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Older adults with memory loss often require assistance from caregivers to manage their medications. This study examined the efficacy of a problem-solving-based intervention focused on caregiver medication management, problem solving, self-efficacy, and daily hassles. Caregiver health-related quality of life (HRQoL) and patient health care utilization were secondary outcomes. Totally, 83 patients (age 79.9±8.8 years) and their informal caregivers (age 66.9±12 years, female 69.9%, White 85.5%) were randomized; data collection occurred at baseline, 8, 16, and 24 weeks. Linear mixed modeling showed significant decreases in medication deficiencies which were sustained over time. No significant changes in caregiver problem solving, daily hassles, or patient health care utilization occurred between groups or over time. In addition, caregiver self-efficacy and mental HRQoL decreased in both groups. Physical HRQoL decreased in the intervention group, yet increased in the usual care group. Future research should investigate these outcomes in larger and more diverse samples. [ABSTRACT FROM AUTHOR]

Limited research exists assessing problem-solving capabilities among caregivers of individuals with memory loss using a validated instrument. To address this gap, the current study evaluated the psychometric properties of the Problem Solving Inventory (PSI) using data at baseline and 8 weeks from a randomized controlled trial among caregivers (N = 78) of community-dwelling individuals with memory loss. Participants were mainly White (85.9%), female (71.8%), and on average age 66.5. Cronbach's alphas ranged from 0.84 to 0.92 for the subscales and overall PSI. Test-retest reliability over 8 weeks ranged from 0.44 to 0.56. Five factors were retained through exploratory factor analysis. Spearman's correlations showed convergent validity and discriminant validity between scores on the PSI and Beck Depression Inventory®-II (r = 0.32, p < 0.01), the Self-Efficacy for Managing Chronic Disease Scale (r = -0.44, p < 0.001), and the Newest Vital Sign questionnaire (r = -0.07, p > 0.05). Findings show that the PSI is reliable and valid in assessing problemsolving capabilities among caregivers of individuals with memory loss. [ABSTRACT FROM AUTHOR]

Caring for an older adult with memory loss is stressful. Caregiver stress could produce negative outcomes such as depression. Previous research is limited in examining multiple intermediate pathways from caregiver stress to depressive symptoms. This study addresses this limitation by examining the role of self-efficacy, social support, and problem solving in mediating the relationships between caregiver stressors and depressive symptoms. Using a sample of 91 family caregivers, we tested simultaneously multiple mediators between caregiver stressors and depression. Results indicate that self-efficacy mediated the pathway from daily hassles to depression. Findings point to the importance of improving self-efficacy in psychosocial interventions for caregivers of older adults with memory loss. [ABSTRACT FROM AUTHOR]

colbert a.m., sereika s.m. & erlen j.a. (2012) Functional health literacy, medication-taking self-efficacy and adherence to antiretroviral therapy. Journal of Advanced Nursing 69(2), 295-304. doi: 10.1111/j.1365-2648.2012.06007.x Abstract Aims. To report a study of the relationship between functional health literacy and medication adherence, as mediated by medication-taking self-efficacy, while controlling for the effect of key demographic variables (such as race, income and level of education). Background. Medication adherence is critical to successful HIV/AIDS self-management. Despite simplified regimens and the availability of tools to assist with medication-taking, adherence remains a challenge for many people living with HIV/AIDS. Design. Cross-sectional, secondary analysis. Methods. Data for this study of 302 adults living with HIV/AIDS who were taking antiretroviral medications were collected from January 2004-December 2007. Medication adherence was measured using electronic event monitors. Bivariate analyses and stepwise regression were conducted to examine the associations among functional health literacy, medication-taking self-efficacy and HIV medication adherence. Results. Overall, functional health literacy was much higher than expected; however, adherence in this sample was sub-optimal. Higher medication-taking self-efficacy was associated with higher medication adherence; however, functional health literacy was not significantly related to either medication adherence or self-efficacy beliefs. Hence, medication-taking self-efficacy did not mediate the relationship between functional health literacy and medication adherence. Conclusions. Medication adherence continues to be an issue for people living with HIV/AIDS. Additional research is needed to understand the disparate findings related to functional health literacy and medication adherence in this and other studies examining this association. [ABSTRACT FROM AUTHOR]

erlen j.a., cha e.s., kim k.h., caruthers d. & sereika s.m. (2010) The HIV Medication Taking Self-efficacy Scale: psychometric evaluation. Journal of Advanced Nursing 66(11), 2560-2572. Aim. This paper is a report of an examination of the psychometric properties of the HIV Medication Taking Self-efficacy Scale. Background. Self-efficacy is a critically important component of strategies to improve HIV medication-taking; however, valid and reliable tools for assessing HIV medication-taking self-efficacy are limited. Method. We used a cross-sectional, correlational design. Between 2003 and 2007, 326 participants were recruited from sites in Pennsylvania and Ohio in the United States of America. Six self-report questionnaires administered at baseline and 12 weeks later during 'Improving Adherence to Antiretroviral Therapy' were used to examine the variables of interest. Means and variances, reliability, criterion, and construct validity of the HIV Medication Taking Self-efficacy Scale were assessed. Findings. Participants reported high self-confidence in their ability to carry out specific medication-related tasks (mean = 8·31) and in the medication's ability to effect good outcomes (mean = 8·56). The HIV Medication Taking Self-efficacy Scale and subscales showed excellent reliability (α = 0·93∼0·94). Criterion validity was well-established by examining the relationships between the HIV Medication Taking Self-efficacy Scale and selected physiological and psychological factors, and self-reported medication adherence ( r = −0·20∼0·58). A two-factor model with a correlation between self-efficacy belief and outcome expectancy fitted the data well (model χ2 = 3871·95, d.f. = 325, P < 001; CFA = 0·96; RMSEA = 0·046). Conclusion. The HIV Medication Taking Self-efficacy Scale is a psychometrically sound measure of medication-taking self-efficacy for use by researchers and clinicians with people with HIV. The findings offer insight into the development of interventions to promote self-efficacy and medication adherence in persons with HIV. [ABSTRACT FROM AUTHOR]

