CONCEPT ANALYSIS
Self-efficacy of family caregivers of older adults with cognitive impairment: A concept analysis
Tarik S. Khan MSN, CRNP,
Karen B. Hirschman PhD, MSW, FGSA,
Matthew D. McHugh PhD, JD, MPH, CRNP, FAAN,
Mary D. Naylor PhD, RN, FAAN,
Corresponding Author
Tarik S. Khan MSN, CRNP
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence Tarik S. Khan, MSN, CRNP, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, USA.
Email: [email protected]
Search for more papers by this authorKaren B. Hirschman PhD, MSW, FGSA
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorMatthew D. McHugh PhD, JD, MPH, CRNP, FAAN
School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorMary D. Naylor PhD, RN, FAAN
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorTarik S. Khan MSN, CRNP,
Karen B. Hirschman PhD, MSW, FGSA,
Matthew D. McHugh PhD, JD, MPH, CRNP, FAAN,
Mary D. Naylor PhD, RN, FAAN,
Corresponding Author
Tarik S. Khan MSN, CRNP
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Correspondence Tarik S. Khan, MSN, CRNP, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104, USA.
Email: [email protected]
Search for more papers by this authorKaren B. Hirschman PhD, MSW, FGSA
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorMatthew D. McHugh PhD, JD, MPH, CRNP, FAAN
School of Nursing, Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorMary D. Naylor PhD, RN, FAAN
School of Nursing, New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania
Search for more papers by this authorAbstract
Background
Research demonstrates that increased self-efficacy can help family caregivers of older adults with Alzheimer's and other types of cognitive impairment experience lower burden and depressive symptom severity.
Aims
The purpose of this concept analysis is to address fundamental gaps in the understanding of self-efficacy in family caregivers of older adults with cognitive impairment, including updating the 26-year-old concept analysis with a contemporary definition.
Methods
This study utilizes Walker and Avant's (2019) concept analysis method, an eight-step iterative process that helps to clarify ambiguous concepts. A literature review was conducted from July 1993 through March 2019 using PubMed/MEDLINE, Scopus, CINAHL, and Embase. Inclusion criteria encompassed peer-reviewed research articles and review articles that included family caregivers of older adults with cognitive impairment.
Results
Eight defining attributes of this concept are identified. The revised definition of self-efficacy in this population is a family caregiver's confidence in their ability to: manage behaviors and other caregiving stresses, control upsetting thoughts, acquire medical information, manage medical issues, obtain self-care, access community supports, assist with activities of daily living and other care, and maintain a good relationship with a relative, friend, or neighbor of an older adult with cognitive impairment.
Conclusion
This paper utilizes over a quarter-century of research to build on the original analysis by Mowat and Spence Laschinger (1994) and update the concept's definition. This analysis should provide researchers with a clearer understanding of this concept and a renewed emphasis on the importance of targeting interventions to improve self-efficacy in this vulnerable caregiving population.
CONFLICT OF INTERESTS
The authors declare that there are no conflict of interests.
REFERENCES
- 1 Alzheimer's Association. 2019 Alzheimer's disease facts and figures. Alzheimers Dement. 2019; 15: 321-387.
- 2Vespa J. The graying of America: more older adults than kids by 2035: the US joins other countries with large aging populations. United States Census Bureau. 2018;14:2018.
- 3 National Academies of Sciences, Engineering, and Medicine. Families Caring for an Aging America. Washington, DC: National Academies Press; 2016.
- 4Zhang SY, Edwards H, Yates P, Ruth E, Guo Q. Preliminary reliability and validity testing of a Self-Efficacy Questionnaire for Chinese Family Caregivers. Aging Ment Health. 2013; 17(5): 630-637.
- 5Moon H, Dilworth-Anderson P. Baby boomer caregiver and dementia caregiving: findings from the National Study of Caregiving. Age Ageing. 2015; 44(2): 300-306.
- 6Pinquart M, Sörensen S. Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychol Aging. 2003; 18(2): 250-267.
