Cathleen M Connell

Development and Validation of the Diabetes Care Profile

To determine the reliability and the validity of the Diabetes Care Profile (DCP), an instrument that assesses the social and psychological factors related to diabetes and its treatment, two studies with separate populations and methodologies were conducted In the first study, the DCP was administered to, and physiologic measures collected from, individuals with diabetes being cared for in a community setting (n = 440). In the second study, the DCP and several previously validated scales were administered to individuals with diabetes receiving care at a university medical center (n = 352). Cronbachs alphas of individual DCP scales ranged from .60 to .95 (Study 1) and from .66 to .94 (Study 2). Glycohemoglobin levels correlated with three DCP scales (Study 1). Several DCP scales discriminated among patients with different levels of disease severity. The results of the studies indicate that the DCP is a reliable and valid instrument for measuring the psychosocial factors related to diabetes and its treatment.

The costs of caring: impact of dementia on family caregivers.

With the aging of the population, an increasing number of older adults are diagnosed with Alzheimers disease or a related disorder. Most people with a dementing illness will be cared for at home by a family member, who may experi ence a variety of physical, emotional, financial, and social burdens associated with the caregiving role. The purpose of this article is to (a) examine the physical and psychological effects of providing care to a family member with a dement ing illness, (b) describe the factors that help determine the nature and magnitude of these effects, and (c) discuss several approaches to caregiver intervention designed to reduce the negative impact of this challenging role. Sociodemographic characteristics (e.g., gender, relationship to the patient, culture, race, ethnicity), caregiver resources (e.g., coping, social support, availability of a companion animal), and personal characteristics (e.g., personality, health behaviors) shape the dementia caregiving experience and have implications for interventions designed to prevent or lessen the stress and burden that often accompany the role. (J Geriatr Psychiatry Neurol 2001; 179-187).

Emotional Support From Parents Early in Life, Aging, and Health

The purpose of this study is to estimate the relationship between receiving emotional support from parents early in life and an individuals health in adulthood. Analysis of data from a nationally representative sample of adults ages 25-74 years suggests that a lack of parental support during childhood is associated with increased levels of depressive symptoms and chronic conditions in adulthood. These associations between early parental support and adult health persist with increasing age throughout adulthood. Personal control, self-esteem, and social relationships during adulthood account for a large portion of these long-term associations. These findings underscore the importance of adopting a life course perspective in studying the social determinants of health among adults.

Predictors of decreased self-care among spouse caregivers of older adults with dementing illnesses.

This study describes the health behaviors (alcohol consumption, exercise, sleep patterns, smoking, and weight maintenance) of a sample of older adult spouse caregivers (N = 233) and investigates the predictors of decreased self-care since caregiving began. Multiple regression results indicate that caregivers who experience greater developmental burden, report a greater number of depressive symptoms, perform a greater number of activities of daily living (ADL) tasks in caregiving and spend more hours in a day providing care, and who have lower self-efficacy for both self-care and spouse care are at greater risk for negative health behavior change. Results have implications for the identification of caregivers who may be particularly vulnerable to the negative health impact of caregiving.

Impact of Social Support, Social Cognitive Variables, and Perceived Threat on Depression Among Adults With Diabetes

Tested was a model of social support and cognitive appraisal of self-efficacy, outcome expectancies, and illness threat on depression. Study participants were community-dwelling adults with diabetes who completed a mailed questionnaire (N = 362). Results of structural equation modeling indicated that 52% of the variance in depression was explained by the model--largely by the direct effects of physical functioning, the perceived availability of social support, and the perceived threat of diabetes as well as the indirect paths from perceived support to perceived threat and from physical functioning to perceived support and perceived threat of diabetes. Diabetes-specific social support, self-efficacy, and outcome expectancies were not significant predictors of depression.

Differences between African Americans and whites in their perceptions of alzheimer disease

To design optimal health services and education programs for Alzheimer disease (AD), it is important to understand cultural differences in perceptions of the disorder. In this study, we investigated differences between African Americans and whites in their beliefs, knowledge, and information sources regarding AD. We distributed a written questionnaire through lay and professional organizations and meetings in the southeastern United States, yielding a sample of 452 adults (61% white, 39% African American; 78% female; mean age 47 years; 33% with family history of AD). The questionnaire assessed the following: (1) illness beliefs, (2) factual knowledge, (3) sources of information, and (4) perceived subjective threat of AD. African Americans and whites were generally similar in their beliefs about common symptoms, prominent risk factors, and the effectiveness of treatments for AD (although whites expressed greater certainty in these beliefs than African Americans). In comparison to whites, African Americans showed less awareness of facts about AD, reported fewer sources of information, and indicated less perceived threat of the disorder. These preliminary findings suggest important distinctions between African Americans and whites in their knowledge about, and conceptualization of, AD. Follow-up studies with more representative samples and more fully validated measures will be necessary to confirm these differences. Health psychologic research suggests that such differences in illness perceptions could shape response to disease burden, assessment and diagnosis, and available health care options.

