Practices, Norms and Options: a
Mixed Methods Study on the
Efficacy of a Support Group
Programme for Cancer Caregivers
30 June 2014, University of Sheffield
Presented by Huiying Ng
On behalf of the research team at the National University
Hospital:
A/P Rathi Mahendran
A/P Konstadina Griva
Joanne Chua
Haikel Lim
Joyce Tan
Supported by National University Cancer Institute (Singapore)
Seed Fund
Overview
• Background: Conceptual Beginnings
• Context: Caregiving in Singapore
• Challenge #1: Finding a theoretical framework (and
introduction to SDT)
• Methodology: Mixed Methods
• Challenges and Solutions Adopted
• Preliminary Findings
• Methodological Recommendations
Fulfillment
Prejudice
Social
Identity
Theory
Conflict
Collective
identity
Discrimination
Insufficient
structure
Options &
information
Self-realisation
Lack of an
“integrated and
continuous
social self”
Individual identities
Norms
Options
Habitus
Caregiving in Singapore
• “Family” / “informal” caregivers
• Low public awareness of caregivers’ psychological
support need
• Filial piety and family obligation
• Disinclination to speak about cancer
Self-determination Theory
Motivation
Autonomy
Basic
Psychological
Needs
Competence
Relatedness
Research Aims
1. How a supportive social environment may assist
caregivers in achieving better psychological
resilience, namely through providing autonomy
support, interpersonal involvement and a
structured framework for caregiving
2. How these aspects of the social environment
interact with caregiving motivations to result in
psychological outcomes
3. The qualitative form that such a social environment
would take.
Methodology
Quantitative
Qualitative
Construct
Measure
Semi-structured interview
Caregiver Quality of
Life and Burden
Caregiver Quality of
Life-Cancer (CQOLC)
Pre-intervention
•Challenges faced
•Family support
•Caregiving disruption to life goals
•Expectations of group
Perceived Stress Scale
(PSS)
Caregiver Stress
Hospital Anxiety and
Depression Scale
(HADS)
Basic Psychological
Needs
Basic Psychological
Needs Scale (BPNS)
Perceived Competence
Perceived Competence
Scale (PCS)
Perceived Autonomy
Support
Healthcare Climate
Questionnaire (HCCQ)
Perceived Relatedness
Interpersonal Support
Evaluation List (ISEL)
Post-intervention
•“What did you like or not like about the
support group?”
•Improvements
•Met expectations?
Quantitative Measures
Construct
Measure
Reliability in previous
samples
Caregiver Quality of Life and
Burden
Caregiver Quality of LifeCancer (CQOLC)
 = .91 (Weitzner et al., 1999)
Perceived Stress Scale (PSS)
 = .91 (Sheldon Cohen &
Janicki-Deverts, 2012)
Caregiver Stress
Hospital Anxiety and
Depression Scale (HADS)
 = .76 (Lok & Bishop, 1999)
Basic Psychological Needs
Basic Psychological Needs
Scale (BPNS)
 = .79 to .87 (Ilardi et al., 1993;
Kasser, Davey, & Ryan, 1992)
Perceived Competence
Perceived Competence Scale
(PCS)
 = .95; Williams et al., 1996)
Perceived Autonomy Support
Healthcare Climate
Questionnaire (HCCQ)
 = 0.80 (Williams, Freedman,
& Deci, 1998)
Perceived Relatedness
Interpersonal Support
Evaluation List (ISEL)
 = .81 (Scrignaro, Barni, &
Magrin, 2011)
Thematic Analysis
Theoretical understanding
of motivations, basic
psychological needs
Review of dataset:
Inductive coding of
themes and codes
Fitting codes to theoretical
framework
Challenges and Solutions
Qualitative:
1. Citing family ties as a reason for caregiving—not explicitly value-laden
2. Citing filial obligation—which is value-laden—how do we decide if someone is
falling on the maladaptive side of a social norm?
3. Choice to use semantic meanings rather than latent meanings
Mixed methods:
1. People mention different motivations all across the duration of the interview.
How do we rank people by their level of motivation?
2. Goals: goal alignment, goal conflict, reprioritization, shifting goals, goals are
unclear. Can we code these into analyzable categories?
3. How to relate personal goals to desires and motivation?
1
Code
Definition (Ng et al., 2012)
Example
Intrinsic motivation
Motivation due to the inherent
enjoyment derived from the
behavior itself. A facet of
autonomous self-regulation.
“I give care because I care
about my care recipient”
Integrated regulation
Motivation to engage in
behaviors which are in
congruence with other central
personal goals and values. A
facet of autonomous selfregulation.
“I give care out of filial piety.”
Identified regulation
Motivation reflecting the
personal value of the behavior’s
outcomes. A facet of
“It makes me happy to see her
clean”
autonomous self-regulation
Introjected Regulation
Motivation reflecting internal
pressures such as contingent
self-worth, guilt, shame, and
need for external approval. A
facet of controlled regulation.
“If I don’t give care, I would feel
ashamed of myself.”
External Regulation
Motivation to comply with
external pressures or rewards.
A type of controlled regulation.
“I give care because it’s
expected of me.”
Ng, J. Y. Y., Ntoumanis, N., Thogersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). SelfDetermination Theory Applied to Health Contexts: A Meta-Analysis. Perspectives on Psychological Science, 7(4), 325–340.
doi:10.1177/1745691612447309
Preliminary Findings
• Preliminary analysis
focuses on motivations
and cultural issues
Change in Positive Adaptation
26
25.5
• Does the group relate to
better wellbeing?
Positive
o Yes: group provides caregivers Adaptation
with expert information,
Scale
reminders of self-care tips, role
models and downward social
comparison, and an
understanding that they are not
alone.
o Yes; quantitatively, the group
increased positive adaptation
scores.
25
24.5
Control
24
Intervention
23.5
23
22.5
Pre
Post
Time
Preliminary Findings
• How do our qualitative and quantitative findings
complement each other?
o Qualitative findings suggest that caregivers’ motivations for caregiving
may influence the benefits they draw from the group, as well as their
support needs
o Motivations for caregiving fell under two broad categories: externally
regulated motivations (FP or family obligations) and intrinsic motivation
(pleasure of caring).
o Quantitatively, more internal motivations correlated with more positive
outcomes and fewer negative outcomes
Pre-intervention
Post-intervention
Motivations for
caregiving
r = .856
r = -.799
+ Basic
Psychological
Needs
- Financial
Concerns
+ Basic
Psychological
Needs
r = .910
+ Autonomy
r = .812
+ Relatedness
r = .969
- Stress
r = -.917
Further steps
• Socio-cultural norms may interact with individual
motivations to influence caregiver distress, the support
they receive from the group, and improvements in
outcomes.
• Norms? Caregiver post-intervention outcomes may
relate to their initial levels of motivation
• Further analysis:
o
o
o
o
o
Qualitative benefits of the support group
Relation of qualitative aspects with basic psychological needs (BPN)
Relation of qualitative aspects with caregiver outcomes
Relation of qualitative and BPN with caregiver outcomes
Interaction of qualitative aspects and motivations to affect outcomes
Thank you for listening!
Questions?