Measuring and Improving the Self-Efficacy of Caregivers of People with Dementia and Related Disorders
Creators: name: Piggott, Cleveland
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2014

description: Alzheimer's disease and related dementias (ADRD) are growing public health problems as the population of the United States ages and we struggle to find ways to provide optimal care for people with dementia, and support for their informal caregivers. These nonprofessional caregivers often suffer from depression, neglect their own health, and feel overwhelmed as a direct result of caring for their relative with dementia. Interventions and resources are being developed with the goal of reducing the burden of disease suffered by caregivers and improving their caregiving skills. One of the goals of many of these interventions is to improve caregivers' self-efficacy. Self-efficacy is one's confidence in achieving a desired result or goal, and it is an important component to caregivers' ability to care for themselves and others. The purpose of this master's paper is to better understand how we can measure and improve self-efficacy in caregivers of people with dementia. As technology continues to become more assessable to individuals, videos are thought to be a promising method to help caregivers improve their self-efficacy. We performed a review of Pubmed and CINAHL databases covering January 1, 1989 to Feb 1, 2014 to better understand the effectiveness of videos in improving self-efficacy of caregivers of people with ADRD. We also did hand searches of three recent systematic reviews. Seven studies were identified, and their quality was assessed using the guidelines set forth by the Agency for Healthcare Research and Quality and the Effective Health Care Program. The seven studies showed a small benefit in using videos to improve caregiver self-efficacy, but the level of uncertainty was high due to the overall low quality of the studies and high potential for bias. Higher quality, large randomized control trials are needed to elucidate the potential benefits of using videos to improve caregiver self-efficacy. Additionally, our review of the literature revealed few studies assessing caregiver's confidence related to medical problems and events. Therefore, we created a self-efficacy measure called the Caregiver Confidence in Symptom Management to fill this gap in the literature. The measure was implemented and evaluated during the pilot test of the Alzheimer's Medical Advisor (AlzMed) project (R01 NR014199), and included expert panel input, cognitive interviews, and psychometric evaluation including test-retest reliability. The measure showed strong face validity, but test-retest reliability showed several individual items had weak reliability. As an aggregate, however, the measure performed well. The final measure contains 25 items that ask questions about caregiver's confidence in knowing enough, taking care of, and deciding what to do about five categories of medical events. It also asks questions about understanding what to do and enacting responsive behavior. The measure will be used, evaluated, and further refined in the larger AlzMed study, which will include a more diverse sample of caregivers.