Search Results (133)

Background/Objectives: Drowning among children younger than five years remains a major public health problem in Thailand, particularly in residential water environments. Caregivers’ supervision and home safety practices play an important role in preventing childhood drowning. This study evaluated the association between participation in the Be SAFE Program, a community-based educational intervention developed using the Health Belief Model (HBM), and changes in caregivers’ health beliefs and self-reported drowning prevention behaviors. Methods: A quasi-experimental pretest–posttest control group study was conducted among 60 caregivers of children younger than five years recruited from two community settings in Ubon Ratchathani Province, Thailand. Participants were assigned to either an intervention group (n = 30) or a control group (n = 30). The intervention group participated in the HBM-based Be SAFE Program, whereas the control group received routine care. Outcomes included HBM constructs and self-reported drowning prevention behaviors. Baseline-adjusted analyses of covariance (ANCOVA) were performed to compare post-intervention outcomes between groups. Holm adjustment was applied to account for multiple comparisons. Results: After adjustment for baseline scores, caregivers in the intervention group demonstrated significantly greater improvements than those in the control group in perceived susceptibility, perceived severity, perceived benefits, cues to action, self-efficacy, and self-reported drowning prevention behaviors, together with significantly lower perceived barriers (all Holm-adjusted p < 0.05). Large effect sizes were observed across all measured outcomes. Conclusions: The findings suggest that the HBM-based Be SAFE Program was associated with greater short-term improvements in caregivers’ health beliefs and self-reported drowning prevention behaviors than routine care. These findings support the potential value of theory-based community educational programs for childhood drowning prevention while highlighting the need for larger multi-site studies with longer follow-up to confirm the program’s effectiveness and broader applicability. Full article

Background/Objectives: Family dietary imbalance is an important source of the double burden of malnutrition, and dietary arrangements in multigenerational households are often deeply embedded in intergenerational caregiving relationships. However, the cognitive formation mechanism through which dietary caregiving behaviors driven by care and responsibility may instead lead to dietary imbalance still lacks systematic explanation. Therefore, this study aimed to examine the cognitive formation mechanism of dietary imbalance behaviors in Chinese multigenerational households. Methods: This study takes primary dietary caregivers in Chinese three-generation households as the research subjects. It integrates the false consensus effect, cognitive dissonance theory, and the information–motivation–behavioral skills (IMB) model. Based on 467 valid samples, the study conducts empirical analysis using partial least squares structural equation modeling (PLS-SEM) and importance-performance map analysis (IPMA). Results: The results show that caregivers’ subjective judgments about family members’ dietary needs based on their own experience trigger cognitive dissonance and further promote their re-examination of dietary risk information, caregiving responsibilities, and family normative expectations. Among these factors, caregiving responsibilities and subjective norms are key factors in improving dietary regulation self-efficacy, whereas the effect of risk information perception on self-efficacy is not significant. The IPMA results further show that self-efficacy is the most important factor driving the formation of behavioral intention to regulate healthy family diets. Conclusions: This study reveals the psychological mechanism through which dietary imbalance behavior in multigenerational households moves from subjective need judgment to the formation of future regulation intention. It extends the application of the IMB model in family caregiving contexts and provides a theoretical basis and practical implications for the formulation of family health promotion and dietary intervention strategies. Full article

