By Caring for Myself I can Care Better for my Family: A

By Caring for Myself I can Care
Better for my Family: A Health
Education Intervention for Moms
Sandy Magaña, Elizabeth Miranda,
Marlen Garcia, Henan Li
Department of Disability and Human Development
People involved

Community partners:
o El Valor- Gloria Curtin & Magdalena Droira
o Community Support Services- Rocio Perez

Promotoras:
o El Valor- Norma Uscanga, Claudia Miranda, Leticia
Ramos, Maria Ochoa, Margarita Barraza, Julia
Gonzalez
o CSS- Myriam Bucio, Maria Resendez, Isela
Marquez

Students:
o Madison- Elizabeth Miranda, Rebecca Paradiso,
Linda Serna
o UIC- Henan Li, Marlen Garcia
Overview of presentation
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Brief background
Theory and promotora model
Program curriculum
Training with promotoras
Results from home visit model
Results from group model
Qualitative findings
Next steps
Background

More than half of adults with developmental
disabilities live with their families
o Especially true among Latino families

Research shows that Latina moms of
children with IDD compared to Latina moms
of TD children are
o More likely to have higher rates of depression
o More likely to have chronic health conditions such
as arthritis and heart problems
o Less likely to see a doctor for themselves
Supportive services for Latina
mothers of children with IDD

Supportive services are primarily aimed at
the child with IDD

Latina mothers often identify their care
giving role as their primarily responsibility

Need for cultural interventions that help
Latina mother to focus on their own health
care needs
Self-Efficacy Theory
o Through health education, participants
feel more confident in carrying out
behavioral change leading to changes in
health behaviors (Bandura)
o Includes:
•
•
•
•
Performance accomplishment
Vicarious experience
Verbal persuasion
Emotional states
Promotora de Salud Model
Mother of
child with
IDD
Understand
host
community
Encourages
performance
accomplishment
Bilingual:
Communicati
-on Bridge
Engages in
modeling
Uses Social
Persuasion
Health education intervention
content
Eight week health education program
• Session One: Taking care of oneself and pre-test,
• Session Two: Health care
• Session Three: Well-being activity
• Session Four: Nutrition
• Session Five: Exercise
• Session Six: Stress and depression
• Session Seven: Including others
• Session Eight: How to sustain growth, post-test and celebration
Program: content
o Manual
• Emphasized dialogue and was culturally relevant.
Example, how can we make our traditional recipes
healthier
De acuerdo a MiPlato, aproximadamente la mitad de lo que usted come en un día deben ser
frutas y verduras. A lo mejor esto le suena un poco extraño porque normalmente no
comemos los alimentos de forma separada. A lo mejor de la manera que usted come se
asemeja más a estos dibujos que contienen un poco de todo. Los 5 grupos que sugiere
MiPlato nos ayudará a entender mejor la forma en que nos alimentamos.
Promotora Training
10 promotoras
Group Format
14 hours/ 3 half days
Review content on the manual
Review strategies for home visits
Promotora dual role: promotora and participant
Promotoras received a stipend for the training and for each
completed case
Communication between promotoras and Magdalena
Research questions
1)
Did participants increase their health related
self-efficacy between pre and post-test
compared to the control group?
Did participants improve their health behavior
(exercise, nutrition, and self care)?
3) Did participants improve caregiver self-efficacy?
2)
4)
Did participants reduce their levels of
psychological distress as measured by
depressive symptoms and caregiver burden?
Methods

Participants:
o 100 Spanish-speaking mothers of
youth and adults with IDD.
• By random assignment, 50 were placed in
intervention and the other 50 in control
group (wait list)
• 90 completed (10% attrition)
o At least 40 years old
o or child 8 years or older
Maternal
Characteristics
Intervention
(N=42)
36 (78.3%)
10 (21.7%)
40 (80.0%)
10 (20.0%)
0.04
Years of Education (SD)
8.1 (3.2)
6.9 (2.8)
1.7
21 (43.8%)
27 (56.3%)
15 (30.0%)
35 (70.0%)
2.0
Employed (%)
Married or living
together (%)
Foreign born (%)
Ethnicity (%)
Mexican descent
Other Latino
Good/excellent health
(%)
Child Characteristics
Mean age (SD)
Percent male
Diagnosis (%)
Autism
Down Syndrome
Cerebral Palsy
Intellectual disability
Other
45.1 (8.3)
Test value+
Mean age (SD)
Level of education
Less than High School
High School or more
Income (%)
0 to $19,999
$20,000 and up
43.9 (9.4)
Control
(N=48)
-0.9
24.5 %
46.9%
5.4*
38 (76.0%)
41 (82.0%)
0.5
92.0%
96.0%
0.7
49 (98.0%)
1 (2.0%)
2.0
22.0%
3.0
18.0 (8.8)
64.0%
-0.4
0.4
47 (94.0%)
1 (6.0%)
38.0%
16.9 (7.6)
58.0%
12 (28.6%)
7 (16.7%)
15 (35.7%)
6 (14.3%)
2 (4.8%)
T-test , F-test or Chi Square values.
*p < .05
5 (19.2%)
7 (26.9%)
10 (38.5%)
3 (8.3%)
1 (3.8%)
1.8
Methods

