Health capability of family caregivers: how different factors interrelate and their respective contributions using a Bayesian approach

in BMC Public Health (2016), 16

The lifestyles of family caregivers pose risks to their physical, mental and social health. The capability to stay healthy may be protective in the context of poor socioeconomic conditions and risk ... [more ▼]

The lifestyles of family caregivers pose risks to their physical, mental and social health. The capability to stay healthy may be protective in the context of poor socioeconomic conditions and risk behaviours, but the interrelations between its aspects and their respective influences remain unclear. The aim of this study was to evaluate the interrelations between the factors comprising health capability of family caregivers (HCFC) and the respective contributions of its components. Methods: All stroke patients admitted to all hospitals in Luxembourg were identified by the ‘Inspection Générale de la Sécurité Sociale’ using the national database system for care expenditure reimbursement, and asked to designate the main person caring for them. Sixty-two caregivers (mean age 59.3 years; 40 women and 22 men) responded face to face, to a questionnaire including 20 items measuring eight aspects of health capability (physical functioning, psychological functioning, lifestyle value, self-efficacy towards the use of health services, family support, social capital, material conditions/sense of security, and satisfaction with the interactions with health services). Using a Bayesian approach, significance values were estimated by comparing the test values to the posterior distribution of the parameters. Structural equation modelling with standard deviations was applied. Results: Female family caregivers had lower scores than men in physical and psychological functioning. Family caregivers with the lowest incomes had the least lifestyle value, social capital and material conditions/security. Self-efficacy towards health services increased with age. The material conditions/sense of security factor was positively correlated with almost all the others. The items that impacted health capability factors the most were - for physical functioning – fatigue, and - for family support - feeling abandoned by the family. Conclusions: During the chronic phase, relationships between risk behaviours can help guide social and health decision-makers to determine their priorities in improving the lives of family caregivers. Enhancing health capability involves implementing programs that relieve family caregivers physically, and foster family networking around the person being cared for. Special attention should also be paid to the socially disadvantaged in order to fight inequalities in health capability. [less ▲]

Why medication or tobacco consumption enhance the life satisfaction of cardiovascular patients?

in European Health Psychologist (2015), special

While life satisfaction (LS) promotes the health of cardiovascular patients, LS may be affected by a range of primary and secondary determinants. We analysed LS and its relationships with cardiovascular ... [more ▼]

While life satisfaction (LS) promotes the health of cardiovascular patients, LS may be affected by a range of primary and secondary determinants. We analysed LS and its relationships with cardiovascular risk factors and unhealthy behaviours. Methods. In 2013, 3,632 survivors who underwent coronary angiography in 2008-2009 at the Luxembourgish National Institute of Cardiac Surgery and Cardiological Intervention (INCCI), living at home were asked to estimate, five years after, their LS [1-10] and other health-related variables. Data were analysed via multiple regression models including interaction effects. Findings. LS of the 1,289 participants (age: 69.2±11.1) was 7.3/10. Most were men, employees or manual workers, had secondary education and a 36,000€ or more/year income. The interactions between hypercholesterolemia and hypertension (regression coefficient= 0.628) and with smoking (rc= 0.941) were positively related with LS, but physical inactivity was negatively associated (rc= -0.630). Discussion. Taking medications or maintaining tobacco consumption produces better LS than being ambivalent towards physical activity. Further research is needed to evaluate the efficacy of health interventions eliciting and promoting the behaviour change wheel based on capabilities, opportunities, and motivations. [less ▲]

Des souffrances multiples à la souffrance paroxystique.

in Pensée plurielle (2015), 2015/1(N°38), 9-22

The purpose of our study is to contribute to the understanding of the mechanisms playing a role in the deconstruction of mental suffering. With the support of the Luxembourgish RE.SO.NORD (REseau du ... [more ▼]

