A cross-sectional study in 12 European countries. PLoS One 13(3):e0194232. https://doi.org/10.1371/journal.pone.0194232CrossRefPubMedPubMedCentral

Cantwell-Bartl AM, Tibballs J (2015) Psychosocial responses of parents to their infant’s diagnosis of hypoplastic left heart syndrome. Cardiol Young 25:1065–1073. https://doi.org/10.1017/S1047951114001590CrossRefPubMed

Clark MC, Diamond PM (2010) Depression in family caregivers of elders: a theoretical model of caregiver burden, sociotropy, and autonomy. Res Nurs Health 33:20–34. https://doi.org/10.1002/nur.20358CrossRefPubMed

Cousino MK, Hazen RA (2013) Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol 38:809–828. https://doi.org/10.1093/jpepsy/jst049CrossRefPubMed

Croissant Y, Millo G (2008) Panel data econometrics in R: the plm package. J Stat Software 27(1–51):10.18637/jss.v027.i02

de Bloom J, Geurts SAE, Kompier MAJ (2013) Vacation (after-) effects on employee health and well-being, and the role of vacation activities, experiences and sleep. J Happiness Stud 14:613–633. https://doi.org/10.1007/s10902-012-9345-3CrossRef

Dehn LB, Korn-Merker E, Pfäfflin M et al (2014) The impact on family scale: psychometric analysis of long and short forms in parents of children with epilepsy. Epilepsy Behav 32:21–26. https://doi.org/10.1016/j.yebeh.2013.12.030CrossRefPubMed

Dlugosch GE, Mücke M (2006) „Pflegen und sich pflegen lassen“ – Evaluation eines Seminarangebotes für pflegende Angehörige. In: Loidl-Keil R, Laskowski W, Evaluationen im Gesundheitswesen. München: Rainer Hampp, pp 279–329 [in German]

Harris EC, D’Angelo S, Syddall HE et al (2020) Relationships between informal caregiving, health and work in the health and employment after fifty study. England Eur J Public Health 30(4):799–806. https://doi.org/10.1093/eurpub/ckaa078CrossRefPubMed

Hetzel C, Alles T, Froböse I (2019) Berlin inventory of caregivers’ burden with dementia patients (BIZA-D-PV) – also for informal caregivers of non-dementia patients? Diagnostica 65:153–166. https://doi.org/10.1026/0012-1924/a000221CrossRef

Hetzel C, Alles T, Mozdzanowski M (2017) “Mach mal PAUSE vom Pflegealltag” – Konzept und Evaluation eines Interventionsprogramms zur Förderung von guter Pflege und Gesundheit bei pflegenden Angehörigen. Asgard, Siegburg [in German]

Hetzel C, Baumann R, Diekmann J, Froböse I (2018) Description of a multidimensional health program for informal caregivers. Gesundheitswesen 80(S02):S51–S56. https://doi.org/10.1055/s-0042-112814CrossRefPubMed

Hetzel C, Opfermann-Kersten M, Holzer M (2016) Informal caregivers’ subjective well-being after a training and recreation week: multilevel models for longitudinal data. Z Gesundheitspsychol 24:13–28. https://doi.org/10.1026/0943-8149/a000155CrossRef

Hetzel C (2020) Häusliche Pflege im grünen Sektor – Daten der Pflegestatistik. Soziale Sicherheit in der Landwirtschaft 2:23–28 [in German]

Judge TA, Piccolo RF, Podsakoff NP et al (2010) The relationship between pay and job satisfaction: a meta-analysis of the literature. J Vocat Behav 77:157–167. https://doi.org/10.1016/j.jvb.2010.04.002CrossRef

Kelly MP, Barker M (2016) Why is changing health-related behaviour so difficult? Public Health 136:109–116. https://doi.org/10.1016/j.puhe.2016.03.030CrossRefPubMed

Kingsnorth S, Lindsay S, Maxwell J et al (2021) Bridging pediatric and adult rehabilitation services for young adults with childhood-onset disabilities: evaluation of the LIFEspan model of transitional care. Front Pediatr 9:728640. https://doi.org/10.3389/fped.2021.728640