Young breast cancer survivors often develop post-breast surgery pain syndrome (PBSPS). Despite potential benefit from physical activity, access to in-person programs is often limited by competing work and caregiving responsibilities. We assessed the feasibility and acceptability of a remotely delivered physical activity intervention for young Hispanic breast cancer survivors with PBSPS. Our single-arm, 12-week feasibility study enrolled Hispanic women aged ≤60, at least 3 months post-treatment for invasive breast cancer or ductal carcinoma in situ (DCIS), with PBSPS. Using a Fitbit Inspire 3 activity tracker and health coaching, the program encouraged whole-of-day movement to increase activity. Feasibility outcomes included recruitment, retention, and adherence. Secondary outcomes assessed pain measures, daily steps, and quality of life (QOL). Twenty-five breast cancer survivors enrolled (mean age 47.4 years [SD 6.3]), with 76% selecting Spanish-language health coaching. Retention at 12 weeks was 79% (19/24). Engagement with health coaching was high, with 95% completing at least 4 of 5 pre-planned calls. The mean change in daily step count was 1502 (−348, 3353), with twelve (66.7%) increasing in step count (median 2334.5, range: 14, 13,422). Each additional 1000-step increase was associated with a 2.67-point increase in pain self-efficacy scores (β = 2.669, 95% CI: 0.884 to 4.454, p = 0.006). A remotely delivered, health coaching physical activity intervention was feasible and acceptable for young Hispanic breast cancer survivors with PBSPS. This supports further evaluation in a larger trial. Accessible survivorship interventions for young breast cancer patients in their preferred language are needed. Full article

Background/Objectives: Although self-efficacy and self-esteem have been associated with caregiver well-being, the available evidence remains fragmented across different caregiving populations and outcomes. Therefore, this systematic review aimed to synthesize the available scientific evidence on the relationship between self-efficacy, self-esteem, and caregiver burden among formal and informal caregivers of dependent individuals, providing an integrative framework to clarify the protective role of these psychological resources. Methods: A systematic review was conducted following PRISMA guidelines, including fifty-six studies of medium and high methodological quality identified through exhaustive searches of international databases up to March 2026. Results: The evidence shows a consistent negative association between self-efficacy and caregiver burden, indicating that greater confidence in caregiving abilities is linked to lower perceived stress and better quality of life among caregivers of people with disabilities and dependency, while self-esteem, although less frequently studied, is associated with higher resilience, lower emotional vulnerability, and more adaptive responses to caregiving demands. Conclusions: From a public health and disability perspective, these findings underscore the central role of psychological resources in caregiver outcomes and suggest that interventions designed to strengthen self-efficacy and self-esteem are key strategies for reducing caregiver burden, enhancing well-being, and improving the long-term sustainability of care. Full article

Background/Objectives: Baby-Led Weaning (BLW) is an increasingly adopted complementary feeding approach in which infants self-feed family foods rather than being spoon-fed purées. Caregivers’ attitudes play a central role in its adoption and implementation, yet no validated instrument has been specifically designed to assess caregivers’ attitudes toward BLW. This study aimed to develop and psychometrically validate the BLW Caregiver Attitudes Scale (BLW-CAS). Methods: A methodological psychometric study was conducted in two phases. Scale development involved a literature review, expert panel evaluation, and cognitive pretesting with caregivers. Psychometric validation was conducted among 256 caregivers, while temporal stability was assessed in an independent test–retest sample of 92 caregivers. Content validity, internal consistency, temporal stability, construct validity, and convergent validity were examined using established psychometric methods. Results: The final 16-item BLW-CAS comprised three dimensions: Predisposition, Self-efficacy, and Practical Skills. The revised scale achieved an S-CVI/Ave of 0.93. The three-factor exploratory solution accounted for 67.46% of the total item variance. The three-factor CFA model showed good overall fit (CFI = 0.995; TLI = 0.994; RMSEA = 0.052; SRMR = 0.066). Internal consistency was acceptable to excellent across subscales (α = 0.757–0.913; ω = 0.807–0.953), and test–retest reliability was good (ICC = 0.832). Positive small-to-moderate correlations with general self-efficacy (r = 0.298) and decision satisfaction (r = 0.350) supported convergent validity. Conclusions: The Spanish BLW-CAS is a concise, multidimensional instrument with promising psychometric properties for assessing caregivers’ attitudes toward BLW, supporting future research and the evaluation of interventions related to complementary feeding practices. Full article

