Linda Lindsey Davis

Selection and use of content experts for instrument development

Content experts frequently are used in the judgment-quantification stage of content validation of instruments. However, errors in instrumentation may arise when important steps in selecting and using these experts are not carefully planned. The systematic process of choosing, orienting, and using content experts in the judgment-qualification stage of instrument development is addressed, with particular attention to the often neglected, important step of familiarizing these experts with the conceptual underpinnings and measurement model of the instrument. An example using experts to validate content for a measure of caregiver burden is used to illustrate this stage of instrument review.

Instrument review: Getting the most from a panel of experts

Summary Authors on research methods frequently recommend the use of a panel of experts to maximize the likelihood of content-valid, well-constructed data collection instruments. Figure 3 summarizes the panel review process as a series of steps, beginning with the first draft of an instrument and ending with the pilot testing of the instrument. When items are revised as a result of expert reviews, the revised instrument also should be subjected to this same series of steps. This article has been an attempt to provide criteria for selecting expert reviewers and maximizing their participation in assessment of data collection instruments. Panel reviews provide opportunities for investigators to secure valuable expert consultation from colleagues in nursing and other disciplines. Careful use of this expertise is one of the most important components of the instrument development process. Finally, an investigator also should keep in mind that the experts who participate in instrument review have a professional investment in the study. As such, it is an expected courtesy to inform experts of the subsequent performance of the instruments they have reviewed, as well as the outcomes of the study.

Mobile health messages help sustain recent weight loss.

BACKGROUND Using regulatory focus theory, an intervention of daily weight loss-sustaining messages was developed and tested for acceptability, feasibility, and efficacy on helping people sustain weight loss. METHODS Participants (n = 120) were randomized to a promotion, prevention, or an attention-control text message group after completion of a weight loss program. Participants completed baseline assessments, and reported their weight at 1 and 3 months postbaseline. RESULTS Participants found the message content and intervention acceptable and valuable. A minimum of one message per day delivered at approximately 8:00 am was deemed the optimal delivery time and frequency. The sustained weight loss rate at month 3 for the control, promotion, and prevention groups was 90%, 95%, and 100%, respectively. Medium-to-large effects were observed for the promotion and prevention groups at month 1 and for prevention at month 3 relative to controls. The mean weight loss for promotion and prevention was 15 pounds, compared with 10 in the controls at month 3. CONCLUSION A clinically significant decrease in mean weight, higher rate of sustained weight loss, and medium-to-large effects on sustained weight loss occurred in the promotion and prevention interventions. Tools such as this text message-based intervention that are constructed and guided by evidence-based content and theoretical constructs show promise in helping people sustain healthy behaviors that can lead to improved health outcomes.

Living with Loss: The Stroke Family Caregiver

Stroke family caregiver self-losses are the focus of this study. The data presented here were collected as part of a larger study of stress, coping, and adaptation in stroke family caregiving. Information on personal losses was derivedfrom a series of intensive interviews over time with stroke caregivers involved in home careforfirst-time stroke survivors during the acute phase of recovery. Thematic analysis of audiotaped transcriptions indicated that family caregivers experienced four major self-losses in caringfor the stroke survivor in the home: loss of the familiar self, loss of the autonomous self, loss of the affiliative self, and loss of the knowing self. Implications for family-centered practice to address these four losses are discussed.

The Nature and Scope of Stressful Spousal Caregiving Relationships

The caregiving literature provides compelling evidence that caregiving burden and depressive symptoms are linked with stressful care relationships, however, relational difficulties around caregiving are seldom described in the literature. This article presents findings from content analysis of baseline interviews with 40 Alzheimer’s disease (AD) and Parkinson’s disease (PD) spousal caregivers enrolled in a home care skill-training trial who identified their care relationship as a source of care burden. Disappointment and sadness about the loss of the relationship; tension within the relationship; and care decision conflicts within the relationship were recurrent themes of relational stress in caregiving. These spousal caregivers had relationship quality scores below the mean and burden and depressive symptom scores above the means of other caregivers in the study. These findings provide support for developing dyadic interventions that help spouses manage relational losses, care-related tensions, and care decision-making conflicts.

Measuring Problem Behaviors in Dementia: Developing a Methodological Agenda

As many as 90% of persons with dementing illness demonstrate problem behaviors that range from repetitive verbalizations, agitation, and wandering to verbal and physical aggression toward self and others. Reliable and accurate measurement of these behaviors is crucial for tracking illness progression; for monitoring the effects of pharmacologic and behavioral interventions; and for continued investigation into the correlates of caregiver stress, burden, and coping. However, there is no single, universally accepted measure or methodology for operationalizing problem behaviors, and variations in definition and measurement across studies complicate drawing meaningful conclusions about these behaviors. This article is an overview of five factors that have complicated accurate and dependable measurement of problem behaviors in dementia: the shifting domain of problem behaviors, slippage across research constructs, unexplored rater bias, scoring bias, and the absence of benchmarking studies. A methodological agenda is discussed for future investigations in this rapidly growing area of gerontological research.

