Effects of Trajectory-based Support Via WeChat in Reducing Burden and Depression among Carers of People after Stroke: A Randomized Controlled Trial

Authors

  • Yue Jia PhD (Candidate), Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Wipada Kunaviktikul Panyapiwat Institute of Management, Thailand.
  • Sirirat Panuthai Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.
  • Jindarat Chaiard Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2024.268856

Keywords:

Caregiver burden, Caregiver, Depression, Stroke, Mobile applications, Preparedness, Social support

Abstract

The lack of preparation among carers in providing care for survivors of stroke leads to increased caregiver burden and depression. Studies on trajectory-based support addressing phase-specific needs for essential knowledge and skills to support caregiving preparedness are limited. This randomized controlled trial involved eighty participants from a Chinese tertiary hospital, randomly assigned to an experimental or control group (n = 40 each). The experimental participants received the 9-weeks of five sessions that included informational, emotional, instrumental, and appraisal support combined with trajectory-based support conducted via the WeChat platform. The control group received only usual care. Caregiver burden and depression were assessed at pre-test before the intervention and post-test at the end of the program. Instruments used to collect the data were a demographic questionnaire, the Chinese version of the Zarit Burden Interview, and the Chinese version of the Patient Health Questionnaire-9. Data were analyzed using descriptive statistics, paired and independent t-tests, Mann-Whitney U test, and Wilcoxon Signed Ranks Test.

The results indicated that after the program, the experimental group had significantly lower mean scores of caregiver burden and depression compared to before the program and the control group. However, no statistical differences were observed in the control group between pre- and post-test depression scores. These findings suggest that enhancing care preparedness through the trajectory-based support program reduces caregiver burden and depression among carers of people with stroke in China. Therefore, nurses can utilize trajectory-based support via WeChat to alleviate caregiver burden and depression in this population. However, further testing in other settings is necessary before widespread implementation.

References

Martin SS, Aday AW, Almarzooq ZI, Anderson CA, Arora P, Avery CL, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024;149(8), e347-913. doi: 10.1161/CIR.0000000000001209. Erratum in: Circulation. 2024;149(19):e1164. doi: 10.1161/CIR.0000000000001247.

Tu WJ, Zhao Z, Yin P, Cao L, Zeng JS, Chen HS, et al. Estimated burden of stroke in China in 2020. JAMA Netw Open. 2023;6(3):e231455. doi: 10.1001/jamanet workopen.2023.1455.

He A, Wang Z, Wu X, Sun W, Yang K, Feng W, et al. Incidence of post-stroke cognitive impairment in patients with first-ever ischemic stroke: a multicenter cross-sectional study in China. Lancet Reg Health West Pac. 2023;33:100687. doi: 10.1016/j.lanwpc.2023.100687.

Shewangizaw S, Fekadu W, Sackley C, Alem A. Life after stroke: exploring social and psychological consequences of stroke survivors and their caregivers. Ethiopian Med J. 2023;61(4):315-25. doi: 10.4314/emj.v61i4.3.

Denham AMJ, Wynne O, Baker AL, Spratt NJ, Loh M, Turner A, et al. The long-term unmet needs of informal carers of stroke survivors at home: a systematic review of qualitative and quantitative studies. Disabil Rehabil. 2022;44(1):1-12. doi: 10.1080/09638288.2020.1756470.

Mei YX, Xiang DD, Zhang ZX, Twumwaah Budu J, Lin BL, Chen SY. Family function, self‐efficacy, care hours per day, closeness and benefit finding among stroke caregivers in China: a moderated mediation model. J Clin Nurs. 2023;32(3-4):506-16. doi:10.1111/jocn.16290.

Achilike S, Beauchamp JES, Cron SG, Okpala M, Payen SS, Baldridge L, et al. Caregiver burden and associated factors among informal caregivers of stroke survivors. J Neurosci Nurs. 2020;52(6):277-83. doi: 10.1097/JNN.0000000000000552.

Chung ML, Lee SJ, Son YJ, Miller JL, King RB. Depressive symptom trajectories in family caregivers of stroke survivors during first year of caregiving. J Cardiovasc Nurs. 2021;36(3):254-62. doi: 10.1097/JCN.000000 0000000773.

Chevance A, Ravaud P, Tomlinson A, Le Berre C, Teufer B, Touboul S, et al. Identifying outcomes for depression that matter to patients, informal caregivers, and health-care professionals: qualitative content analysis of a large international online survey. Lancet Psychiatry. 2020;7(8): 692-702. doi: 10.1016/S2215-0366(20)30191-7. Erratum in: Lancet Psychiatry. 2020;7(9):e59. doi: 10.1016/S2215-0366(20)30351-5.