The postnatal period involves significant emotional and relational shifts that can challenge early mother–infant interactions, particularly under conditions of psychosocial vulnerability (e.g., maternal anxiety/depression) or infant-related risk (e.g., preterm birth). Maternal mentalization, operationalized as Parental Reflective Functioning (PRF), is a key protective factor for sensitive caregiving and dyadic regulation. Objectives: This protocol describes a multicenter, open-label, single-arm feasibility study evaluating a brief, fully online, mentalization-based video-feedback intervention (VFI-RF). The study is designed to assess the feasibility and acceptability of the intervention, rather than its efficacy. We aim to recruit 48 mothers, 24 in each of two risk groups, through socio-health services and neonatal intensive care units. Risk Group 1 will include mothers with clinically significant depressive and/or anxiety symptoms, defined as EPDS > 9 and/or GAD-7 ≥ 10, whereas Risk Group 2 will include mothers of preterm infants, defined as infants born before 37 weeks of gestation. Methods: The intervention consists of 8 + 2 synchronous online sessions over approximately 5 months. Mothers record brief everyday caregiving interactions (~5 min) to review with a trained clinician, focusing on the infant’s internal states and reflective meaning-making. Assessments occur at baseline (T0, infant age ~3 months), post-intervention (T1, ~8 months), and follow-up (T2, ~12 months). Primary feasibility outcomes include recruitment/referral metrics, uptake, retention, assessment completion, missing data, and participant-reported acceptability. Secondary exploratory clinical outcomes include maternal PRF, symptoms, parenting stress, social support, and mother–infant attachment, evaluated via validated self-report questionnaires. Results: The study is designed to evaluate referral and recruitment patterns, intervention uptake, and participant retention, as well as the acceptability and suitability of study procedures and outcome measures for a future controlled trial. Preliminary trajectories of change in maternal reflective functioning and early relational indicators will be examined descriptively and exploratorily. Conclusions: Findings will inform the feasibility and refinement of a brief online mentalization-based video-feedback intervention to support at-risk mother–infant dyads during the first postnatal year. Trial registration: Registered on Open Science Framework, osf.io/6g9ja, date of registration 4th March 2026. Full article

Background: Underweight in preschool children remains a significant public health concern, particularly in the community where caregivers are key contributors to child nutrition. This quasi-experimental study aimed to assess the effectiveness of a caregiver self-efficacy-based intervention on caregiving practices and nutritional outcomes. Materials and Methods: The study was conducted over three months at a child development center in Tha Sala District, Nakhon Si Thammarat, Thailand. The study involved 60 primary caregivers of underweight preschool children (aged 2.5–5 years). The study was conducted in Tha Sala District, Nakhon Si Thammarat Province, which was selected by simple random sampling from the five districts with the highest prevalence of underweight preschool children. Ten child development centers were randomly selected from 28 centers and randomly allocated to the experimental group (5 centers) or the control group (5 centers), with 30 participants in each group. The intervention was designed to improve caregiver self-efficacy through structured education, practical skills training, and support provided for effective behavior practice. We collected data using structured questionnaires on demographic characteristics, health status of the child, self-efficacy of the caregiver, and caregiving practices. Participant characteristics were summarized using descriptive statistics. The Wilcoxon signed-rank test was used to compare differences within groups, and the Mann–Whitney U test compared differences between groups. Results: After the intervention, caregivers in the experimental group had significantly better self-efficacy and caregiving practice scores compared to both baseline and control (p < 0.05). In addition, the experimental group had greater improvements in body weight. The findings demonstrate the effectiveness of self-efficacy-based interventions in enhancing caregiver behaviors and child nutritional status. Conclusions: Incorporating such interventions into community-based child health programs has the potential to increase the effectiveness of interventions and can serve as a sustainable approach to reducing childhood undernutrition in comparable settings. Full article

