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For caregivers, the stress process is multifaceted, involving primary stressors, which stem directly from the needs of the patient, and secondary stressors, which relate to the subjective burden of caregiving. According to stress proliferation theories, both primary and secondary stressors can exacerbate caregiver distress. However, individuals vary considerably in their reactions to caregiving. This study explored whether seeing oneself as part of a couple and incorporating one's relationship into one's self-concept (couple identity) alleviates the negative effects of primary and secondary stressors on caregiver mental health. The sample comprised 92 healthy spouses who had been caregiving for a partner with a chronic physical illness for an average of 5.9 years. Results showed that couple identity partially mediated the effects of negative primary (i.e., relational deprivation and overload) and secondary (i.e., loss of self and captivity) role stressors, and fully mediated the effects of positive secondary role stressors (i.e., caregiver self-esteem and competence) on caregiver mental health. Viewing the relationship as an extension of oneself, or high levels of couple identity, may thus help to minimize the negative effects and maximize the positive effects of the caregiving experience on caregiver mental health. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To validate the transtheoretical model for exercise behavior and the constructs of decisional balance and self-efficacy for exercise in a low-income, poorly educated primary care sample. METHODS: Patients attending public primary-care clinics from 4 separate sites in Louisiana were interviewed regarding their health behaviors. RESULTS: The data provide equivocal support for applying the transtheoretical model for exercise and integrating it with other models of behavior change within this population. CONCLUSIONS: Further studies modifying the decisional balance measures are necessary before definitive statements regarding the applicability of these models to exercise within this specialized population can be made. [ABSTRACT FROM AUTHOR]

Purpose: The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise.Design: A cross-sectional design was used.Setting: The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas.Subjects: Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%).Measures: Standard questionnaires were given to asses stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction.Results: Although the chi 2 analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson chi 2 (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precontemplators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated.Conclusions: These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one. [ABSTRACT FROM AUTHOR]