Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity

Abstract

Objective: To test associations between parent-reported confidence to avoid hospitalization and caregiving strain, activation, and health-related quality of life (HRQOL).

Study design: In this prospective cohort study, enrolled parents of children with medical complexity (n = 75) from 3 complex care programs received text messages (at random times every 2 weeks for 3 months) asking them to rate their confidence to avoid hospitalization in the next month. Low confidence, as measured on a 10-point Likert scale (1 = not confident; 10 = fully confident), was defined as a mean rating <5. Caregiving measures included the Caregiver Strain Questionnaire, Family Caregiver Activation in Transition (FCAT), and caregiver HRQOL (Medical Outcomes Study Short Form 12 [SF12]). Relationships between caregiving and confidence were assessed with a hierarchical logistic regression and classification and regression trees (CART) model.

Results: The parents were mostly mothers (77%) and were linguistically diverse (20% spoke Spanish as their primary language), and 18% had low confidence on average. Demographic and clinical variables had weaker associations with confidence. In regression models, low confidence was associated with higher caregiver strain (aOR, 3.52; 95% CI, 1.45-8.54). Better mental HRQOL was associated with lower likelihood of low confidence (aOR, 0.89; 95% CI, 0.80-0.97). In the CART model, higher strain similarly identified parents with lower confidence. In all models, low confidence was not associated with caregiver activation (FCAT) or physical HRQOL (SF12) scores.

Conclusions: Parents of children with medical complexity with high strain and low mental HRQOL had low confidence in the range in which intervention to avoid hospitalization would be warranted. Future work could determine how adaptive interventions to improve confidence and prevent hospitalizations should account for strain and low mental HRQOL.

Keywords: caregiving; confidence; mHealth; medical complexity; mixed methods.

Figure 1.. Conceptual Model Linking CMC Parent Confidence to Hospitalization in the Context of a Future Adaptive Digital Intervention.

Prior research on preventing hospitalizations,^,,– combined with behavioral intervention theory suggests that decisions to seek hospital care are influenced by family capacity, susceptibility, health system, and confidence. Solid lines represent hypothesized causal assumptions to be tested in future studies. Dashed lines represent potential confounding association.

Figure 2.. CART model depicting relationships with mean confidence to avoid hospitalization among parents of children with medical complexity.

Confidence ranges from 1 (lowest) to 10 (highest), and strain ranges from 2 (lowest) to 10 (highest). Splits were significant at P < .05. CMC, children with medical complexity; UW, University of Wisconsin.