Background: Multiple sclerosis (MS) is a condition that requires long-term, multidisciplinary management. The growing digital transformation in healthcare has highlighted the central role of nurses in supporting key aspects such as patient self-management, continuity of (at home) care, and patient empowerment. However, evidence on nurse-led digital interventions in MS remains fragmented. Objective: To map the available literature on nurse-led digital interventions in MS, focusing on the role of nurses, clinical outcomes, and research gaps. Methods: The review was conducted using the methodological framework of the Joanna Briggs Institute (JBI) and the PRISMA-ScR checklist. A systematic search was performed in PubMed, Scopus, Web of Science, and CINAHL. Studies were included if they described digital or telehealth interventions led or coordinated by nurses in patients with MS. Results: A total of 12 studies published between 2015 and 2025 met the inclusion criteria. Four main thematic areas were identified: (1) telenursing and empowerment-based interventions; (2) mobile and web-based patient self-management programs; (3) digital systems for monitoring and integrated care pathways; and (4) digital interventions targeting symptom management and psychosocial outcomes. Across the studies, nurse-led digital interventions were associated with improvements in self-management, treatment adherence, self-efficacy, and health-promoting behaviors. Positive effects were also reported on clinical outcomes such as fatigue, sleep quality, and balance, as well as on psychosocial variables including quality of life, coping strategies, and emotional well-being. Furthermore, the identified systems, in general, contributed to enhanced continuity of care, patient engagement, and organizational efficiency. Conclusions: Nurse-led digital interventions represent a promising approach in the management of patients with multiple sclerosis, supporting both clinical and psychosocial outcomes while enhancing continuity of care. However, the current evidence base remains limited by small sample sizes, heterogeneity of interventions, and short follow-up periods. Future research should prioritize multicenter randomized studies with larger samples and long-term follow-up to strengthen the evidence. Additionally, the integration of digital interventions into routine clinical practice, along with targeted training for nurses, is essential to ensure sustainability, accessibility, and equitable implementation. Further studies should also explore cost-effectiveness and the impact on caregivers and long-term quality of life. Full article

Background/Objectives: Family dyad-focused support plays an important role in health outcomes and has been incorporated in diabetes interventions to enhance diabetes self-management. The purpose of this meta-analysis was to examine the pooled efficacy of dyad-focused diabetes interventions on glycemic control for people with Type 2 diabetes (T2D). Methods: The PRISMA was used to guide the study. Four databases (PubMed, Embase, CINAHL, and Scopus) were searched from inception through 18 December 2025 to identify randomized controlled trials (RCTs) that tested glycemic control (A1C) of family-based diabetes interventions for people with T2D. Controlled vocabulary and key terms included “Diabetes, Mellitus, Type 2,” “type 2 diabetes,” “self-management,” “self-care,” “spouses,” “dyad,” “caregiver,” and “partner support”. Studies were excluded if they were not RCTs, contained peer-support dyads, lacked family/friend dyads, or did not measure glycemic control. Results: Nineteen eligible RCTs were included in this meta-analysis. Short-term efficacy (3–6 months) was reported in 17 studies with a total of 863 dyads; long-term efficacy (9–12+ months) was reported in 9 studies with a total of 707 dyads. Compared to the control groups, dyad-focused interventions showed a statistically significant reduction in A1C in both short-term (−0.50; 95% CI −0.72, −0.28) and long-term (−0.52; 95% CI −0.77, −0.27) measurement points (p < 0.001). The meta-analyses showed low or moderate detectable heterogeneity (I² = 38%, 45%). The funnel plot suggested no obvious evidence of publication bias. Conclusions: Meta-analysis provided evidence on the efficacy of family dyad-focused diabetes intervention on improving glycemic control. Future large RCTs are warranted to explore innovative strategies to better incorporate family/friend dyad support in diabetes self-management. Full article

