COMBINED CARING vs ALL OTHER GROUPS
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Description
Randomized controlled trial of combined caring vs nurse caring, self-caring, or no treatment on how partners perceived themselves, their couple relationship, and their partner's caring during the first year after miscarriage.
Kristen M. Swanson, RN, PhD, FAAN George Knafl, PhD School of Nursing University of North Carolina at Chapel Hill
BACKGROUND
• At least 1 in 6 pregnancies end in miscarriage: the unplanned, unexpected loss of pregnancy prior to 20 weeks gestation (Ventura et al, 1999). • Both men and women grieve after loss, with depth and duration of women’s grief tending to be greater (Swanson et al, 2009).
• When asked what was lost, typically mothers say their baby; spouses say their partner (Wojnar et al, 2011). • One year after loss approx. One-third of women claim their couple and / or sexual relationships are more distant than before their miscarriage (Swanson et al, 2003).
RESEARCH QUESTION
Are there differences in how partners perceive themselves, their couple relationship, and their partner's caring during the first year after miscarriage based on whether couples received Nurse Caring, Self Caring, Combined Caring, or no treatment?
Couples Miscarriage Healing Project
CMHP TEAM Kristen M. Swanson, RN, PhD, FAAN George Knafl, PhD Carolyn Huffman RN, MSN, AWHNP Anthippy Petras, MSW Danuta Wojnar, RN, PhD Hsien-Tzu Chen, RN, PhD Rosalie Houston, RN, MN Susan Sandblom, ARNP, MN Jeannette Quaeck, RN, MN Appalachia Martine, RN, BSN Helga Fridjonsdottir, RN, PhD Alyson Shapiro, PhD Christopher Graham, PhD
1 R01 NR 05343-01A1
RECRUITMENT RECRUITED • Posters, ads (newspaper, radio), provider referral SELECTION CRITERIA • Miscarried w/in last 3 mos. • In a committed relationship • Speak / write English • If not married, both must be 18 • Both parents consent and return baseline data
ENROLLMENT (January, 2003 to June, 2006) Screened
Eligible
Enrolled
Retained
• 418 volunteers • 393 couples • 341 couples • 324 couples
DEMOGRAPHICS
Women
Men
Age
32.4
33.9 *
College Education
91%
87%
Caucasian
84%
86%
Employed
69%
87% *
Mental Health Tx
49%
26% *
COUPLES • Together • Children
(M = 6.9 yrs; SD = 4.5)
• Miscarriages
(range = 1 to 6)
(range = 0 to 6) (0 = 53%; 1 = 31%) (1 = 68%)
• Pregnancy planned 72% • Pregnancy wanted 98% • Ges. age at loss (M = 9.8 wks; SD = 3.1)
INTERVENTION • PROCESS (Swanson Caring Theory) • CONTENT (Meaning of Miscarriage Model) • Four Arms – Nurse Caring (3 counseling sessions) – Self Caring (3 videotape & workbook modules) – Combined Caring (1 counseling & SC modules) – Control (no treatment)
DESIGN 1
Phone screen
5
11 weeks
X nurse
X
X
selfX
X
X
combined X X
X
randomized
control
Baseline
t2
t3
t4
1 mo.
3 mos.
5 mos.
13 mos.
Time since miscarriage
MEASURES Concept
INTIMACY
SELF
PARTNER CARING
Total PAIR Emotional (Shaefer & Olson, Social 1981) Sexual Intellectual
Chronbach alpha Men Women .888 - .917 .901 - .931 .811 - .860 .863 - .902 .707 - .760 .729 - .799 .795 - .843 .749 - .803 .756 - .804 .797 - .843
Total How I See Myself Emotionally Strong (Swanson) Satisfied
.876 - .902 .850 -.886 .784 - .831
.885 - .906 .848 - .899 .798 - .875
.848 - .876 .795 - .847 .817 - .869
.895 - .905 .882 - .888 .826 - .881
Measure
How My Mate Cares (Swanson)
Scales
Total Mutual Sharing Cares for Me
DATA
• 1,739 PAIR Total measurements • for 636 subjects • 321 women • 315 men
• from 324 families
• from 1-6 PAIR Total measurements per couple
ANALYSIS
• Elapsed days since loss • Controlled for baseline values • PAIR Total used to determine the analysis model that best fit the data
MODEL REFINEMENT
1. Started with most complex model including all main effects and all interaction effects. (used to select covariance structure)
2. Guided by Cross Validation (CV) values, reduced the model systematically to obtain best fit model. 3. Best fit model deployed to analyze all other scales and subscales.
Selected Covariance Structure • Covariance structure selection was based on a 2dimensional structure (time and spouse) • correlation between partners – at the same time had estimated value 0.30 – decreased as time between measurements increased
• correlation across time within partner – 10 weeks apart had estimated value 0.46 – decreased as time between measurements increased
• standard deviations increased over time – but same for partners at each time
STEP 1: FULL MODEL Main effects group (4 levels) p = 0.337 gender (2 levels) p = 0.585 elapsed days since loss (continuous) p = 0.396
Conclusion: Only baseline value is significant. All two way interactions group X gender p = 0.673 Question: some non-significant terms be masking groupMight X elapsed days p = 0.796 effectsgender of other terms?days p = 0.449 X elapsed Three way interaction group X gender X elapsed days p = 0.973 Baseline value p < 0.001
STEP 2: ADDITIVE MODEL Eliminated all interaction effects Conclusion: On one to oneCV comparison, groupmodel stood Generated an aimproved score, so no better out as effects significantly different. Main group (4 levels) 0.198way to compare Question: Might there bep a=better groups? One group vs. all p others, two groups vs. two gender (2 levels) = 0.463 groups, etc.? elapsed days since loss p = 0.101 Baseline value p
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