Caregiving and Confidence to Avoid Hospitalization for Children with Medical Complexity

Area of Science:

• Pediatric Complex Care
• Caregiver Support
• Health Services Research

Background:

• Children with medical complexity (CMC) require intensive caregiving.
• Parental confidence in managing care is crucial for preventing hospitalizations.
• Understanding factors associated with low parental confidence is essential for targeted interventions.

Purpose of the Study:

• To examine the relationship between parent-reported confidence to avoid hospitalization and caregiver strain, activation, and health-related quality of life (HRQOL) in parents of CMC.
• To identify predictors of low parental confidence in avoiding hospitalization.

Main Methods:

• Prospective cohort study of 75 parents of CMC.
• Utilized text messages to assess parental confidence (Likert scale) bi-weekly for 3 months.
• Assessed caregiver strain, activation (Family Caregiver Activation in Transition [FCAT]), and HRQOL (SF-12) using validated questionnaires.
• Employed hierarchical logistic regression and classification and regression trees (CART) for analysis.

Main Results:

• 18% of parents reported low confidence (mean rating <5) in avoiding hospitalization.
• Low confidence was significantly associated with higher caregiver strain (aOR, 3.52) and lower mental HRQOL (aOR, 0.89).
• Caregiver activation (FCAT) and physical HRQOL were not associated with parental confidence.

Conclusions:

• Parents of CMC with high strain and low mental HRQOL are at greater risk for low confidence in avoiding hospitalization.
• Interventions aimed at improving parental confidence and preventing hospitalizations should consider caregiver strain and mental HRQOL.
• Further research is needed to develop adaptive interventions tailored to these factors.