Background/Objectives: Urinary catheterization is common across care settings, but safe management at home and during care transitions often depends on caregivers who receive limited and inconsistent training. Mobile health (mHealth) applications may support caregiver education and decision-making. This review mapped and synthesized evidence on interactive mobile applications for caregiver training in urinary catheterization and developed a conceptual framework to inform nursing practice. Methods: A scoping review was conducted according to Joanna Briggs Institute guidance and reported following PRISMA-ScR. Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, and LILACS, with complementary grey literature searches. Studies evaluating interactive mobile applications for caregiver training in urinary catheterization were included. Data were extracted and synthesized descriptively and narratively. Results: Five studies published between 2020 and 2025 were included. Most were early-stage studies with small samples and heterogeneous designs. Interventions generally combined educational content with interactive features, such as decision-support tools, and less often behavioral strategies, including reminders and feedback. Outcomes mainly addressed knowledge, skills, and self-efficacy, while clinical outcomes, such as infection reduction, were rarely assessed. A conceptual framework was developed showing how intervention components may influence caregiver competence and care outcomes, moderated by contextual factors such as health literacy and digital access. Conclusions: Interactive mobile applications may represent a promising approach to support caregiver training and improve the safety of urinary catheter management. However, current evidence remains preliminary and limited. Full article

Background/Objectives: Children born very preterm (VPT; <33 weeks gestation) are at increased risk for atypical neurodevelopment and deficits in self-regulation, including executive function (EF) and emotion regulation (ER). Responsive parenting interventions, such as Play and Learning Strategies (PALS), improve caregiver behavior; however, their effects on neurodevelopmental outcomes in VPT populations remain limited. This study describes a randomized controlled trial evaluating a digital adaptation of PALS (ePALS). Methods: Families of toddlers aged 15–28 months born very preterm were randomized to either the ePALS intervention or an active control condition. Assessments were conducted at pre-test and post-test to evaluate caregiver responsiveness, child EF and ER, and neural development using behavioral tasks, EEG, and MRI. Results: To date, 84 families have been randomized (43 ePALS, 41 control). Preliminary findings indicate that parents in the ePALS condition demonstrate greater improvements in responsiveness compared to the control group. Intervention adherence rates are reported. Conclusions: These findings support the feasibility and preliminary efficacy of a digitally delivered parenting intervention for improving caregiver responsiveness in families of VPT toddlers. Ongoing analyses will evaluate long-term behavioral and neurodevelopmental outcomes. Full article

As the global cancer burden rises, adults with advanced cancer face significant physical and psychosocial symptoms requiring early integration of palliative and supportive care. Nurses in oncology, emergency, and community settings are central to symptom assessment, care coordination, communication, and advance care planning, yet their roles in early integration remain underexplored. This scoping review mapped nursing contributions to early palliative and supportive care for adults with advanced cancer and described related patient, caregiver, and system outcomes. A search of PubMed, CINAHL, Scopus, and ScienceDirect was conducted for English-language studies published between January 2016 and November 2025 involving nursing-relevant interventions in early palliative or supportive care. Fourteen studies were included: trials, observational studies, qualitative research, reviews, and a meta-analysis. Six domains emerged. Early integration consistently improved quality of life and reduced symptom burden. Nurse-led interventions increased end-of-life discussions and advance directive completion. Telehealth and telephone follow-up proved feasible for symptom management. Studies noted moderate palliative competence but gaps in communication and structural support. Caregiver-focused interventions enhanced caregiver quality of life and self-efficacy. Conclusions: Nurses are pivotal in early palliative care. Expanding structured nurse-led models, strengthening communication training, and addressing organizational barriers are essential to deliver timely, person-centered care. Full article