- 7Steffen AM, McKibbin C, Zeiss AM, Gallagher-Thompson D, Bandura A. The Revised Scale for Caregiving Self-Efficacy: reliability and validity studies. J Gerontol B Psychol Sci Soc Sci. 2002; 57(1): P74-P86.
- 8Cheng ST, Lam LC, Kwok T, Ng NS, Fung AW. Self-efficacy is associated with less burden and more gains from behavioral problems of Alzheimer's disease in Hong Kong Chinese Caregivers. Gerontologist. 2013; 53(1): 71-80.
- 9Coon DW, Thompson L, Steffen A, Sorocco K, Gallagher-Thompson D. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist. 2003; 43(5): 678-689.
- 10Gallagher D, Ni Mhaolain A, Crosby L, et al. Self-efficacy for managing dementia may protect against burden and depression in Alzheimer's caregivers. Aging Ment Health. 2011; 15(6): 663-670.
- 11Rabinowitz YG, Mausbach BT, Thompson LW, Gallagher-Thompson D. The relationship between self-efficacy and cumulative health risk associated with health behavior patterns in female caregivers of elderly relatives with Alzheimer's dementia. Journal of Aging and Health. 2007; 19(6): 946-964.
- 12Boots L, de Vugt M, Kempen G, Verhey F. Effectiveness of the blended care self-management program “Partner in Balance” for early-stage dementia caregivers: results of a randomized controlled trial. J Med Internet Res. 2018; 20(7):e10017.
- 13Chenoweth L, Stein-Parbury J, White D, McNeill G, Jeon YH, Zaratan B. Coaching in self-efficacy improves care responses, health and well-being in dementia carers: a pre/post-test/follow-up study. BMC Health Serv Res. 2016; 16(1): 166.
- 14Gaugler JE, Zmora R, Mitchell LL, et al. Six-month effectiveness of remote activity monitoring for persons living with dementia and their family caregivers: an experimental mixed methods study. Gerontologist. 2019; 59(1): 78-89.
- 15Beauchamp N, Irvine AB, Seeley J, Johnson B. Worksite-based internet multimedia program for family caregivers of persons with dementia. Gerontologist. 2005; 45(6): 793-801.
- 16Huang HL, Kuo LM, Chen YS, et al. A home-based training program improves caregivers' skills and dementia patients' aggressive behaviors: a randomized controlled trial. Am J Geriatr Psychiatry. 2013; 21(11): 1060-1070.
- 17Parra-Vidales E, Soto-Pérez F, Perea-Bartolomé MV, Franco-Martín MA, Muñoz-Sánchez JL. Online interventions for caregivers of people with dementia: a systematic. Actas Esp Psiquiatr. 2017; 45(3): 116-126.
- 18Biello S, Tomolo A, Abraham C, et al. A qualitative evaluation of caregiver support services offered at the Atlanta Veterans Affairs Health Care System. Prev Chronic Dis. 2019; 16: E24.
- 19Zhang P, Xing FM, Li CZ, Wang FL, Zhang XL. Effects of a nurse-led transitional care programme on readmission, self-efficacy to implement health-promoting behaviours, functional status and life quality among Chinese patients with coronary artery disease: a randomised controlled trial. J Clin Nurs. 2018; 27(5-6): 969-979.
- 20Duggleby W, Ruiz KJ, Ploeg J, et al. Mixed-methods single-arm repeated measures study evaluating the feasibility of a web-based intervention to support family carers of persons with dementia in long-term care facilities. Pilot and Feasibility Studies. 2018; 4(1): 165.
- 21Barnes CJ, Markham C. A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: The Talking Sense programme. International Journal of Language & Communication Disorders. 2018; 53(3): 615-627.
- 22Merrilees JJ, Bernstein A, Dulaney S, et al. The Care Ecosystem: promoting self-efficacy among dementia family caregivers. Dementia. 2018: 1-19. https://doi.org/10.1177/1471301218814121
- 23Pihet S, Kipfer S. Coping with dementia caregiving: a mixed-methods study on feasibility and benefits of a psycho-educative group program. BMC Geriatr. 2018; 18(1): 209.
