Presentation on theme: "Practices, Norms and Options: a Mixed Methods Study on the Efficacy of a Support Group Programme for Cancer Caregivers 30 June 2014, University of Sheffield."— Presentation transcript:
Practices, Norms and Options: a Mixed Methods Study on the Efficacy of a Support Group Programme for Cancer Caregivers 30 June 2014, University of Sheffield Presented by Huiying Ng 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 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
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 Psychological Needs MotivationCompetence Autonomy Relatedness
Research Aims 1.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 Qualitative Semi-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? ConstructMeasure 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 Measures ConstructMeasure Reliability in previous samples Caregiver 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 Analysis Theoretical understanding of motivations, basic psychological needs Review of dataset: Inductive coding of themes and codes Fitting codes to theoretical framework
Challenges and Solutions Qualitative: 1.Citing family ties as a reason for caregiving—not explicitly value-laden 2.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: 1.People mention different motivations all across the duration of the interview. How do we rank people by their level of motivation? 2.Goals: goal alignment, goal conflict, reprioritization, shifting goals, goals are unclear. Can we code these into analyzable categories? 3.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.
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 group o Relation of qualitative aspects with basic psychological needs (BPN) o Relation of qualitative aspects with caregiver outcomes o Relation of qualitative and BPN with caregiver outcomes o Interaction of qualitative aspects and motivations to affect outcomes