title: Factors influencing changes in health related quality of life of caregivers of persons with multiple chronic conditions.
abstract: BACKGROUND
  The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from a literature review.
  
  
  METHODS
  This is a secondary analysis of a study of 194 family caregivers who were recruited from two Canadian provinces Alberta and Ontario. Data were collected in-person, by telephone, by Skype or by mail at two time periods spaced 6 months apart. The sample size for this secondary analysis was n = 185, as 9 participants had dropped out of the study at 6 months. Changes in the scores between the two time periods were calculated for SF12v2 physical component score (PCS) and mental component score (MCS) and the other main variables. Generalized Linear Modeling was then used to determine factors associated with changes in HRQL.
  
  
  RESULTS
  Participants who had significantly positive increases in their MCS (baseline to 6 months) reported lower burden (ZBI, p < 0.001), and higher general self-efficacy (GSES, p < 0.001) and Masculine BSRI (p = 0.025). There were no significant associations among variables and changes in PCS (baseline to 6 months).
  
  
  CONCLUSIONS
  Our findings suggest that a masculine gender identity (which incorporates assertive and instrumental approaches to caregiving), and confidence in the ability to deal with difficult situations was positively related to improvement in mental health for caregivers of persons with MCC. Decreases in perceptions of burden in this populations was also associated with improvements in mental health. Further research is needed to explore ways to support caregivers of older persons with multiple chronic conditions living at home.
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd Level ECHA, 11405 - 87th Ave, Edmonton, AB, T6G 1C9, Canada. wendy.duggleby@ualberta.ca.
authors.forename: Wendy
authors.initials: W
authors.lastname: Duggleby
authors.affiliation: School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.affiliation: Alberta Health Services-Cancer Care, University of Alberta, Edmonton, AB, Canada.
authors.forename: Sunita
authors.initials: S
authors.lastname: Ghosh
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd Level ECHA, 11405 - 87th Ave, Edmonton, AB, T6G 1C9, Canada.
authors.forename: Heather
authors.initials: H
authors.lastname: Moquin
authors.affiliation: School of Nursing, McMaster University, Room HSc3N25C, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
authors.affiliation: College of Nursing, University of Saskatchewan, E-Wing, 4340, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
authors.forename: Shelley
authors.initials: S
authors.lastname: Peacock
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease / Q000451:nursing* / Q000523:psychology*; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009864:Ontario; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D020377:Self Efficacy; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: Caregivers; Gender identity; General self efficacy; Quality of life