Care transitions for individuals with disabling conditions, such as stroke, are often ineffective and inefficient, resulting in unmet patient and caregiver needs, increased safety risks, readmissions, and increased healthcare costs. An assessment instrument designed to evaluate caregiver’s preparation to assume the caregiving role is needed to facilitate the development of tailored care plans and interventions to mitigate the risks of poorly prepared caregivers, and associated health effects on caregiver and stroke survivor. The purpose of this dissertation was to develop and then evaluate selected psychometric properties of the proposed Preparedness Assessment for the Transition Home after Stroke (PATH-s), a 25-item self-administered instrument to assess the commitment and capacity of caregivers based on the Improving Stroke Caregiver Readiness Model. We utilized a sequential, multi-method approach, which included item generation from qualitative data, review of items by expert clinicians, and cognitive interviews of caregivers of stroke survivors. This was followed by a cross-sectional study of 183 caregiver-stroke survivor dyads during IRF admission to identify the factor structure, and to evaluate the internal consistency reliability, construct validity, and criterion-related validity of the PATH-s. Data were collected using a self-administered questionnaire to describe participant characteristics, the PATH-s, Preparedness for Caregiving Scale (PCS), PHQ-9, Perceived Stress Scale, and Global Health Survey (GHS). Factor analysis revealed 8 factors aligned with the Improving Stroke Caregiver Readiness Model, upon which the PATH-s was developed. The PATH-s demonstrated excellent internal consistency (Cronbach’s α = 0.90). Criterion related validity of the PATH-s with the PCS was demonstrated (R = 0.79; p < 0.01). The PATH-s and PCS were negatively correlated with the PHQ-9 (R = –0.26, –0.27 respectively, p < 0.01) and positively correlated with the GHS (R = –0.46, 0.46 respectively, p < 0.01), which demonstrated convergent validity. Preliminary psychometric testing of the PATH-s indicated good reliability and validity, although assessment of validity was limited. Further testing of the PATH-s to assess additional psychometric properties is suggested. The PATH-s may support a primary prevention strategy to identify gaps in preparedness for stroke caregivers, with the long-range goal to mitigate the effects of suboptimal preparation. Once gaps are identified, care plans can be tailored to better prepare caregivers for the transition home.
|Advisor:||Joseph, Jill G.|
|Commitee:||Drake, Christiana, Harvath, Theresa, Kim, Katherine, Lutz, Barbara J.|
|School:||University of California, Davis|
|School Location:||United States -- California|
|Source:||DAI-B 79/12(E), Dissertation Abstracts International|
|Subjects:||Nursing, Health care management|
|Keywords:||Care transitions, Caregiver, Discharge planning, Instrument development, Psychometric testing, Stroke|
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