The purpose of our study is to contribute to the understanding of the mechanisms playing a role in the deconstruction of mental suffering. With the support of the Luxembourgish RE.SO.NORD (REseau du centre SOcial de la région du NORD), a diagnosis of the sufferings of people living in rural districts was completed with the first-line health and social professionals who work with their clients on a daily basis. Twenty-six professionals participated in interviews during which they described the sufferings of their clients. They appeared as the effects of a drift and show how the amplification process of psychic sufferings (permanent anxiety, depression, etc.) and the accumulation of social and family factors (job loss, family separation, etc.) can lead to the emergence of critical mental health conditions. In this logic of paroxystic gradation, mental health problems may aggregate a set of harmful behaviors. This gradation illustrates the state achieved by the clients when their intimate and social domains of life are impeded. The paroxystic suffering represents the state during which the individual seems to fail to cope with their sufferings and is no longer able to recover. The professionals recognize a lack of information and incentive during medical consultation in which their clients dread the fear of being stigmatized. They admit the existence of poor coordination and access to primary health care and a lack of support for those who suffer and their family caregivers in order to prepare them to become actors that can mobilize their "health capability". [less ▲]

La capabilité de santé des aidants familiaux: Analyses du paradigme et pistes d'opérationnalisation

Doctoral thesis (2014)

Home care of persons with a chronic disease is increasingly provided by family caregivers, but their lifestyle creates a risk to their health. Therefore, leading a research on their "health capability ... [more ▼]

Home care of persons with a chronic disease is increasingly provided by family caregivers, but their lifestyle creates a risk to their health. Therefore, leading a research on their "health capability", in other words, on their ability to adopt a healthy lifestyle is of major scientific interest. The operationalization of this paradigm, developed by Ruger in 2010 to understand the factors of maintaining a state of optimal health, has been the heart of our research. Based on a quantitative data collection conducted in Luxembourg and Lorraine (France), a Health Capability of Family Caregivers instrument (HCFC-20 items) was developed and tested. It explores eight areas: physical health, psychological health, lifestyle value, sense of self-efficacy, family support, social capital, material conditions/sense of security, satisfaction with information and healthcare services. Additional qualitative surveys have completed the HCFC-20 with 77 items covering areas such as motivation, life skills and coping styles. This instrument allows to develop personalized diagnoses and to evaluate health-promoting programs. Our preliminary analyses have also indicated that the impacts of a chronic disease are experienced jointly in patient-caregiver dyads; and the value placed on the role of caregiver is encouraged by the support from professionals and a social network. In order to improve the health capability of caregivers, taking into account both their autonomy and their need for support is therefore required. [less ▲]

Socioeconomic inequalities in fatal opiate and cocaine related overdoses: Transgenerational baggage versus individual attainments

in European Health Psychologist (2014)

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law ... [more ▼]

Background. To determine socioeconomic inequalities in opiates and cocaine related Fatal OverDose (FOD) cases and their implications in terms of preventive measures. Methods. Cross-examination of law enforcement and healthcare data sources and of forensic evidence in a nested case-control study design. FOD cases were individually matched with 4 controls, according to sex, year of birth, drug administration route and duration of drug use. 272 cases vs. 1,056 controls were compared through conditional logistic regression. Findings. Being professionally active [OR=0.662 (95% CI 0.446–0.985)], reporting salary as main income source [OR=0.417 (95% CI 0.258–0.674)], and education attainment higher than primary school [OR=0.501 (95% CI 0.344-0.729)] revealed to be protective factors, whereas parental professional status was not associated to FOD. Discussion. Compared to their peers, drug users with lower socioeconomic profiles show increased odds of FOD. However, actual and self-referred socioeconomic characteristics of drug users, impacting on daily life quality, such as educational attainment, employment and revenue, appeared to be more predictive of FOD than transgenerational factors such as the parental socioeconomic status. Thus, motivational interventions aimed at socio-professional reintegration should be given due attention in dedicated harm prevention policies. [less ▲]

Physical and mental health, substance abuse and preventive behaviour: disparities between Central/Eastern versus Western European first-year university students in social sciences

in Analele Stiintifice ale Universitatii "Alexandru Ioan Cuza". Sectiunea Sociologie si Asistenta Sociala = Scientific Annals of the “Alexandru Ioan Cuza” University. Sociology and Social Work Section (2014), 7(1), 96-115