Uhm KE, Jung H, Woo MW, Kwon HE, Oh-Park M, Lee BR, et al. Influence of preparedness on caregiver burden, depression, and quality of life in caregivers of people with disabilities. Front Public Health. 2023;11:1153588. doi: 10.3389/fpubh.2023.1153588.

Chen L, Xiao LD, Chamberlain D. An integrative review: challenges and opportunities for stroke survivors and caregivers in hospital to home transition care. J Adv Nurs. 2020;76(9):2253-65. doi: 10.1111/jan.14446.

Lobo EH, Frølich A, Abdelrazek M, Rasmussen LJ, Grundy J, Livingston PM, et al. Information, involvement, self-care and support—The needs of caregivers of people with stroke: a grounded theory approach. PloS One. 2023; 18(1):e0281198. doi: 10.1371/journal.pone.0281198.

Hagedoorn EI, Keers JC, Jaarsma T, van der Schans CP, Luttik MLA, Paans W. The association of collaboration between family caregivers and nurses in the hospital and their preparedness for caregiving at home. Geriatr Nurs. 2020;41(4):373-80. doi: 10.1016/j.gerinurse.2019.02.004.

Van Houtven CH, Smith VA, Lindquist JH, Chapman JG, Hendrix C, Hastings SN, et al. Family caregiver skills training to improve experiences of care: a randomized clinical trial. J Gen Intern Med. 2019;34(10):2114-22. doi: 10.1007/s11606-019-05209-x.

Mores G, Whiteman RM, Ploeg J, Knobl P, Cahn M, Klaponski L, et al. An evaluation of the family informal caregiver stroke self-management program. Can J Neurol Sci. 2018;45(6):660-8. doi: 10.1017/cjn.2018.335.

Choi HS, Cho SH. Effects of multimodal rehabilitation on the activities of daily living, quality of life, and burden of care for patients with Parkinson’s disease: a randomized control study. Healthcare (Basel). 2022;10(10):1888. doi: 10.3390/healthcare10101888.

Chen HM, Huang MF, Yeh YC, Huang WH, Chen CS. Effectiveness of coping strategies intervention on caregiver burden among caregivers of elderly patients with dementia. Psychogeriatrics. 2015;15(1):20-5. doi: 10.1111/psyg.12071.

King RB, Hartke RJ, Denby F. Problem-solving early intervention: a pilot study of stroke caregivers. Rehabil Nurs. 2007;32(2):68-76. doi: 10.1002/j.2048-7940.2007.tb00154.x.

Bakas T, Austin JK, Habermann B, Jessup NM, McLennon SM, Mitchell PH, et al. Telephone assessment and skill-building kit for stroke caregivers: a randomized controlled clinical trial. Stroke. 2015;46(12):3478-87. doi: 10.1161/STROKEAHA.115.011099.

Cheng HY, Chair SY, Chau JPC. Effectiveness of a strength-oriented psychoeducation on caregiving competence, problem-solving abilities, psychosocial outcomes and physical health among family caregiver of stroke survivors: a randomised controlled trial. Int J Nurs Stud. 2018;87:84- 93. doi: 10.1016/j.ijnurstu.2018.07.005.

Keramatikerman M, Varaei S, Vaezi M, Sayadi, L. Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial. BMJ Support Palliat Care. 2024 Jan 25:spcare-2023-004610. doi:10.1136/spcare-2023-004610.

Fields B, Turner RL, Naidu M, Schulz R, James E, Rodakowski J. Assessments for caregivers of hospitalized older adults. Clin Nurs Res. 2020;29(6):382-91. doi: 10.1177/1054773818816207.

Yang L, Wei W, Wu Y, Zhu S, Zeng X, Wang R, et al. The experiences of caring for disabled older adults in long-term: a qualitative study from the perspective of spousal caregivers. Chronic Illn. 2023;19(4):848-61. doi: 10.1177/17423953221148972.

Corbin JM. The Corbin and Strauss chronic illness trajectory model: an update. Sch Inq Nurs Pract. 1998; 12(1):33-41. PMID: 9805470.

Burton CR. Rethinking stroke rehabilitation: the Corbin and Strauss chronic illness trajectory framework. J Adv Nurs. 2000;32(3):595-602. doi: 10.1046/j.1365-2648.2000.01517.x.