Background: Adults closest to children, including parents and caregivers, teachers, and therapists, are major determinants of child mental health outcomes. However, access to high-quality psychological training for these groups remains severely limited and inequitable. Artificial intelligence (AI) tools may offer a scalable, accessible, and low-cost route to training delivery. This review aimed to provide the first systematic synthesis of evidence on AI tools used to train caregivers, educators, and therapists/practitioners in psychological approaches relevant to child and adolescent mental health. Methods: A systematic review was conducted in accordance with PRISMA guidelines (PROSPERO: CRD420261336167). Five databases, MEDLINE, PsycINFO, Embase, Web of Science, and ERIC, were searched from inception to March 2026, supplemented by reference hand-searching and forward citation tracking. Studies were eligible if they evaluated an AI-based training tool used with adults in caregiving, educational, or therapeutic roles involving children or adolescents aged 0–18 years, delivered a defined psychological approach, and reported at least one training outcome. Owing to substantial methodological and outcome heterogeneity, findings were synthesised narratively, and meta-analysis was not undertaken. Results: Twenty-four studies from nine countries, published between 2019 and 2026, met inclusion criteria. Studies were grouped into caregiver training (Group A, 5 papers), educator training (Group B, 3 papers), and therapist/practitioner training (Group C, 16 papers). Identified AI modalities included natural language processing (NLP)-based chatbots, generative AI/large language model (LLM) systems, AI-integrated virtual reality (VR), and AI-based feedback and analysis tools. Feasibility and acceptability findings were generally positive across groups. However, the evidence base was limited by pervasive methodological weaknesses, including small samples, with most studies enrolling fewer than 30 participants, reliance on unvalidated self-report outcomes, and the absence of follow-up data beyond one month. Conclusions: AI tools show early promise as scalable approaches to psychological training, particularly for procedural skill acquisition and enhancement of practitioner self-efficacy. However, the current evidence base is insufficient to support claims of effectiveness. A structural credibility–accessibility paradox characterises the field: tools with the strongest controlled evidence are the least scalable, while the most accessible tools have the weakest empirical support. Adequately powered, independent randomised controlled trials (RCTs) using validated outcomes, active comparators, and follow-up extending over multiple months are needed across all three population groups. Full article

Background: Dependent older adults experience a high burden of preventable oral conditions, particularly gingivitis, while caregivers’ preventive practices remain insufficiently explained by conventional single-factor models. This study aimed to develop and validate a theory-informed structural equation model (SEM) to explain how oral health literacy and psychosocial determinants shape preventive behaviors for gingivitis among caregivers of dependent older adults in Sisaket Province, Thailand. Methods: A cross-sectional analytical study was conducted among 420 caregivers selected using multistage random sampling. Data were collected using a validated questionnaire based on the Health Belief Model and Social Cognitive Theory, covering knowledge, attitude, perceived severity, perceived benefits, self-efficacy, preventive behaviors, and social support. Reliability was excellent. Descriptive statistics, Pearson’s correlation, and SEM with maximum likelihood estimation were applied. Results: The SEM demonstrated excellent fit (χ²/df = 0.80, p = 1.000; CFI = 1.000; TLI = 1.008; RMSEA = 0.000; SRMR = 0.092). Knowledge directly influenced attitude (β = 0.355, p = 0.013) and self-efficacy (β = 0.381, p = 0.003). Attitude (β = 0.406, p < 0.001), self-efficacy (β = 0.384, p < 0.001), and social support (β = 0.260, p < 0.001) were significant predictors of preventive behaviors. The model explained 68.3% of variance in behaviors, with knowledge exerting significant total effects through mediated pathways (β_total = 0.290, p < 0.001). Conclusions: A theory-based SEM effectively explains caregiver preventive oral health behaviors in a rural, resource-limited setting. Interventions should integrate literacy-focused education with strategies that strengthen attitudes, self-efficacy, and social support to achieve sustainable improvements in dependent older adults’ oral health. Full article

Caring for adult children with disabilities represents a prolonged and emotionally demanding experience for family caregivers, frequently associated with psychological distress and reduced well-being. This study examined the effects of a group-based parent training program on key psychological dimensions in caregivers of adults with disabilities. One hundred and nine caregivers participated in a psychoeducational intervention and completed measures of self-compassion, perceived self-efficacy, emotional maturity, empathy, and adult attachment. Results showed significant improvements in self-compassion and self-efficacy, with trends toward more secure attachment patterns, while empathy remained stable. Overall, findings suggest that parent training can foster emotional regulation and caregiving processes. Full article