Background: Students at many European universities are in poor health and have unhealthy lifestyles. This study assessed and compared physical and mental health, substance use and preventive behaviour ... [more ▼]

Background: Students at many European universities are in poor health and have unhealthy lifestyles. This study assessed and compared physical and mental health, substance use and preventive behaviour among Polish and Romanian students versus students from France, a longer-standing member of the European Union. Methods: Four months after the beginning of the academic year, 934 French (Metz), 480 Polish (Katowice), and 195 Romanian (Iasi) first-year students of human and social sciences volunteered to complete an online self-reported questionnaire in their native language. The data were analysed using the age and sex adjusted odds ratios (OR) computed with logistic models and analysis of variance controlling for age and sex. Results: 41.9% of French students, 79.2% of Polish students and 48.2% of Romanian students were aged 20 years or over, and 58%, 82% and 87% respectively were female. Compared with French students, Romanian and Polish students experienced more stress/psychological distress, received less social support, and smokers smoked more intensively (ORs about 2.3). Drunkenness, impaired physical health or morale and suicidal ideation were more frequent (ORs 1.5-1.8) while tobacco use was less frequent (0.34) among Polish than among French students. Being uneasy, wanting to cry, having financial problems, and impaired physical health or morale were more frequent (ORs 1.5-4.9) among Romanian than among French students, in contrast to drunkenness (0.43). Both not using a motorcycle/cycle helmet and drink driving were less frequent among Polish students (ORs 0.06 and 0.47, respectively). Romanian students less frequently used tranquillisers (0.07) but were more likely not to use a condom during sexual intercourse (2.06). Finally, French students more frequently reported feeling isolated or dissatisfied with their integration into university. Conclusion: Poor health, substance use and lack of support were common but the risks greatly differed between Polish, Romanian and French students. There is a need to help students solve their integration problems and material difficulties. Health promotion on campus should provide appropriate advice, particularly for individuals at risk that takes account of the socio-economic and cultural context. [less ▲]

Lifestyle as a Health Risk for Family Caregivers with Least Life Satisfaction, in Home-Based Post-Stroke Caring

in Healthcare Policy (2013), 9

Our purpose was to clarify that the caregiving role respresent a situation of risk for the health of family caregivers in home-based caring two years after cerebrovascular disease. Our aim was to ... [more ▼]

Our purpose was to clarify that the caregiving role respresent a situation of risk for the health of family caregivers in home-based caring two years after cerebrovascular disease. Our aim was to determine the social and emotional repercussions of the event on family caregivers. Family caregivers living at home with stroke survivors were identified by a national survey. The Life Satisfaction (LS) national indicator for Luxembourg is 7.9/10, while in Canada it stands at 7.7. Caregivers with a LS level ≤ 7 were more likely to care for survivors affected by motor, sensory and memory neurological impairments. For a great majority, these impairments led to serious upheaval among families, and for spouses it was “a drama.” For family caregivers with a least life satisfaction, their lifestyle poses a real health risk. [less ▲]

Which Caregiving esteem for which Gender ?

in Psychology and Health (2012), 27(suppl 1), 170-171

Background: Two years after stroke, are the factors of the esteem of caregiving the same by gender? Methods: Face-to-face questionnaires administered to 92 Luxembourgish and Portuguese stroke patients and ... [more ▼]

Background: Two years after stroke, are the factors of the esteem of caregiving the same by gender? Methods: Face-to-face questionnaires administered to 92 Luxembourgish and Portuguese stroke patients and their 67 men and 25 women caregivers. For each sex, a multiple regression entering:- Neurological impairments,- Patients’ and caregivers’ life satisfaction [1;10],- Reactions towards caregiving: esteem (dependent variable), lack of family support, impacts on finances, schedule and health (Caregiver Reaction Assessment subscales),- Confidence in information subscale from the Carer Satisfaction Community Services. Results: Caregivers with a high caregiving esteem are, in women: those who trust information from community services ( ¼0.412***) and care for patients keeping few sensory impairments ( ¼0.300**; R2adj.¼0.257); in men : those who are low impacted on their health ( ¼0.471*) and care for patients satisfied with life ( ¼0.371; R2adj.¼0.447). Discussion: Home-based rehabilitation can be sustained by developing men and women caregivers’ specific health capabilities. [less ▲]