Kent de Grey RG, Uchino BN, Trettevik R, Cronan S, Hogan JN. Social support and sleep: a meta-analysis. Health Psychol. 2018;37(8):787-98. doi:10.1037/hea0000628.

Swartz K, Collins LG. Caregiver care. Am Fam Physician. 2019;99(11):699-706. PMID: 31150177.

Li X, Li T, Chen J, Xie Y, An X, Lv Y, et al. A WeChat-based self-management intervention for community middle-aged and elderly adults with hypertension in Guangzhou, China: a cluster-randomized controlled trial. Int J Environ Res Public Health. 2019;16(21):4058. doi: 10.3390/ijerph16214058.

Reeves MJ, Boden-Albala B, Cadilhac DA. Care transition interventions to improve stroke outcomes: evidence gaps in underserved and minority populations. Stroke. 2023;54(2): 386-95. doi: 10.1161/STROKEAHA.122.039565.

Camicia M, Lutz BJ, Harvath T, Kim KK, Drake C, Joseph JG. Development of an instrument to assess stroke carer readiness for the transition home. Rehabil Nurs. 2020:45(5): 287-98. doi: 10.1097/rnj.0000000000000204.

Archbold PG, Stewart BJ, Greenlick MR, Harvath T. Mutuality and preparedness as predictors of caregiver role strain. Res Nurs Health. 1990;13(6):375-84. doi: 10.1002/nur.4770130605.

Wang H, Wu H, Zhang Y, Ding Q. WeChat continuity nursing on postpartum depression and quality of life in primiparas undergoing cesarean delivery. Altern Ther Health Med. 2024 Mar 22:AT10147. PMID: 38518146.

Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, et al. Long-term survival after out-of-hospital cardiac arrest: a systematic review and meta-analysis. JAMA Cardiol. 2022;7(6):633-43. doi: 10.1001/jamacardio.2022.0795.

Hong YA, Shen K, Han HR, Ta Park V, Bagchi P, Lu HK, et al. A WeChat-based intervention, wellness enhancement for caregivers (WECARE), for Chinese American dementia caregivers: pilot assessment of feasibility, acceptability, and preliminary efficacy. JMIR Aging. 2023;6:e42972. doi: 10.2196/42972.

Shang L, Zhou J, Zuo M. Understanding older adults’ intention to share health information on social media: the role of health belief and information processing. Internet Res. 2021;31(1):100-22. doi: 10.1108/INTR-12-2019-0512.

Carr AL, Bilenduke E, Adolf E, Kessler ER, Arch JJ, Ranby KW, et al. A pilot randomized study of a telephone-based cognitive-behavioral stress-management intervention to reduce distress in phase 1 oncology trial caregivers. Palliat Support Care. 2023;21(5):820-8. doi: 10.1017/S1478951523000196.

Kusi G, Atenafu EG, Boamah Mensah AB, Lee CT, Viswabandya A, Puts M, et al. The effectiveness of psychoeducational interventions on caregiver‐oriented outcomes in caregivers of adult cancer patients: a systematic review and meta-analysis. Psychooncology. 2023;32(2): 189-202. doi: 10.1002/pon.6050.

Zhang C, Zhang X, Zhang H, Zeng P, Yin P, Li Z, et al. Psychometric properties of the Barthel Index for evaluating physical function among Chinese oldest-old. JCSM Clin Reports.2022;7(2):33-43. doi: 10.1002/crt2.47.

Wang W, Bian Q, Zhao Y, Li X, Wang W, Du J, et al. Reliability and validity of the Chinese variant of the Patient Health Questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry. 2014;36(5):539-44. doi: 10.1016/j.genhosppsych.2014.05.021.

Lu L, Wang L, Yang X, Feng Q. Zarit Caregiver Burden Interview: development, reliability and validity of the Chinese version. Psychiatry Clin Neurosci. 2009;63(6):730-4. doi: 10.1111/j.1440-1819.2009.02019.x.

HU SS. Epidemiology and current management of cerebrovascular disease in China. J Geriatr Cardiol. 2024;21(5): 465-74. doi: 10.26599/1671-5411.2024.05.009.

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Published

2024-09-11

How to Cite

1.
Jia Y, Kunaviktikul W, Panuthai S, Chaiard J. Effects of Trajectory-based Support Via WeChat in Reducing Burden and Depression among Carers of People after Stroke: A Randomized Controlled Trial. PRIJNR [Internet]. 2024 Sep. 11 [cited 2024 Dec. 22];28(4):838-54. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/268856