Center for Home Care Policy & Research at VNS Health, New York, NY, United States of America; University of Pennsylvania, Philadelphia, PA, United States of America; Penn Medicine Princeton Health, Princeton, NJ, United States of America.
Department of Psychology, Sapienza University, Rome, Italy.
Appl Nurs Res. 2024 Aug;78:151810. doi: 10.1016/j.apnr.2024.151810. Epub 2024 Jun 13.
Support interventions often address both self-care and coping. Different approaches are used to promote self-care and coping so clarifying the intervention effect can guide clinicians and researchers to provide interventions that achieve benefit.
To compare two models to determine whether self-care improves coping or coping improves self-care.
We used cross-sectional data from 248 caregivers obtained at enrollment into a randomized controlled trial testing the efficacy of a support intervention. Factor scores for scales measuring caregiver demand, self-care, coping, stress appraisal, and mental health were derived from exploratory factor analysis. Structural equation models were analyzed using the factor scores as estimates of each construct. To control possible spurious effects caregiver age, gender, relationship with the patient, and income adequacy were included.
Both models were compatible with the data, but the self-care model was stronger than the coping model. That model had a non-significant chi square and an excellent fit to the data, χ(4, N = 248) = 2.64, p = .62. The percentage of variance explained by the self-care model was 54 % for mental health, 42 % for stress appraisal, 10 % for avoidance coping, and 6 % for active coping. In the coping model the explained variance of stress appraisal dropped to 33 %, avoidance coping dropped to 0 %, and active coping dropped to 3 %.
The self-care model was strongest, illustrating that self-care decreases stress, promotes coping, and improves mental health. These results suggest that promoting self-care may be more effective in improving mental health than interventions aimed at improving coping.
支持干预措施通常同时针对自我护理和应对。不同的方法被用来促进自我护理和应对，因此明确干预效果可以指导临床医生和研究人员提供实现获益的干预措施。
比较两种模型，以确定自我护理是否可以改善应对，或者应对是否可以改善自我护理。
我们使用了 248 名照顾者在一项支持干预措施的随机对照试验入组时获得的横断面数据。从探索性因子分析中得出了用于测量照顾者需求、自我护理、应对、压力评估和心理健康的量表的因子分数。使用因子分数作为每个结构的估计值来分析结构方程模型。为了控制可能的虚假效应，将照顾者年龄、性别、与患者的关系和收入充足性纳入了分析。
两种模型都与数据兼容，但自我护理模型比应对模型更强。该模型的卡方值不显著，与数据拟合良好，χ(4, N=248)=2.64, p=0.62。自我护理模型对心理健康的解释方差为 54%，对压力评估的解释方差为 42%，对回避应对的解释方差为 10%，对积极应对的解释方差为 6%。在应对模型中，压力评估的解释方差降至 33%，回避应对降至 0%，积极应对降至 3%。
自我护理模型最强，表明自我护理可以降低压力，促进应对，改善心理健康。这些结果表明，促进自我护理可能比旨在改善应对的干预措施更有效地改善心理健康。