Harmonie et divergences des couples sur les repercussions familiales et sociales apres la survenue d’un accident vasculaire cerebral.

in Analele Stiintifice ale Universitatii "Alexandru Ioan Cuza". Sectiunea Sociologie si Asistenta Sociala = Scientific Annals of the “Alexandru Ioan Cuza” University. Sociology and Social Work Section (2012), 5(1), 155-173

Deux ans après la survenue d’un accident vasculaire cérébral (AVC), l’harmonie et la divergence entre les déclarations des patients et des conjoints ont été analysées auprès de 51 couples vivant au ... [more ▼]

Deux ans après la survenue d’un accident vasculaire cérébral (AVC), l’harmonie et la divergence entre les déclarations des patients et des conjoints ont été analysées auprès de 51 couples vivant au Luxembourg à l’aide d’un entretien mené à leur domicile. « L’AVC a créé des bouleversements considérables dans ma famille » et « au début, personne ne savait quelle attitude avoir avec la personne AVC »; ces retentissements sont, pour les couples, indiscutables. D’autres effets les affectent: « le caractère de la personne AVC a changé complètement depuis son AVC », ils estiment que « c’est sur le plan psychologique que cela a été le plus difficile ». Malgré les changements intervenus, les voyages demeurent un sujet qui les mobilise. Les besoins « d’information concernant l’aide financière » et « d’aide pour faire des demandes administratives, d’allocations ou de services » sanitaires et socio-éducatifs sont des priorités communes. Ils sont attentifs au fait que « les services et l’équipement fournis soient de bonne qualité » et dispensés à « des moments de la journée qui conviennent ». Les personnes victimes d’un AVC sont plus nombreuses que leurs aidants à reconnaître que « lorsqu’on a un AVC, on se sent dévalorisé ». Cette différence entre les attitudes des patients et des conjoints est une forme de stigmatisation du handicap dont souffrent les victimes confrontées à une image qui n’est plus celle qu’ils avaient d’eux avant l’accident. Avec le vieillissement de la population, une conception de la prise en charge par couple devrait être pensée dans le cadre du maintien à domicile. De nouvelles perspectives de recherche en sociologie médicale pourraient être développées. [less ▲]

L’estime ressentie en accomplissant le rôle d’aidant naturel et ses déterminants psychosociaux

in La pratique: un lieu de théorie (2011)

Avec l’augmentation des accidents vasculaires cérébraux (AVC), améliorer le bien-être des aidants naturels (AN) est devenu une priorité. Quels sont les déterminants psychosociaux de l’estime ressentie par ... [more ▼]

Avec l’augmentation des accidents vasculaires cérébraux (AVC), améliorer le bien-être des aidants naturels (AN) est devenu une priorité. Quels sont les déterminants psychosociaux de l’estime ressentie par les AN en accomplissant ce rôle ? Méthodologie. Sur une période de 12 mois, les personnes victimes d’un AVC deux ans auparavant, dont le diagnostic a été confirmé, vivant au Luxembourg et ayant donné leur consentement, ont désigné leur AN principal. Etude nationale transversale menée au domicile. Instruments : - Caregiver Reaction Assessment : estime de l’aide, manque de soutien familial, impacts financier, sur l’emploi du temps, sur la santé générale. - Carer Satisfaction of Community Services : services socio-sanitaires et éducatifs - Aides à domicile utilisées : soins corporels, repas, ménage, sorties, courses Résultats. Taux participation 26,5 % ; 48 AN (59,5 ±12,3 ans). Régression multiple (R²ajusté=.230) : une estime élevée est associée à un faible impact de l’aide sur la santé (β=.479***) et un recours important aux aides à domicile (β=.351**). Discussion. Il est possible de valoriser le rôle d’AN en motivant les aidants à utiliser les services disponibles pour les soulager dans leurs tâches quotidiennes. Les soutiens psychologiques peuvent également intégrer le concept de « health capability » pour renforcer l’acquisition de cette estime. [less ▲]