Lefranc A, Pérol D, Plantier M et al (2017) Assessment of informal caregiver's needs by self-administered instruments: a literature review. Eur J Pub Health 27(5):796–801. https://doi.org/10.1093/eurpub/ckx103CrossRef

Maguire R, Hanly P, Maguire P (2019) Beyond care burden: associations between positive psychological appraisals and well-being among informal caregivers in Europe. Qual Life Res 28:2135–2146. https://doi.org/10.1007/s11136-019-02122-yCrossRefPubMed

Mauz E, Lange M, Houben R et al (2019) Cohort profile: KiGGS cohort longitudinal study on the health of children, adolescents and young adults in Germany. Int J Epidemiol 49:375–375k. https://doi.org/10.1093/ije/dyz231CrossRefPubMedCentral

Michie S, Ashford S, Sniehotta F et al (2011) A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health 26:1479–1498. https://doi.org/10.1080/08870446.2010.540664CrossRefPubMed

Nehring I, Riedel C, Baghi L et al (2015) Psychosocial situation of families with chronically ill children: a survey of parent initiatives. Gesundheitswesen 77(2):102–107. https://doi.org/10.1055/s-0034-1372573CrossRefPubMed

Pearlin LI, Mullan JT, Semple SJ et al (1990) Caregiving and the stress process: an overview of concepts and their measures. Gerontologist 30:583–594. https://doi.org/10.1093/geront/30.5.583CrossRefPubMed

Prochaska JO, Velicer WF, Rossi JS et al (1994) Stages of change and decisional balance for 12 problem behaviors. Health Psychol 13(1):39–46. https://doi.org/10.1037//0278-6133.13.1.39CrossRefPubMed

Rothgang H, Müller R, Runte R, Unger R (2017) BARMER Pflegereport 2017. BARMER Gesundheitsanalyse, Berlin, Wuppertal

Rüttenauer T, Ludwig V (2020) Fixed effects individual slopes: accounting and testing for heterogeneous effects in panel data or other multilevel models. Sociol Methods Res. https://doi.org/10.1177/0049124120926211

Seliner B, Latal B, Spirig R (2016) 2016 when children with profound multiple disabilities are hospitalized: a cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care. J Spec Pediatr Nurs 21(147–157):10/10.1111/jspn.12150

Sörensen S, Duberstein P, Gill D et al (2006) Dementia care: mental health effects, intervention strategies, and clinical implications. Lancet Neurol 5:961–973. https://doi.org/10.1016/S1474-4422(06)70599-3CrossRefPubMed

Topp CW, Østergaard SD, Søndergaard S et al (2015) The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 84:167–176. https://doi.org/10.1159/000376585CrossRefPubMed

Verbakel E, Tamlagsrønning S, Winstone L et al (2017) Informal care in Europe: findings from the European social survey (2014) special module on the social determinants of health. Eur J public health 27(suppl_1):90–95. https://doi.org/10.1093/eurpub/ckw229

Verdam MGE, Oort FJ, Sprangers MAG (2016) Using structural equation modeling to detect response shifts and true change in discrete variables: an application to the items of the SF-36. Qual Life Res 25:1361–1383. https://doi.org/10.1007/s11136-015-1195-0CrossRefPubMed

Vonneilich N, Lüdecke D, Kofahl C (2016) The impact of care on family and health-related quality of life of parents with chronically ill and disabled children. Disabil Rehabil 38:761–767. https://doi.org/10.3109/09638288.2015.1060267CrossRefPubMed

Wooldridge J (2010) The econometrics of cross-section and panel data. MIT Press, Cambridge

Title: Does a one-week health program promote well-being among caregiving parents? A quasiexperimental intervention study in Germany
Authors: Christian Hetzel
Torsten Alles
Michael Holzer
Erich Koch
Ingo Froböse
Publication date: 15-01-2022
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Journal of Public Health / Issue 8/2023
Print ISSN: 2198-1833
Electronic ISSN: 1613-2238
DOI: https://doi.org/10.1007/s10389-021-01671-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does a one-week health program promote well-being among caregiving parents? A quasiexperimental intervention study in Germany

Abstract

Background

Aim

Subject and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Subject and methods

Results

Conclusion

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