Abstract: Background: To date, only a few studies have examined the mediating role of self-efficacy on the relationship between depressive symptoms or perceived social support and medication adherence in persons with HIV. Objectives: The purpose of this study was to examine the impact of perceived social support, depressive symptoms and medication-taking self-efficacy on self-reported medication adherence in persons with HIV. A proposed comprehensive model included three mediation hypotheses in order to examine the mediating roles of medication-taking self-efficacy and depressive symptoms. Method: Baseline data from “Adherence to Protease Inhibitors” were used. The 215 persons with HIV aged 19–61 (mean=40.7, S.D.=7.58) were recruited from multiple sites in Pittsburgh, PA (USA) and through self-referral. The participants were assessed using the Beck Depression Inventory, Interpersonal Support Evaluation List, the Medication Taking Self-Efficacy Scale, and the modified Morisky Self-report Medication Taking Scale. Structural equation modeling (EQS version 6.1) was used. The Satorra–Bentler Scaled χ 2 test statistics (S–B χ 2), Comparative Fit Index (CFI), and the Standardized Root Mean Squared Residual (SRMR) were used to assess the fit of a comprehensive model including three mediation hypotheses. Results: A comprehensive model with the three hypotheses showed a good model fit (S–B χ 2 (24, N=215)=69.06, p<.001; CFI=.95; SRMR=.057). Medication adherence self-efficacy fully mediated the prediction of self-reported medication adherence by perceived social support and depressive symptoms. Depressive symptoms partially mediated the prediction of medication-taking self-efficacy by perceived social support. Conclusions: The findings of this study provide researchers with increased understanding of the mediating role of medication-taking self-efficacy beliefs between selected psychological variables and self-reported medication adherence in persons with HIV. Future studies need to test the moderating effect of gender, ethnicity and risk factors for HIV on this model and the intervention effect of self-efficacy beliefs using longitudinal data. [Copyright &y& Elsevier]

Supplemental digital content is available in the text. Background: Diabetes self-management and glycemic control are suboptimal among Chinese patients with Type 2 diabetes with a large proportion of patients identified with metabolic syndrome. Objectives: Based on social cognitive theory, this study examines the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, metabolic syndrome and Type 2 diabetes. Methods: A cross-sectional study was conducted among 207 Chinese with Type 2 diabetes living in a suburban area of Beijing, China. Regression models were applied to examine the effect of selected personal, behavioral, and environmental factors on self-management behaviors, glycemic control, and metabolic syndrome. The relationship among individual self-management behaviors, glycemic control, and metabolic syndrome was also examined. Results: Self-efficacy was significantly associated with all self-management behaviors. Social support was related to overall self-management, diabetes knowledge was related to diet, and depressive symptoms was related to self-monitoring. Problem-solving and self-management behaviors related to medication adherence and diet were significant correlates of glycemic control. Health literacy and self-management behaviors related to physical activity were correlates of metabolic syndrome. Discussion: Findings suggest that a multifactorial approach may be beneficial when providing care for Chinese with Type 2 diabetes. In addition, these findings provide support for developing and testing tailored interventions that address problem-solving, health literacy, and self-efficacy, among other factors, to help patients achieve optimal glycemic control and thereby reduce their risk for metabolic syndrome and related complications. [ABSTRACT FROM AUTHOR]

Background: Understanding caregiver's perceptions of their family member's memory loss is a necessary step in planning nursing interventions to detect and address caregiver burden. Objective: The purpose of this study was to characterize caregivers' perceptions of their family members' memory loss and identify potential correlates within Leventhal's common sense model (CSM). Methods: This secondary analysis used baseline data from a larger randomized controlled trial. Patients with memory loss and their caregivers (N = 83 dyads) from the community were included. The adapted Brief Illness Perception Questionnaire (BIPQ) assessed caregivers' illness perceptions. Eight additional instruments measured correlates within the CSM. Responses were described; multiple linear regression was used to predict BIPQ dimension scores, and logistic regression was used to predict dichotomized BIPQ scores. Results: Most caregivers were female, White, and spouses of the patients; they reported a range of perceptions on the nine BIPQ dimensions. Patients' cognitive function consistently emerged as a significant correlate of caregivers' illness perceptions, explaining the most variance in caregivers' perceived consequences, identity, and treatment control (p < .01). Caregivers' reactions to patients' behavioral symptoms and caregivers' trait anxiety were associated with perceived illness coherence (p < .01). Caregivers with higher severity of daily hassles and White caregivers perceived that their family members' memory loss would last longer (p < .001). Discussion: Caregivers' perceptionsof family members' memory loss varied; distinct dimensions of caregivers' illness perception were associated with a range of clinical and psychosocial factors. This exploratory study demonstrates the complexity of applying the CSM to caregivers of persons with memory loss. [ABSTRACT FROM AUTHOR]