Abstract:
Majority of informal caregivers of People Living with HIV/AIDS (PLWHAs) in Nigeria carry out their activities with insufficient information. This, coupled with the general burden and risks of caregiving leads to poor psychological well-being and loss of confidence by many caregivers. Previous studies have focused largely on the PLWHAs and the formal caregiving with less emphasis on the improvement of the informal caregiving process using psycho-educational package. This study was, therefore, designed to develop a Psycho-educational Training Package (PeTP) for the informal caregivers as well as determine its effectiveness on their caregiving self-efficacy and psychological well-being in Oyo State, Nigeria. The moderating effects of gender and caregiving stress were also examined.
The study was anchored to Transactional Stress and Conservation of Resource theories, while the pretest-posttest and control group quasi-experimental design of 2x2x2 factorial matrix were adopted. Two approved non-governmental HIV/AIDS support and counselling centers were purposively selected in Ibadan. The Zarit Burden interview and Instrumental activities of daily living screening tools were used to select 100 out of 600 screened informal caregivers of the PLWHAs attending the centers. Those who scored high on caregiving burden but low on caregiving competence and confidence were randomly assigned into psycho-educational training (50) and control (50) groups. The developed PeTP was validated using Cronbach alpha method: HIV/AIDS facts (r=0.89), caregiver’s roles (r=0.70), caregiving challenges (r=0.75), infections self mastery skills modeling (r=0.73) safety precautions (r=0.81) and stress reduction techniques (r=0.87) were rated high. Treatment lasted six weeks. Psychological Well-being (α=0.75), Caregiving Self-efficacy (α=0.89) and Kingston Caregiver Stress (α=0.82) scales were used. These were complemented with 10 in-depth interview sessions with informal caregivers. Quantitative data were analysed using descriptive statistics and Analysis of covariance at 0.05 level of significance, while qualitative data were content analysed.
The mean age of informal caregivers was 33.12±6.32 years; majority were female (71.0%), mostly from monogamous families (96.0%) and not educated (49.0%). Their marital status were: widowed (31.0%), single (29.0%), divorced (20.0%) and married (20.0%). There were significant main effects of treatment on caregivers’ psychological well-being (F(1,97) = 68.90; η2=0.53) and self-efficacy (F(1,97) = 198.74; η2 = 0.78). Participants in the treatment group had higher post mean scores (psychological well-being = 63.41; self-efficacy = 46.61) than those in control (psychological well-being = 45.44; self-efficacy = 32.24) group. There were significant main effects of caregiving stress on caregivers’ psychological well-being (F(1,97) = 25.05; η2 = 0.22) and self-efficacy (F(1,97 = 4.97; η2 = 0.05). Participants with low stress had higher post mean scores (psychological well-being = 55.75; self-efficacy = 40.11) than those with high stress (psychological well-being= 50.22; self-efficacy = 38.51). Main effect of gender, two-way, and three-way interaction effects were not significant on psychological well-being and self-efficacy. Though, caregivers encountered financial and work-family stressors, they derived great benefits from the intervention on caregiving skills and nutritional information for the PLWHAs.
Psycho-educational training package enhanced the psychological well-being and self-efficacy of informal caregivers of People Living with HIV/AIDS in Oyo State. Caregiver-based psycho-education training should be inculcated into HIV/AIDS care services across Nigeria.
