Positive Aspects of Caregiving (PAC):

Factor structure & Association with

exemplary care

Dr. Vivian W. Q. Lou

Miss Hi Po Bobo Lau (presenting author)

Dr. Karen S. L. Cheung

The University of Hong Kong, Hong Kong

30th International Conference of Alzheimer’s Disease International –

Care, Cure, and the Dementia Experience – A Global Challenge

15th – 18th April 2015, Perth, Australia

Positive Side of Caregiving

Positive role appraisals that mediate between the stressor and caregiver well-being (Tarlow et al., 2004)

Associated with - better self-rated heath - less depressive symptoms - higher caregiving competence (Basu et al., 2013; Belle et al., 2006; Cheng et al., 2013; Tarlow et al., 2004)

Negative Positive

Enhanced relationships

Joyful moments

Skills enhancement

Meaningful life

Lack of personal time

Anger, frustration

Role conflict

No more time for friends

“There are many faces to

dementia” (Helga Rohra, yesterday)

“Caregiving is an activity of mixed

valence for the caregivers (Lawton et

al., 1991)

Positive Side of Caregiving

- Culture influences

appraisals of burden, roles,

resources (Aranda & Knight, 1997;

Dilworth Anderson, Williams, & Gibson, 2002)

- Racial differences in PAC

due to religiosity (Roff et al., 2004)

Questions:

1. Is the content of PAC

the same across

cultures?

2. How to measure PAC

in Chinese caregivers?

Risk identificatio

n

Assessing intervention outcomes

Capitalizing strengths

Value of assessing

positive side of caregiving

Measurement Tool:

Positive Aspects of Caregiving (PAC) (Tarlow et al., 2004)

11-item

Validating PAC among Chinese dementia

caregivers in Hong Kong

Translation and back-translation by bilingual RAs

Expert validation on face validity (research team and frontline social workers)

Piloting and collection of responses from frontline interventionists at pilot phase of individualized intervention study - REACH-HK (Oct 2011 to Feb 2012)

1. Exploratory factor analysis (EFA) 2. Test of reliability & concurent validity

Sample characteristics

REACH-HK Phase 1 baseline data (April 2012 -

January 2014) : N = 374, who completed all 11-

items of PAC at baseline interview.

GENDER: 76.7% female caregivers

AGE: M = 62.9 (SD = 12.4; RANGE = 23 to 89)

RELATIONSHIP: 50.8% spousal caregivers, 48.4%

children caregivers

EDUCATION: 41.9% primary or less; 38.6% high

school or more

Responses on C-PAC items

• Feel needed (M = 3.25)

• Feel important (M = 3.11)

• Feel useful (M = 2.76)

Most endorsed

items

• Feel appreciated (M = 2.29)

• More positive toward life (M = 2.28)

• Strengthened relationship (M = 1.95)

Least endorsed

items

Response scale : 0 (strongly disagree) to 4 (strongly

agree)

Exploratory factor analysis

Principal Component Analysis with Promax rotation

2 components of eigenvalue over 1.00

a) Enriching life (Item 7 to 11; min loading = .59)

b) Affirming self (Item 1 to 6; min loading = .49)

Item-total

correlation:

.46 - .74

11-item, 2-factors solution was accepted.

Chinese-PAC Scale mean = 27.8; SD = 9.45

Cronbach’s α = .89

Concurrent validity of C-PAC

Sig. negative

correlations:

- CES-D

- bother with problem

behaviors (PB)

- occurrence of problem

behaviors

Sig. positive correlations:

- confidence in dealing

with problem behaviors

- self-rated health (SRH)

Conclusion 1 1. All 11 items loaded satisfactorily on the Chinese

version of the PAC scale, with a 2-factor structure.

2. C-PAC has satisfactory reliability.

3. As expected, C-PAC was related to less depressive

symptoms, lower bother with PBs, lower

occurrence of PBs, higher confidence in dealing

with PBs and better CG self-rated health.

Protective effect of PAC on exemplary

care

Exemplary care: “(…) reflect caregiver affection for the care

recipient and willingness or even eagerness to provide care

that is more than adequate, extending beyond the bounds of

meeting basic needs (…) communicating to care recipients

that they are loved, respected, and worthy of special

consideration (…)” (Dooley et al., 2007).

Exemplary care

CG emotional well-being

CG role appraisals

CG resources

Caregiving context

Protective effect of PAC on exemplary

care

18-item Exemplary care (EC)

20-item CES-D

11-item C-PAC

Social support, financial

sufficiency

CG / CR age, gender,

relationship, CR health, caregiving

years

Example items of EC:

• I actively avoid treating (care recipient) like a child.

• I take the time to sit and talk with (care recipient).

• I make sure that where (care recipient) lives is

bright and cheery.

Based on REACH-HK

Phase 1 baseline data:

N = 248

Protective effect of PAC on exemplary care Variables Model 1 Model 2 Model 3

Social support .08 .00 .02

Caregiving years -.11 -.11 -.10

CG age -.10 -.09 -.11

CR age .08 .11 .12

CG gender -.17* -.16* -.15*

CR gender -33** -.32** -.33**

CR health .11 .12 .10

Financial difficulties -.10 -.10 -.10

Spousal CG .38 .22 .17

Children CG .15 .00 -.07

PAC .36** .37**

CESD (depression) -.03 -.03

CESD X PAC -.15**

Model summary △F(10, 237) = 2.92,

p = .002, △r2 = .11

△F(2, 235) = 19.65,

p = .000, △r2 = .13

△F(1, 234) = 7.21,

p = .008, △r2 = .02

Protective effect of PAC on exemplary

care

Conclusion 2:

Higher PAC tends to amplify the salutary effect of

low depression and generate greater levels of

Exemplary Care (EC)

Limitations

Cross-sectional data analysis

Latent change models to model the relationships

among changes in C-PAC, EC, and other variables

Take home messages

1. Care partners may experience

positive aspects in their caregiving

role, which can be & should be

assessed.

2. Positive role appraisals are related to

good quality of care.

Acknowledgement Funders: Charles K. Kao Foundation for Alzheimer’s Disease,

Henderson Land Development Co Ltd., Partnership Fund.

The REACH-HK Research team: PI – Dr. Karen Cheung S.L. and Co-Is – Dr. Vivian Lou W. Q., Dr. Paul Wong, Dr. Angela Leung,

and COA research members – Dr. Terry Lum, Dr. Gloria Wong, Dr. Andy Ho, Dr. Jennifer Tang, and Ms. Vivian So

Hong Kong Council of Social Service

61 centers of 11 participating NGOs (Baptist Oi Kwan Social Service, Caritas Hong Kong, Sik Sik Yuen, St. James Settlement, The Hong Kong Society for Rehabilitation, The Salvation Army-Hong Kong and Macau Command, Tung Wah Group of Hospitals, The Evangel Lutheran Church of Hong Kong, Yan Chai Hospital Social Service Department, Yan Oi Tong and Hong Kong Sheng Kung Hui Welfare Council Limited)

500 participating caregiver-care recipients dyads

124 trained interventionists

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