Abstract
Background
Burden of care and negative health consequences are evident in informal caregiving. Intervention studies, if any, are largely limited to the field of adult or elderly care although there are specific needs for parents of chronically ill and disabled children, for example, lack of acceptance, special life course problems, and supply deficits.
Aim
The effect of a legally funded, one-week health program offered by the Social Insurance for Agriculture, Forestry, and Horticulture (SVLFG) on the well-being of the participating parents of children with a high level of care is determined. Secondary outcome measures are stress and behavior theory-based characteristics.
Subject and methods
In a controlled panel study (intervention group n = 23, comparison group n = 33, allocation not randomized) well-being (WHO-5 index) and other measures (subjective burden, acceptance of the care situation, institutional and social support, recreational and care-related behavior) were collected at several measurement points. Statistical methods are fixed effects panel regressions under control of time-varying characteristics (external conditions, period effects).
Results
At the start of the intervention, 70% of the intervention group (83% mothers, 73% at least 51 years old) are at the threshold of clinically relevant depressiveness. After a very clear initial effect, the level remains above the baseline level for up to 15 weeks after the intervention (under stable conditions). A sinking below the initial level is prevented until at least 26 weeks even with significantly increasing external conditions. The main drivers appear to be sustained increases in acceptance of the care situation, institutional support, and recreational behavior.
Conclusion
Given the high initial burden of the participants, the sustainability of the prevention-oriented intervention is considerable. Nevertheless low-threshold interventions such as telephone or online counselling could be useful after approximately 25 weeks. The intervention is unique for the social insurance system in Germany. The design allows a causal interpretation of the treatment effects despite the small number of cases. Further studies should particularly address effect heterogeneity.
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The authors confirm that all relevant data are included in the article.
Code availability
Code available on request from the corresponding author.
Notes
The terms “informal care,” “family members providing care,” and “home care” are used synonymously here. This refers to persons who provide nursing, medical, and psychosocial care for a person recognized as being in need of care in the home environment and not on a gainful basis.
Frequency of sports/exercise, relaxation exercises, pursuing hobbies, spending free time with others.
Frequency of care provided by professionals (e.g., outpatient service, day care, short-term care), care provided by family, friends, or neighbors, and meetings, phone calls, or other contacts with other caregivers.
Has your child’s need for assistance increased, and if so, how significantly? Have the circumstances for care worsened and if so how significantly? Has something happened that has put a lot of emotional strain on you, and if so, how severe was it?
Such comparisons are bias-free only if there is randomized group assignment or, in the case of nonexperimental designs, only if certain conditions are met (e.g., Hausman test).
For reference, at the last measurement point, the 50% and 75% quantiles of ext. are 23 and 58 points, respectively. Figure 2 shows the coefficients b (filled/unfilled points for p < 0.05/p < 0.10) from the fixed effects panel regression (model 5 for different trajectories of the external conditions)
Due to the different centering of ext., only the main effects of the measurement time points change; all other model parameters are identical to model 5 in Table 2. The initial effect at the end of the intervention is identical for all manifestations of ext. because no change in the external conditions can be assumed for the one-week intervention period and these were therefore not surveyed. The values (b/s.e./p) for ext. = 25 (5 weeks: 7.58/4.65/0.105; 15 weeks: 9.44/3.99/0.019; 26 weeks: 4.98/3.98/0.213) and for ext. = 50 (5 weeks: 1.09/8.86/0.902; 15 weeks: 3.47/4.64/0.456, 26 weeks: 4.67/4.52/0.303).
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This work was supported by the Bayerisches Staatsministerium für Gesundheit und Pflege (VI6/33442/0/17).
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All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by CH and TA. The first draft of the manuscript was written by CH and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The Ethical Committee of the German Sport University Cologne approved the study protocol (Nr. 066/2018).
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Hetzel, C., Alles, T., Holzer, M. et al. Does a one-week health program promote well-being among caregiving parents? A quasiexperimental intervention study in Germany. J Public Health (Berl.) 31, 1361–1372 (2023). https://doi.org/10.1007/s10389-021-01671-2
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DOI: https://doi.org/10.1007/s10389-021-01671-2