Biopsychological Markers of Distress in Informal Caregivers

Background. Thirty caregiving wives participated in a study of caregiving distress and negative mood (depressive symptoms) by making diary entries on stressful caregiving situations and collecting saliva samples 4 times a day. At the end of the 7-day study period, caregivers’ salivary cortisol production was compared with their diary entries and correlated with pencil and paper self-report scores of caregiver distress and depressive symptoms. Findings. Despite the inability to control a number of factors thought to confound cortisol production (exercise, smoking, alcohol ingestion, and prescription medications), there was a statistically significant difference between No Caregiving and Caregiving cortisol, F(1,739) = 7.67, P = 0.006, with cortisol production higher when caregiving events occurred. However, efforts to code specific types of caregiving situations (e.g., 1 = indirect care; 4 = AD problem behavior care) did not further differentiate cortisol production. Although caregivers’ self-reports for the same 7-day period indicated they were depressed, pencil-and-paper measures of distress and negative affect were not significantly correlated with cortisol production. Conclusions and Recommendations. The finding that this caregiving group was significantly stressed by caregiving, as evidenced by increased cortisol production during caregiving episodes, verifies the importance of further exploration of specific caregiving situations as contributory factors in caregiver health and well-being. In that saliva is a relatively economical and comparatively noninvasive biological data source for community-based stress studies, methodological limitations of the study are identified and 5 recommendations are made for future biological marker studies of caregiver distress in community-based settings.

Caring for Family with Alzheimer's Disease and Parkinson's Disease

A convenience sample of 40 family members caring for an individual with either Alzheimers disease (AD) or Parkinsons disease (PD) completed the Caregiver Assistance Measure (CAM) to identify the types of assistance that would be most helpful in caring for a family member at home. The CAM measures three categories or types of assistance: care knowledge and skills, self-care, and resource acquisition. Caregivers also completed open-ended questions about the difficulties and the satisfactions of caregiving. The PD and AD caregivers agreed on the importance of 75% of the assistance items on the CAM. In addition, both groups of caregivers identified issues related to care knowledge and skills and selfcare as the most difficult aspects of caregiving. These findings suggest many caregiver needs may be common across chronic illness populations and provide initial support for the development and testing of standardized interventions for caregivers.

Development of a Theoretically Driven mHealth Text Messaging Application for Sustaining Recent Weight Loss

Background Mobile phone short message service (SMS) text messaging, has the potential to serve as an intervention medium to promote sustainability of weight loss that can be easily and affordably used by clinicians and consumers. Objective To develop theoretically driven weight loss sustaining text messages and pilot an mHealth SMS text messaging intervention to promote sustaining recent weight loss in order to understand optimal frequency and timing of message delivery, and for feasibility and usability testing. Results from the pilot study were used to design and construct a patient privacy compliant automated SMS application to deliver weight loss sustaining messages. Methods We first conducted a pilot study in which participants (N=16) received a daily SMS text message for one month following a structured weight loss program. Messages were developed from diet and exercise guidelines. Following the intervention, interviews were conducted and self-reported weight was collected via SMS text messaging. Results All participants (N=16) were capable of sending and receiving SMS text messages. During the phone interview at 1 month post-baseline and at 3 months post-baseline, 13/14 (93%) of participants who completed the study reported their weight via SMS. At 3 months post-baseline, 79% (11/14) participants sustained or continued to lose weight. Participants (13/14, 93%) were favorable toward the messages and the majority (10/14, 71%) felt they were useful in helping them sustain weight loss. All 14 participants who completed the interview thought SMS was a favorable communication medium and was useful to receive short relevant messages promptly and directly. All participants read the messages when they knew they arrived and most (11/14, 79%) read the messages at the time of delivery. All participants felt that at least one daily message is needed to sustain weight loss behaviors and that they should be delivered in the morning. Results were then used to develop the SMS text messaging application. Conclusions Study results demonstrated the feasibility of developing weight loss SMS text messages, and the development of an mHealth SMS text messaging application. SMS text messaging was perceived as an appropriate and accepted tool to deliver health promotion content.

Constructing the reality of recovery: family home care management strategies.

Development of home health care programs for family caregivers is predicated on an understanding of prolems caregivers encounter and ways in which they manage those problems. This article describes home care management strategies of family caregivers of stroke survivors. Qualitative analysis of interviews with a purposive sample of family caregivers indicated that caregivers of stroke survivors practice situational vigilance for the stroke survivor, create solutions for problems associated with functional losses of a stroke, construct the reality of recovery for themselves and the stroke survivor, and seek to find personal meaning in the caregiving experience. Implications for practice and future research are proposed.