Validating a Model of Chronic Illness and Family Caregiving
Curry, Linda Cox, Walker, Charles A., Moore, Penny, Hogstel, Mildred O., Journal of Theory Construction and Testing
Numerous studies have investigated chronic illness (CI) and family caregiving (FC), but the intimate link between these 2 constructs has not been explored. This study validates parallel structures in a deductive model connecting the constructs of CI and FC. Data used to validate the model's parallel structures were obtained from participants in a caregiver support group. The CI-FC Interaction Model illustrates the similarity of major concepts and processes characterizing CI and FC. The model may provide a framework to facilitate discussions between chronically ill individuals and their family caregivers promoting more effective relationships.
Key Words: Chronic illness, content analysis, family caregiving, model validation
The number of older adults receiving care from family members increased dramatically during the past decade. This increase was influenced by an expanding population of adults age 60 and older, greater life expectancy, and a higher incidence of chronic illness (CI). Despite medical advances, chronic illnesses and the resulting complications are primary causes of hospitalization an^ death (Family Caregiver Alliance, 2007). Family caregivers are a critical resource for assisting older adults with Cl. Although some family caregivers report good health, many exhibit evidence that family caregiving (FC) jeopardizes their health (Bradley, 2003; Son, Erno, Shea, Femia, Zarit, & Stephens, 2007). The impact of FC on caregivers' lives is primarily influenced by the type and intensity of the care they provide. Greater intensity of FC produces greater physical, emotional, and financial consequences for family caregivers (NAC & AARP, 2004).
Several studies demonstrate how professional caregivers interface with chronically ill, older adults (De Geest, 2009), but most studies of CI or FC isolate the experiences of family caregivers and their care recipients (Tally & Crews, 2007; Murray, 2007; Thompson, Hunter, Murray, Ninci, Rolfs, & Pallikkathayil, 2008; De Geest, 2009). Although FC is inextricably linked to the diagnosis, treatment and course of CI, a clear connection between these two constructs is lacking in the literature.
The study's purpose was to validate parallel structures in a deductive model connecting the constructs of CI and FC. Data used to validate the model's parallel structures were obtained from participants in a caregiver support group.
The CI-FC Interaction Model (see Figure 1) began as a class project for undergraduate and graduate nursing students taking courses in gerontology, family health, theory, research, and health care policy. Students and professors analyzed both qualitative and quantitative research studies related to CI or FC. In these studies, recipients of FC included adult and pediatric patients with such life-threatening and chronic conditions as cancer, dementia, heart failure, schizophrenia, and end stage renal disease (Bakas, Lewis & Parsons, 2001; Brown & Stetz, 1999; Coyne, 1997; Lim & Ahn, 2003; Rungreangkulkiu & Gilliss, 2000; Sterling, Peterson & Weekes, 1997; Winslow, 1997). The contexts included hospitals, home care, and long-term care facilities. Students were urged to cull conceptual relationships between the constructs of CI and FC. See Table 1 for concepts and subconcepts.
Dluhy's (1995) method for mapping knowledge in CI inspired model development. Following Dluhy's method, hundreds of FC and CI studies were reviewed. Evidence from these studies revealed 6 major concepts for each construct. The concepts were revised and reorganized many times and became the basis for a mid-range theory, the CI-FC Interaction Model (Walket, 2001).
Chronic illness. Although some studies about CI dealt with the topic optimistically, as experiencing "health within illness" (Lindsey, 1996) or "making meaning of disability" (Gordon, Feldman & Crose, 1998; Youngkhill& McCormick, 2002), most regarded CI as a difficult, if not insurmountable, life challenge for patients and families. …