- 24Piggott CA, Zimmerman S, Reed D, Sloane PD. Development and testing of a measure of caregiver confidence in medical sign/symptom management. American Journal of Alzheimer's Disease & Other Dementias. 2017; 32(7): 373-381.
- 25Kobiske KR, Bekhet AK. Resilience in caregivers of partners with young onset dementia: a concept analysis. Issues Ment Health Nurs. 2018; 39(5): 411-419.
- 26Walker LO, Avant KC. Strategies for Theory Construction in Nursing. 6th ed. Boston, MA: Prentice Hall; 2019.
- 27Mowat J, Spence Laschinger HK. Self-efficacy in caregivers of cognitively impaired elderly people: a concept analysis. J Adv Nurs. 1994; 19(6): 1105-1113.
- 28Bandura A. Self-Efficacy: The Exercise of Control. New York, NY: W. H. Freeman and Company; 1997.
- 29Gitlin LN, Winter L, Dennis MP, Hodgson N, Hauck WW. Targeting and managing behavioral symptoms in individuals with dementia: a randomized trial of a nonpharmacological intervention. J Am Geriatr Soc. 2010; 58(8): 1465-1474.
- 30Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Annals of Internal Medicine. 2006; 145(10): 713-726.
- 31 Self-efficacy. In Oxford English Dictionary. 2019. http://proxy.library.upenn.edu:2817/view/Entry/175092?redirectedFrom=self-efficacy. Accessed on April 10, 2019.
- 32 Efficacy. In Merriam Webster's Online Dictionary. 2019. https://www.merriam-webster.com/dictionary/efficacy. Accessed on April 3, 2019.
- 33 Efficacy. In Oxford English Dictionary. 2019. http://proxy.library.upenn.edu:2817/view/Entry/59736?redirectedFrom=efficacy. Accessed on April 10, 2019.
- 34 Efficacy. In Merriam Webster's Online Thesaurus. 2019. https://www.merriam-webster.com/thesaurus/efficacy. Accessed on April 3, 2019.
- 35 Edge. In Merriam Webster's Online Dictionary. 2019. https://www.merriam-webster.com/dictionary/edge. Accessed on April 3, 2019.
- 36Reinhard SC, Young HM, Levine C, Kelly K, Choula RB, Accius J. Home Alone Revisited: Family Caregivers Providing Complex Care. Washington, DC: AARP Public Policy Institute; 2019. https://www.aarp.org/content/dam/aarp/ppi/2019/04/home-alone-revisited-family-caregivers-providing-complex-care.pdf. Accessed on April 23, 2019.
10.26419/ppi.00086.001 Google Scholar
- 37Reinhard SC, Given B, Petlick NH, Bemis A. Supporting family caregivers in providing care. In: RG Hughes, ed. Patient Safety and Quality: An Evidenced-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
- 38 Caregiver. In Oxford English Dictionary. 2019. http://proxy.library.upenn.edu:2817/view/Entry/27899?redirectedFrom=Caregiver. Accessed on April 10, 2019.
- 39Kirkman MS, Briscoe VJ, Clark N, et al. Diabetes in older adults. Diabetes Care. 2012; 35(12): 2650-2664.
- 40 World Health Organization. World Report on Ageing and Health. Luxembourg: World Health Organization; 2015.
- 41Rodder J, Walker Z, Carter J. Depression in older adults. BMJ. 2011; 343: 683-687.
- 42Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003; 51(4): 451-458.
- 43Bergen G, Stevens MR. Falls and fall injuries among adults aged [greater than or equal to] 65. MMWR Morb Mortal Wkly Rep. 2016; 65(37): 993-998.
- 44Blumenthal D, Davis K, Guterman S. Medicare at 50—origins and evolution. N Engl J Med. 2015; 372(5): 479-486.
- 45 Cognition. In Oxford English Dictionary. 2019. http://proxy.library.upenn.edu:2817/view/Entry/35876?redirectedFrom=cognition. Accessed on April 10, 2019.
- 46 Cognitive. In Oxford English Dictionary. 2019. http://proxy.library.upenn.edu:2817/view/Entry/35878?redirectedFrom=cognitive. Accessed on April 10, 2019.
