Supporting family carers in caring for older people in the community in Indonesia

The purpose of the study:

The purpose of this research study was to improve the health status of older people living in the community through implementing a family carers' training program.

Background of the study:

Many previous studies have reported the improvement of family carers' knowledge in providing better care for older people as well as reducing their burden, anxiety and depression. However, those studies have not addressed clearly the impact of the programs on the health status of older people living in the community.

Design of the study:

An experimental design with pre and post-tests of intervention and control groups was used in the study.

The intervention of the study:

The intervention group attended the training program and received a training package consisting of 8 health education booklets and trainees'guide at the beginning of the study. They were also provided with guidance practice and follow-up support following the training program. The control group received usual care and support during the study. However, at the end of the study they were provided with the training package.

Population and sample:

All older people (60 years and above) living with their family carers in the district of Beiji, Depok Indonesia formed the population for this study. Two villages were randomly selected from the six villages in this district. One village was randomised to become the intervention group and the other became the control group. A sample of 120 older people and their primary carers (120) were selected from of the two villages. Therefore, the total sample consisted of 480 participants made up of 240 family carers and 240 older people.

Data collection and instruments:

The data were collected within three time points (baseline, 3 and 6 months) by using several tested and widely used instruments. Some additional questions relating to the family carers' training program were also added. All instruments were tested for reliability in Indonesia before being used for the present study.

Data analysis:

T-test and Chi-square analyses were used to identify baseline differences between the intervention and control groups. ANOVA was used to examine the differences between selected internal or external factors of older people and the health status of older people. Two-way repeated measures ANCOV A was chosen to evaluate the differences within the three time points and between groups and controlled for baseline differences or some potential confounders. Friedman's test was used to test the variances which were not equal and for categorical data. For the dichotomous variables, the Cochran's test was chosen.

Results:

Overall, the findings over the six-month period for the intervention group showed a significant increase for the knowledge, skills, attitudes, global social support and life satisfaction perceived by family carers when compared to those of the control group. The objective burden was significantly lower in the intervention group than that of the control group. The subjective burden was not significantly different between the groups. However, further analysis using independent pairwise comparisons (Bonferroni) showed the intervention group significantly lower than the control group. Similarly the health status of older people in the intervention group, including physical, mental, global social support, life satisfaction, and blood pressure was significantly increased when compared to those of the control group. In contrast to these findings, the activities of daily living of older people were not significantly different between groups.

Conclusions:

In conclusion, the Family Carers' Training Program made a positive impact on the health status of older people through increasing the family carers' ability in caring for older people. This program was found to be acceptable by the population and feasible to implement within the Indonesian population.