S. Nicole Culos-Reed

Studying Adherence to Therapeutic Regimens: Overview, Theories, Recommendations

Prediction of adherence and planning of behavior change can be systematically accomplished by using or modifying well-investigated theories. An overview of these models and recommendations for their use is offered. Control Clin Trials 2000;21:156S-163S

An Exploratory Investigation of the Relationship between Proxy Efficacy, Self-efficacy and Exercise Attendance:

The purpose of the study was to examine the relationship between perceptions of self-efficacy, proxy efficacy, and exercise class attendance of participants involved in a 10-week structured group fitness program. At week 3, 127 females completed measures of self-efficacy and proxy efficacy and their class attendance was monitored for the subsequent four weeks. Self-efficacy was assessed through measures of exercise, scheduling, and barrier self-efficacy. Proxy efficacy was assessed through a measure of fitness instructor efficacy defined as participants’ confidence in their fitness instructors’ communication, teaching, and motivating capabilities. Results revealed positive correlations between self-efficacy variables and proxy efficacy. Hierarchical multiple regression analyses indicated that among those who were classified as exercise initiates (n = 33), self-efficacy and proxy efficacy accounted for 34 percent of the variance in exercise class attendance with the latter variable explaining a unique 12 percent. Consistent with theorizing, these preliminary findings indicate that for instructor-led, group physical activities such as aerobics classes, proxy efficacy perceptions are related to self-efficacy and may also be an important predictor of exercise behavior.

Predictors of Adherence to Behavior Change Interventions in the Elderly

Considering factors at the individual, interpersonal, and environmental level may enhance adherence to interventions in the elderly. A collaborative practitioner-participant relationship is also essential. Control Clin Trials 2000;21:200S-205S

What is the State of the Science on Physical Activity Interventions for Family Caregivers? A Systematic Review and RE-AIM Evaluation

BACKGROUND Family caregivers are an important health care resource and represent a significant proportion of Canadian and US populations. Family caregivers suffer physical and psychological health problems because of being in the caregiver role. Interventions to support caregiver health, including physical activity (PA), are slow to be investigated and translated into practice. PURPOSE To examine the evidence for PA interventions in caregivers and determine factors hampering the uptake of this evidence into practice. METHODS A systematic review and evaluation of internal and external validity using the RE-AIM (Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance) framework was conducted. Randomized controlled trials or pretest/posttest studies of PA interventions were included. RESULTS Fourteen studies were published between 1997 and 2015. Methodological quality of studies and risk of bias was variable. External validity criteria were often not reported. Mean reporting levels were 1) reach, 53%; 2) efficacy/effectiveness, 73%; 3) adoption, 18%; 4) implementation, 48%; and 5) maintenance, 2%. CONCLUSIONS The lack of reporting of components of internal and external validity hinders the integration of caregiver PA interventions into clinical or community settings. Researchers should focus on standardized outcomes, accepted reporting criteria, and balancing factors of internal and external validity, to advance the state of the science.

Exploring Gender Differences in Self-Reported Physical Activity and Health Among Older Caregivers

PURPOSE/OBJECTIVES To document self-reported physical health and activity levels of older caregivers. Gender differences in physical health, physical activity levels, and predictors of physical activity were also examined.
. DESIGN A cross-sectional study.
. SETTING Tom Baker Cancer Centre in Calgary, Alberta, Canada.
. SAMPLE 130 caregivers aged 60 years or older caring for individuals with breast, prostate, or colorectal cancer.
. METHODS Self-report survey including validated questionnaires on physical and mental health and physical activity levels. Convenience sampling was used. Data were analyzed using descriptive statistics, correlations, and multiple regression.
. MAIN RESEARCH VARIABLES The physical component score of the SF-36v2® was the main research variable. Other variables included the mental component score of the SF-36v2, sleep quality, depression, social support, physical activity levels, and anxiety.
. FINDINGS The mean age of caregivers was 70 years. Physical health and physical activity levels were higher than population norms. A significant difference in physical health (p = 0.015) existed between men and women but not in physical activity levels (p = 0.079). Predictors of physical activity levels were age (β = -0.291), physical health (β = 0.307), and caregiving hours per week (β = -0.221).
. CONCLUSIONS The findings suggest that gender had a minimal effect on physical health and no effect on physical activity levels in older caregivers. Depression and poor sleep quality were high in some caregivers but did not predict physical activity levels. 
. IMPLICATIONS FOR NURSING The negative effects of caregiving on physical health and physical activity levels in older caregivers are not universal. Nurses should be aware of the caregiving situation and promote health based on the individual.

