Date Presented 04/04/19
This pilot mixed-method study explored the use of an activity log and a reflective journal to increase participation in meaningful occupation for female spousal caregivers. Results indicated increased quality of life and satisfaction in performance of meaningful activities. This study increases understanding of caregivers’ occupational performance and adds to the evidence base of OT by exploring an intervention to decrease the negative effects of caregiving.
Primary Author and Speaker: Patricia Watford
Contributing Authors: Vanessa Jewell, Karen Atler
PURPOSE: Caregiving for a loved one can be difficult and negatively affect health and quality of life. Approximately 43.5 million people in the United States served as an informal caregiver for a family member in 2014 (National Alliance for Caregiving [NAC] & AARP Public Policy Institute, 2015). As the population continues to age, the number of people living at home with physical and cognitive disabilities will increase along with the need for informal caregivers (Roth, Perkins, Wadley, Temple, & Haley, 2009). Due to the cost of caring for an aging population and the amount of services informal caregivers provide, it is imperative to identify ways to support caregivers and reduce health risks. The purpose of this pilot mixed method study was to examine the effectiveness of journaling and an activity log to increase participation in meaningful occupation for women who care for their spouse.
DESIGN: Participants (n = 8) consisted of women 55 years of age and older who provided care for their spouse. Recruiting methods included convenience and snowball sampling. A quasi-experimental pretest/posttest design was used to collect the quantitative data. Narrative data from the reflective journal was analyzed during the qualitative section.
METHOD: The 4-week intervention consisted of an activity log (Daily Experiences of Pleasure, Productivity, and Restoration Profile) and a reflective journal (Journal of Activities and Experience). Investigators analyzed the first two questions and the four domain sections of the WHOQOL-BREF using a Wilcoxon signed-ranks test to test the direction of difference and the relative amount of difference between the pretest and posttest score. Researchers then examined the COPM results by calculating the change score of the Performance and Satisfaction section for each individual participant. The qualitative portion employed a broad qualitative approach and inductive content analysis guided the coding process. To establish trustworthiness, the first researcher interpreted and coded the qualitative data, then submitted the results for peer review for final consensus. Member checking was used to check for accuracy of the information by providing participants with the analysis of the PPR Profile. In addition, the primary researcher left a detailed audit trail to provide insight into the logic utilized to analyze the data. Methodological triangulation was used to increase validity and provide confirmation of the findings and the use of electronic journaling provided reflexivity by revealing any personal bias related to the study (Curtin & Fossey, 2007).
RESULTS: The intervention increased quality of life (physical domain, p<.05) and satisfaction in performance of meaningful activities had clinical significance, but not for psychological health, social relationships, and environmental. Qualitative themes included: writing down experiences helped caregivers take action, caregivers were better able to organize time, priorities, and resources, and caregiving is a demanding role.
CONCLUSION: Although the results improved physical quality of life, occupational performance and satisfaction, more research is needed to determine if greater gains are possible, and can be sustained.
IMPACT STATEMENT: These results increase the understanding of the importance of the occupational performance of caregivers and adds to the evidence base of occupational therapy by exploring an intervention for therapists to utilize with caregivers to decrease the negative effects of caregiver burden.
References
The National Alliance for Caregiving, & AARP Public Policy Institute. (2015). Caregiving in the U.S. 2015. Retrieved from http://www.aarp.org/content/dam/aarp/ppi/2015/caregiving-in-the-united-states-2015-report-revised.pdf
Roth, D. L., Perkins, M., Wadley, V. G., Temple, E. M., & Haley, W. E. (2009). Family caregiving and emotional strain: Associations with quality of life in a large national sample of middle-aged and older adults. Quality of Life Research, 18(6), 679-688. doi:10.1007/s11136-009-9482-2
Curtin, M., & Fossey, E. (2007). Appraising the trustworthiness of qualitative studies: Guidelines for occupational therapists. Australian Occupational Therapy Journal, 54(2), 88-94. doi:10.1111/j.1440-1630.2007.00661.x