- 47Petersen RC. Mild cognitive impairment. N Engl J Med. 2011; 364(23): 2227-2234.
- 48O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol. 2003; 2(2): 89-98.
- 49Forlenza OV, Diniz BS, Gattaz WF. Diagnosis and biomarkers of predementia in Alzheimer's disease. BMC Med. 2010; 8(1): 89.
- 50Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004; 256(3): 183-194.
- 51Ballard C, Mobley W, Hardy J, Williams G, Corbett A. Dementia in Down's syndrome. Lancet Neurol. 2016; 15: 622-636.
- 52O'Malley D, Higgins A, Smith V. Postpartum sexual health: a principle-based concept analysis. J Adv Nurs. 2015; 71(10): 2247-2257.
- 53Ridner SH. Psychological distress: concept analysis. J Adv Nurs. 2004; 45(5): 536-545.
- 54Haley WE, Levine EG, Brown SL, Bartolucci AA. Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers. Psychol Aging. 1987; 2(4): 323-330.
- 55Gallant M, Connell C. The stress process among dementia spouse caregivers. Res Aging. 1998; 20(3): 267-297.
- 56Fortinsky RH, Kercher K, Burant CJ. Measurement and correlates of family caregiver self-efficacy for managing dementia. Aging Ment Health. 2002; 6(2): 153-160.
- 57Gottlieb BH, Rooney JA. Validation of the RIS eldercare self-efficacy scale. Can J Aging. 2003; 22(1): 95-107.
- 58Huang HL, Shyu YI, Chen MC, Chen ST, Lin LC. A pilot study on a home-based caregiver training program for improving caregiver self-efficacy and decreasing the behavioral problems of elders with dementia in Taiwan. Int J Geriatr Psychiatry. 2003; 18(4): 337-345.
- 59Zhang SY, Edwards H, Yates P, Ruth E, Guo QH. Development of Self-Efficacy Questionnaire for Chinese Family Caregivers. Int J Ment Health Nurs. 2012; 21(4): 358-365.
- 60Piggott CA, Zimmerman S, Reed D, Sloane PD. Development and testing of a measure of caregiver confidence in medical sign/symptom management. Am J Alzheimers Dis Other Demen. 2017; 32(7): 373-381.
- 61Hirschman KB, Shaid E, McCauley K, Pauly MV, Naylor MD. Continuity of care: The Transitional Care Model. Online J Issues Nurs. 2015; 20(3): 1.
- 62Ducharme FC, Lévesque LL, Lachance LM, et al. “Learning to become a family caregiver” efficacy of an intervention program for caregivers following diagnosis of dementia in a relative. Gerontologist. 2011; 51(4): 484-494.
- 63Mackenzie CS, Peragine G. Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia. Am J Alzheimers Dis Other Demen. 2003; 18(5): 291-299.
- 64Fisher PA, Laschinger HS. A relaxation training program to increase self-efficacy for anxiety control in Alzheimer family caregivers. Holist Nurs Pract. 2001; 15(2): 47-58.
- 65Corey KL, McCurry MK. An exploration of caregiver choice through the lens of sartrean existentialism. Nursing Philosophy. 2017; 18(4):e12170.
- 66Bandura A. Guide for constructing self-efficacy scales. In: F Pajares, T Urdan, eds. Self-Efficacy Beliefs of Adolescents. Vol 5. Greenwich, CT: Information Age Publishing; 2005: 307-337.
- 67Rabinowitz YG, Mausbach BT, Coon DW, Depp C, Thompson LW, Gallagher-Thompson D. The moderating effect of self-efficacy on intervention response in women family caregivers of older adults with dementia. Am J Geriatr Psychiatry. 2006; 14(8): 642-649.
- 68Au A, Lai MK, Lau KM, et al. Social support and well-being in dementia family caregivers: the mediating role of self-efficacy. Aging Ment Health. 2009; 13(5): 761-768.
- 69Rabinowitz YG, Mausbach BT, Gallagher-Thompson D. Self-efficacy as a moderator of the relationship between care recipient memory and behavioral problems and caregiver depression in female dementia caregivers. Alzheimer Dis Assoc Disord. 2009; 23(4): 389-394.