Measurement of health-related QOL in diabetes mellitus

A number of health-related QOL (HR-QOL) measures specifically designed for people with diabetes mellitus have appeared in the literature. This article provides a selective review of 12 measures that address this important construct. For each included study, a description of the measure and its development phase is provided, followed by discussion of sampling, reliability, validity and appropriateness for selected populations. Measures designed to investigate broad and specific conceptualisations of diabetes-specific QOL are included.For research in which a broad conceptualisation of diabetes-specific QOL is appropriate, the following measures are recommended: Diabetes-39, Diabetes Care Profile (DCP), Diabetes Impact Management Scales (DIMS), Diabetes Quality of Life (DQOL) and the Diabetes-Specific Quality of Life Scale (DSQOLS). For investigation of one or more specific aspects of diabetes-specific QOL, other measures may also be appropriate: single-scale questionnaires such as the Appraisal of Diabetes Scale (ADS) [stressful impact], Audit of Diabetes-Dependent Quality of Life (ADDQoL) [life without diabetes] and the Problem Areas in Diabetes scale (PAID) [diabetes-related distress]; the Diabetes Health Profile (DHP) which focuses on diabetes-related distress, activity and eating behaviour; the Questionnaire on Stress in Patients with Diabetes-Revised (QSDR) which has a primary focus on diabetes-related distress; and the Well-Being Enquiry for Diabetics (WED) which is primarily concerned with the perceptions of patients with diabetes in relation to mental health. Researchers selecting a diabetes-specific QOL measure should also carefully consider the conceptual underpinnings of the available instruments, as there is little uniformity in the definition and conceptualisation of HR-QOL.Based upon participants involved in questionnaire development and validation studies, those questionnaires that appear to be most appropriate for use with a variety of patient populations include the Diabetes-39, DIMS, Diabetes Quality of Life Clinical Trial Questionnaire — Revised (DQLCTQ-R), PAID and the QSD-R. The DCP and DHP appear to be especially relevant measures of HR-QOL for patients with type 2 diabetes, while the DQOL, DSQOLS and WED have clear emphases on concerns of individuals with type 1 diabetes. The length of the DQLCTQ-R may raise concerns about its use among some populations (e.g. older adults).Recommendations for future research include: (i) increasing the diversity of samples used to develop and evaluate existing and new measures in terms of race/ethnicity, age and gender; (ii) examination of the causal relationship between diabetes self-management and QOL using longitudinal designs; (iii) increasing emphasis on the positive aspects of successful chronic illness self-management; and (iv) use of HR-QOL measures to inform empowering relationships between physicians and patients.

Public opinion about alzheimer disease among blacks, hispanics, and whites : Results from a national survey

Recent research has documented notable differences in knowledge, awareness, and cultural beliefs about Alzheimer disease (AD) among groups defined by race and ethnicity. The present study was conducted to assess racial differences in knowledge and attitudes about AD among a national sample of adults. Data from 1176 adults aged 35 years and over (48.6% White, 25.7% Black, and 25.8% Hispanic) obtained via telephone interview were used in this study. Although some notable group differences defined by race/ethnicity were observed, more similarities in patterns of response were discovered than expected. Black and Hispanic respondents were significantly more likely to believe that AD is a normal part of aging, but were more optimistic about future advances in research than White participants. Compared with White and Black respondents, Hispanics were more likely to report feeling well-prepared for handling a diagnosis of AD in a family member. Overall, the results suggest that misconceptions about AD remain among large segments of the population, that AD remains a source of significant concern, and that continued efforts are needed to educate the public about this disease.

The Stress Process among Dementia Spouse Caregivers: Are Caregivers at Risk for Negative Health Behavior Change?

This study examines the relationship between the demands of providing care to a spouse with dementia and caregiver health behaviors, specifically exercise, sleep patterns, weight maintenance, smoking, and alcohol consumption. Structural equation modeling was used to test a model predicting health behavior change from personal and environmental characteristics, perceived stress, social support, and depressive symptoms in a sample of 233 spouse caregivers of dementia patients and to examine gender differences in these relationships. Results support the hypothesis that caregiving negatively influences health behaviors. Among both women and men, health behavior change is directly influenced by depressive symptoms and objective burden. In addition, depressive symptoms mediate the effects of self-efficacy and objective burden on health behavior change. These results support the notion that health behavior change may represent one mechanism by which caregiving stress leads to adverse health outcomes.

Spouse Caregivers' Attitudes Toward Obtaining a Diagnosis of a Dementing Illness

OBJECTIVES: To examine attitudes of spouse caregivers about the process of obtaining a diagnosis of a dementing illness, including perceived benefits and obstacles to obtaining a diagnosis and suggestions for improving the process.