Dyadic communication between family caregivers and persons living with dementia
Creators: name: Kim, Sohyun
Publisher: name: University of Iowa
Year: 2023
Subjects: public abstract

description: Background: Understanding dyadic communication in dementia care is essential to improve social interaction, quality care, and health outcomes of family caregivers and persons living with dementia. This dissertation includes three studies to understand dyadic communication between family caregivers and persons living with dementia.Objective: The characteristics and psychometric properties of instruments that assess dyadic communication and environment between caregivers and persons living with dementia were described (Chapter 2). Study 1 described the development of the Dyadic Communication Observational coding scheme in DEmentia care (DCODE). Study 2 examined the relationships between communication patterns and characteristics of caregivers and care recipients.
description: Methods: A systematic review was conducted by searching literature published until June 30th, 2021 (Chapter 2). Ten psychometric properties and the ratio of sample size to the number of items were evaluated. In Study 1, the DCODE was developed and refined based on literature review, expert review, and pretesting. Psychometric properties were tested using 75 video-recorded home care observations from 19 caregiver-care recipient dyads. In Study 2, communication patterns were described with the relative frequency and relative duration and compared between groups using Ranked ANCOVA and linear mixed modeling.
description: Results: A total of 3,708 scholarly records were identified and 24 eligible instruments from 48 scholarly records were evaluated. Twenty-two instruments assessed dyadic communication and two assessed dyadic communication and environment. All instruments were scored as low psychometric quality (score range = 0 - 7). Behavioral Observation Scoring System was scored the highest (Chapter 2). The DCODE was finalized with 50 items for caregivers and 45 items for care recipients. The DCODE demonstrated adequate internal consistency (Cronbach’s α = .733), moderate item-total correlation between caregiver and care recipient codes (rs, range = .413 to .505), and adequate intra-rater reliability (Cohen’s Kappa = .83, percentage of agreement = 83.88%) and inter-rater reliability (Cohen’s Kappa = .81, percentage of agreement = 81.75%). Content validity was adequate (Item-level Content Validity Index [I-CVI] = .93, Scale-level Content Validity Index/Universal agreement [S-CVI/UA] = .71, Scale-level Content Validity Index/Average [S-CVI/Ave] = .93 with 6 experts). Convergent validity was moderate (rs range = .458 - .508). Predictive validity was moderate for caregiver disabling communication (95% CI = .036, 1.255, OR = .213) and care recipient challenging communication (95% CI = .733, 103.843, OR = 8.727) predicting caregiver burden (Study 1). In Study 2, caregivers exhibited facilitative verbal communication (n = 2,978, 35.8%) and care recipients exhibited engaging verbal communication (n = 3,561, 44.4%) most frequently. Caregivers of care recipients with shorter dementia diagnosis length exhibited more disabling communication (p = .011) and marginally less neutral communication (p = .059). Caregivers exhibited more disabling communication (p = .043) and care recipients exhibited less challenging communication (p = .014) when their gender was identical. Caregivers with less subjective burden exhibited less neutral communication (p = .051) and marginally less disabling communication (p = .051). Caregivers of female care recipients exhibited less neutral communication (p = .043). Care recipients with shorter dementia diagnosis length exhibited more neutral communication (p = .014) and marginally less engaging communication (p = .059).
description: Discussion and Implications: Literature synthesis suggested the need to develop and validate instruments to assess dyadic communication between family caregivers and persons living with dementia. The DCODE was established with preliminary psychometric evidence and further testing is needed for concurrent, divergent, and structural validity. Findings suggest communication patterns may be associated with individual and dyad characteristics and needs for support to promote meaningful communication at the earliest time after a dementia diagnosis. Further analysis is needed to identify mediating factors and causal relationships in dyadic communication.