Impact of yoga on quality of life for young adult noncurative cancer patients: A pilot study.

249 Background: A growing body of evidence is emerging to suggest that the practice of yoga can improve disease and treatment-related side effects in the non-curative cancer patient by addressing their physical, psychological, and spiritual needs. Regrettably, the literature regarding the positive benefits of yoga for the young adult (YA) non-curative cancer patient is limited. Accordingly, the purpose of this ongoing exploratory study is to examine the feasibility and safety of a 7-week home/hospice based instructive Hatha yoga intervention (Yoga Thrive - available on DVD) in non-curative, YA cancer patients. Secondary outcomes include the examination of the efficacy of yoga in mitigating cancer and treatment-related side effects through ratings of self-reported quality of life (QOL). METHODS A single-arm, non-randomized, pre and post-test, pilot investigation of a 7-week instructive home/hospice-based Hatha yoga program is currently ongoing. Pre/post program data include measures of QOL, specific to palliative disease and spiritual domains as well as open-ended measures of perceived program value. Feasibility data (e.g., recruitment, adherence, safety) are also collected. RESULTS To date, four YA non-curative cancer patients have participated in the 7-week yoga program. Preliminary data show a significant difference in both functional well-being (p= .047, ηp2= 0.78) and spirituality (FACIT-Sp) scores (p= 0.04, ηp2= 0.77). Although not statistically significant, a large effect in physical well-being (ηp2= 0.38); general cancer outcomes (FACT-G) (ηp2= 0.42); and palliative specific scores (ηp2= 0.62) have also emerged. Early responses to the post-program exit questions suggest that participants find the program as an opportunity for self-care, separate from traditional cancer therapies. Subjective improvements in flexibility and mindfulness (e.g., body awareness, relaxation, and calmness) have also been reported. Additionally, participants have complemented the program for its ease and flexibility of use. CONCLUSIONS Early findings of this study provide support for the feasibility and efficacy of a home/hospice-based yoga program for YA non-curative cancer patients.

Exploring correlates of quality of life in older family caregivers to cancer patients.

186 Background: Family caregivers (FCs) have negative impacts to their physical and emotional health, and poorer quality of life (QoL) compared to non-caregivers. Most research on FCs has included heterogeneous samples, therefore little is known about specific groups such as older (age 60+) FCs. Older persons are at increased risk for health problems, may have co-morbidities, and be socially isolated. Understanding factors related to QoL may lead to interventions targeted to older FCs. The purpose of this study was to examine factors associated with QoL in older FCs to cancer patients. METHODS The data for this study are from a larger survey of FCs aged 60+, recruited from a hospital-based cancer facility. FCs were included if their care recipient had breast, prostate or colorectal cancer. QoL was measured using the MOSF-36. Analyses using descriptive statistics and Pearsons correlations were conducted. RESULTS n = 168 participants consented, with n = 129 surveys returned. The majority of participants were female (60.5 %), 70 yrs old (sd 7.4), had at least a college diploma (65.2 %), were spouses of the patient 92.2%, and retired (60.5%). Mean caregiving hours per week was 24.2 (sd 26.3). Mean time as a caregiver was 31 months (45.9). The majority of patients were on treatment (75.2%) and were 71.3 yrs old (sd 7.5). The Physical Component Summary (PCS) of the MOSF-36 was significantly correlated with gender r = -.24, social support r = .25, sleep quality r = -.47, depression r = -.51, state anxiety r = -.40, and trait anxiety r = -.45 (all ps < .01). There were significant correlations between the Mental Component Summary (MCS) and social support r = .40, sleep quality r = -.40, depression r = -.77, gender r = -.25, state anxiety r = -.72, and trait anxiety r = -.71 (all ps < .01). The MCS was correlated with caregiving hours, r = -.197 (p < .05), however, not with patient treatment status. The PCS was not correlated with caregiving hours or patient treatment status. CONCLUSIONS Consistent with previous FC research across different diseases, QoL was associated with gender, caregiving hours per week, social support, sleep quality, depression, and anxiety. Interventions for older FCs of cancer patients could be targeted to specific factors of overall QoL.