Design and Quantitative Analysis
o Pre and post- test
o Paired-sample t-test
o Multivariate Analysis of Covariance

Measures
o Health-related self-efficacy
• Chronic Disease Self-Efficacy Scales, 10 items, 1-10
o Depressive symptoms
• Center for Epidemiology Studies Depression Scale CES-D, 20 items, 0-3 with
reverse items
o Caregiver Appraisals
• 15 items, 0-3
o Positive health behaviors
•
Adaptation of the Family Habits Scale, 36 items, 0-3
Results: 1) Did participants increased their
health-related self-efficacy between pre and posttest?
Pre-test
Post-test
89.4
100
74.2
74.2
80
74.6
60
40
20
0
Intervention
Control
Note: Results from MANCOVA. error bars indicate the 95% CI
Results: 2) Did participants improve their
health behavior (exercise, nutrition, and self
care) between pre and post test?
80.0
Exercise Habits
Self-Care Habits
Nutrition Habits
60.0
40.0
40.6
20.0
33.1
34.8
16.4
10.9
0.0
9.4
14.5
Pre-test
Post-test
Intervention
34.2
11.4
12.4
8.8
10.5
Pre-test
Post-Test
Control
2a) Did participants improve their EXERCISE
health behaviors between pre and post test?
20
15
10
14.5
5
9.4
8.8
10.5
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
2b) Did participants improve their SELF CARE
health behaviors between pre and post test?
20
15
10
16.4
5
11.4
10.9
12.4
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
2c) Did participants improve their NUTRITION
health behavior between pre and post test?
60
40
20
40.6
34.8
33.1
34.2
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
Results: 3) Did participants improve
caregiver self-efficacy between pre and post test?
20
15.8
16.5
16.1
15.2
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
Results: 4) Did participants reduce their levels
of psychological distress (CES-D score) as
measured by depressive symptoms between pre
and post-test?
25
20
15
10
19.0
15.1
5
14.3
10.1
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
Results: 4) Did participants reduce caregiver
burden between pre and post-test?
20
15
10
14.8
14.9
13.7
14.0
5
0
Intervention
Pre-test
Control
Post-test
Note: error bars indicate the 95% CI
Group format

Conducted at Beth Lacey Center
o Part of Community Support
Services
o Collaborator Rocio Perez
Pre and post-test 1 group design
 Participation

o 23 participants enrolled
o 15 participants completed program
o 35% attrition rate
Group format results
Health habits
pretest
postest
63.7
37.3
12.2
9.3
exercise
habits
12.7
51.6
32.3
8.7
selfcare
habits
nutrition
overall
More group results
Health related self efficacy
Depressive symptoms
90
30
80
25
70
60
20
50
pretest
postest
40
30
pretest
postest
15
10
20
5
10
0
0
health efficacy
depress
Caregiver appraisals-group
14.6
14.4
14.2
14
13.8
pretest
postest
13.6
13.4
13.2
13
12.8
cg self efficacy
cg burden
Qualitative Results:
Evidence of performance accomplishment
Engaging
in
activities
Positive
outcomes
Increases
SE
“ Me ayudo a comer mas frutas y ejercicios para
relajarme un poco o quitarme el estres.”
(Participante de Chicago)
“It helped me to eat more fruits and exercises that
relaxed me or relieve stress.” (Chicago Participant)
Evidence of vicarious experience
Observing
others perform
activities
Learning
through
others’
experiences
Offering
suggestions
that have
worked in the
past
Promotoras who also had children with disabilities often shared how they
accomplished the activity in their lives.
“Las conversaciones con la promotora me sirvieron de mucho porque aprendi que yo
soy muy necesaria en la vida de mis hijos especiales y que debo cuidarme para que
ellos esten bien.” (Participante de Chicago)
“The conversations with the promotora helped me a lot because I learned
that I am needed in the lives of my sons with special needs and that I
have to take care of myself so they can be well.” (Chicago Participant)
Evidence of emotional states
Reducing
stress and
depression
helps SE
Can effect
perceived selfefficacy in
coping with
difficult
situations
Ability to
express
feelings with
promotora
“Por medio de este programa tiene uno la oportunidad de
compartir lo que uno siente y saber que nos pueden
escuchar.” (Participante de Chicago)
“Through this program, one has the opportunity to
share what one feels and know that they can listen to
us.” (Chicago Participant)
Evidence of verbal persuasion
Encourage participants to believe they
can take control
“ Es importante darme tiempo para mi y hacer cosas
que me gustan sin sentir que dejo de lado a mi
familia.” (Participante de Chicago)
“It is important to have time for me and do things I
like without feeling that I am putting my family to the
side.” (Chicago Participant)
Next steps
 Examine
follow-up data
 Most of the control group has participated in intervention
 2 additional follow-up points with all participants
 Dissemination
 Make manuals and materials professional and
available to other organizations
 Let other orgs know about the intervention and
potential training to implement
 Ideas?
Questions and Comments?
Support provided by

Rehabilitation Research and Training Center
on Aging with Developmental Disabilities at
the University of Illinois at Chicago (NIDRR
Grant #H133B080009)