30 june 2014, university of sheffield presented by huiying ng
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Practices , Norms and Options: a Mixed Methods Study on the Efficacy of a Support Group Programme for Cancer Caregivers. On behalf of the research team at the National University Hospital: A/P Rathi Mahendran A/P Konstadina Griva Joanne Chua Haikel Lim Joyce Tan - PowerPoint PPT PresentationTRANSCRIPT
Practices, Norms and Options: a Mixed Methods Study on the Efficacy of a
Support Group Programme for Cancer Caregivers30 June 2014, University of Sheffield
Presented by Huiying NgOn behalf of the research team at the National University
Hospital:A/P Rathi MahendranA/P Konstadina Griva
Joanne ChuaHaikel LimJoyce Tan
Supported by National University Cancer Institute (Singapore) Seed Fund
Overview• Background: Conceptual Beginnings
• Context: Caregiving in Singapore
• Challenge #1: Finding a theoretical framework (and introduction to SDT)
• Methodology: Mixed Methods
• Challenges and Solutions Adopted
• Preliminary Findings
• Methodological Recommendations
Social Identity Theory
Prejudice
Discrimination
Conflict
Options & information
Insufficient structure
Lack of an “integrated and continuous social self”
Collective identity
Fulfillment Self-realisation
Individual identities
Habitus
Options
Norms
Caregiving in Singapore• “Family” / “informal” caregivers
• Low public awareness of caregivers’ psychological support need
• Filial piety and family obligation
• Disinclination to speak about cancer
Self-determination Theory
Basic Psychologica
l Needs
Motivation
Competence
Autonomy
Relatedness
Research Aims1. How a supportive social environment may assist
caregivers in achieving better psychological resilience, namely through providing autonomy support, interpersonal involvement and a structured framework for caregiving
2. How these aspects of the social environment interact with caregiving motivations to result in psychological outcomes
3. The qualitative form that such a social environment would take.
Methodology
Quantitative QualitativeSemi-structured interview
Pre-intervention•Challenges faced•Family support•Caregiving disruption to life goals•Expectations of group
Post-intervention•“What did you like or not like about the support group?”•Improvements•Met expectations?
Construct Measure
Caregiver Quality of Life and Burden
Caregiver Quality of Life-Cancer (CQOLC)
Caregiver Stress
Perceived Stress Scale (PSS)
Hospital Anxiety and Depression Scale (HADS)
Basic Psychological Needs
Basic Psychological Needs Scale (BPNS)
Perceived Competence
Perceived Competence Scale (PCS)
Perceived Autonomy Support
Healthcare Climate Questionnaire (HCCQ)
Perceived Relatedness
Interpersonal Support Evaluation List (ISEL)
Quantitative MeasuresConstruct Measure Reliability in previous
samplesCaregiver Quality of Life and Burden
Caregiver Quality of Life-Cancer (CQOLC)
= .91 (Weitzner et al., 1999)
Caregiver Stress
Perceived Stress Scale (PSS)
Hospital Anxiety and Depression Scale (HADS)
= .91 (Sheldon Cohen & Janicki-Deverts, 2012)
= .76 (Lok & Bishop, 1999)
Basic Psychological Needs Basic Psychological Needs Scale (BPNS)
= .79 to .87 (Ilardi et al., 1993; Kasser, Davey, & Ryan, 1992)
Perceived Competence Perceived Competence Scale (PCS)
= .95; Williams et al., 1996)
Perceived Autonomy Support
Healthcare Climate Questionnaire (HCCQ)
= 0.80 (Williams, Freedman, & Deci, 1998)
Perceived Relatedness Interpersonal Support Evaluation List (ISEL)
= .81 (Scrignaro, Barni, & Magrin, 2011)
Thematic AnalysisTheoretical
understanding of motivations, basic
psychological needs
Review of dataset: Inductive coding of themes and codes
Fitting codes to theoretical framework
Challenges and SolutionsQualitative:1. Citing family ties as a reason for caregiving—not explicitly value-laden2. Citing filial obligation—which is value-laden—how do we decide if
someone is falling on the maladaptive side of a social norm?3. Choice to use semantic meanings rather than latent meanings
Mixed methods:4. People mention different motivations all across the duration of the
interview. How do we rank people by their level of motivation? 5. Goals: goal alignment, goal conflict, reprioritization, shifting goals, goals
are unclear. Can we code these into analyzable categories?6. How to relate personal goals to desires and motivation?
Ng, J. Y. Y., Ntoumanis, N., Thogersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-
Determination Theory Applied to Health Contexts: A Meta-Analysis. Perspectives on Psychological Science, 7(4), 325–340.
doi:10.1177/1745691612447309
Preliminary Findings• Preliminary analysis
focuses on motivations and cultural issues
• Does the group relate to better wellbeing?o Yes: group provides caregivers
with expert information, reminders of self-care tips, role models and downward social comparison, and an understanding that they are not alone.
o Yes; quantitatively, the group increased positive adaptation scores.
Pre Post22.5
23
23.5
24
24.5
25
25.5
26
Change in Positive Adaptation
ControlIntervention
Time
Positive Adaptation
Scale
Preliminary Findings• How do our qualitative and quantitative findings
complement each other?o Qualitative findings suggest that caregivers’ motivations for caregiving
may influence the benefits they draw from the group, as well as their support needs
o Motivations for caregiving fell under two broad categories: externally regulated motivations (FP or family obligations) and intrinsic motivation (pleasure of caring).
o Quantitatively, more internal motivations correlated with more positive outcomes and fewer negative outcomes
Motivations for caregiving
+ Basic Psychological
Needs
Pre-intervention
r = .856
+ Basic Psychological
Needs
Post-intervention
r = .910
+ Autonomy
+ Relatedness r = .969
r = .812
- Financial Concerns
- Stress r = -.917
r = -.799
Further steps• Socio-cultural norms may interact with individual
motivations to influence caregiver distress, the support they receive from the group, and improvements in outcomes.
• Norms? Caregiver post-intervention outcomes may relate to their initial levels of motivation
• Further analysis:o Qualitative benefits of the support groupo Relation of qualitative aspects with basic psychological needs (BPN)o Relation of qualitative aspects with caregiver outcomeso Relation of qualitative and BPN with caregiver outcomeso Interaction of qualitative aspects and motivations to affect outcomes
Thank you for listening!Questions?