School of Health, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland.
Haute Ecole de Santé Fribourg, Route des Cliniques 15, 1700, Fribourg, Switzerland.
BMC Geriatr. 2018 Sep 10;18(1):209. doi: 10.1186/s12877-018-0896-y.
Persons with dementia experience a progressive decline associated with an increasing dependency. Most of the support they require to stay at home comes from their informal caregivers (IC). Dementia informal caregiving imposes high costs on IC's health and quality of life, related to long periods of chronic stress. Based on evidence that more adequate coping strategies can reduce chronic stress and its negative consequences, and that psycho-educative interventions have the broadest effects on IC quality of life, the program "Learning to feel better… and help better" was developed in French-speaking Canada. This group intervention focusing on coping with the daily stress of dementia caregiving showed efficacy in decreasing the behavior problems of the person with dementia and the associated stress reactions in their IC. The objectives of our study were to examine within a one group pre- and post-test design 1) the feasibility of implementing the program in two regions of French-speaking Switzerland, 2) the effects of the program, and 3) the participants' use of the trained strategies in daily life.
A mixed-methods concurrent nested design was used to quantitatively evaluate the feasibility, the effects on five core outcomes, and strategy use in daily life. Additional qualitative data documented in depth the acceptability and impact of the intervention.
We analyzed 18 complete data sets. Regarding feasibility, qualitative and quantitative results converged towards a very good acceptance of the program and a strong implication of the participants. Regarding effects, the program resulted in substantial and significant improvements in burden (d = 0.41, p < .05), psychological distress (d = 0.54, p < .05) and self-efficacy (d = 0.43, p < .05). The qualitative results emphasized the benefits of a group format: Participants felt understood by peers, could build new social bonds and experienced reduced social isolation. Data regularly collected in daily life showed that participants were using more and more over time the strategies they learned (β = 0.55, p < .001), particularly reframing.
This study expands on the original one conducted by the developers of the program in French-speaking Canada, by showing the feasibility and the very promising effects of this intervention in two regions of French-speaking Switzerland.
痴呆症患者会经历与依赖性增加相关的进行性下降。他们在家中所需的大部分支持来自他们的非正式照顾者（IC）。痴呆症的非正式护理给 IC 的健康和生活质量带来了高昂的成本，这与长期的慢性压力有关。基于更充分的应对策略可以减轻慢性压力及其负面影响的证据，以及心理教育干预对 IC 生活质量影响最广泛的证据，“学会感觉更好……并更好地帮助”计划在法语国家加拿大开发。该小组干预侧重于应对痴呆症护理日常压力，已显示出减少痴呆症患者的行为问题及其 IC 中相关应激反应的功效。我们的研究目的是在一项针对法语瑞士两个地区的 1 组预 - 后测试设计中检查 1）该计划实施的可行性，2）该计划的效果，以及 3）参与者在日常生活中使用训练策略的情况。
采用混合方法同时嵌套设计，定量评估可行性、对五个核心结果的影响以及日常生活中的策略使用。额外的定性数据详细记录了干预措施的可接受性和影响。
我们分析了 18 个完整的数据集。关于可行性，定性和定量结果都非常好地接受了该计划，并得到了参与者的大力支持。关于效果，该计划导致负担（d=0.41，p<0.05）、心理困扰（d=0.54，p<0.05）和自我效能（d=0.43，p<0.05）有显著和实质性的改善。定性结果强调了小组形式的好处：参与者感到被同龄人理解，可以建立新的社会联系，并体验到减少的社会孤立。在日常生活中定期收集的数据表明，参与者随着时间的推移越来越多地使用他们所学的策略（β=0.55，p<0.001），特别是重新构建。
本研究扩展了该计划开发者在法语加拿大进行的原始研究，表明了该干预措施在法语瑞士两个地区的可行性和非常有前途的效果。