- 70Romero-Moreno R, Losada A, Mausbach BT, Marquez-Gonzalez M, Patterson TL, Lopez J. Analysis of the moderating effect of self-efficacy domains in different points of the dementia caregiving process. Aging Ment Health. 2011; 15(2): 221-231.
- 71Stockwell-Smith G, Moyle W, Kellett U. The impact of early psychosocial intervention on self-efficacy of care recipient/carer dyads living with early-stage dementia—a mixed-methods study. J Adv Nurs. 2018; 74(9): 2167-2180.
- 72Sakanashi S, Fujita K. Empowerment of family caregivers of adults and elderly persons: a concept analysis. Int J Nurs Pract. 2017; 23(5):e1257.
- 73Cheng ST, Fung HH, Chan WC, Lam LC. Short-term effects of a gain focused reappraisal intervention for dementia caregivers: a double-blind cluster-randomized controlled trial. Am J Geriat Psychiatry. 2016; 24(9): 740-750.
- 74Rabinowitz YG, Saenz EC, Thompson LW, Gallagher-Thompson D. Understanding caregiver health behaviors: depressive symptoms mediate caregiver self-efficacy and health behavior patterns. Am J Alzheimers Dis Other Demen. 2011; 26(4): 310-316.
- 75Semiatin AM, O'Connor MK. The relationship between self-efficacy and positive aspects of caregiving in Alzheimer's disease caregivers. Aging Ment Health. 2012; 16(6): 683-688.
- 76Mausbach BT, von Känel R, Roepke SK, et al. Self-efficacy buffers the relationship between dementia caregiving stress and circulating concentrations of the proinflammatory cytokine interleukin-6. Am J Geriatr Psychiatry. 2011; 19(1): 64-71.
- 77Au A, Lau K, Sit E, et al. The role of self-efficacy in the Alzheimer's family caregiver stress process: a partial mediator between physical health and depressive symptoms. Clin Gerontol. 2010; 33(4): 298-315.
- 78Zhang S, Edwards H, Yates P, Li C, Guo Q. Self-efficacy partially mediates between social support and health-related quality of life in family caregivers for dementia patients in Shanghai. Dementia Geriatr Cognit Disord. 2013; 37(1-2): 34-44.
- 79Zhang S, Guo Q, Edwards H, Yates P, Li C. Self-efficacy moderation and mediation roles on BPSD and social support influences on subjective caregiver burden in Chinese spouse caregivers of dementia patients. Int Psychogeriatr. 2014; 26(9): 1465-1473.
- 80Liu HY, Huang LH. The relationship between family functioning and caregiving appraisal of dementia family caregivers: caregiving self-efficacy as a mediator. Aging Ment Health. 2018; 22(4): 558-567.
- 81Nogales-González C, Romero-Moreno R, Losada A, Márquez-González M, Zarit SH. Moderating effect of self-efficacy on the relation between behavior problems in persons with dementia and the distress they cause in caregivers. Aging Ment Health. 2015; 19(11): 1022-1030.
- 82Novak M, Guest C. Application of a multidimensional caregiver burden inventory. Gerontologist. 1989; 29(6): 798-803.
- 83Zhang P, Xing FM, Li CZ, Wang FL, Zhang XL. Effects of a nurse-led transitional care programme on readmission, self-efficacy to implement health-promoting behaviours, functional status and life quality among Chinese patients with coronary artery disease: a randomised controlled trial. J Clin Nurs. 2018; 27(5-6): 969-979.
- 84Kuhn D, Fulton BR, Edelman P. Powerful tools for caregivers: Improving self-care and self-efficacy of family caregivers. Alzheimers Care Today. 2003; 4(3): 189-200.
- 85Savundranayagam MY, Brintnall-Peterson M. Testing self-efficacy as a pathway that supports self-care among family caregivers in a psychoeducational intervention. J Fam Soc Work. 2010; 13(2): 149-162.
10.1080/10522150903487107 Google Scholar
