767 - Understanding How the Caregiver-Child Relationship, Responsibilities, and Role Influence Adult Caregiver Health and Health Behavior Change: A Qualitative Study of Caregivers' Perspectives

Publication Number: 767.6917

Stephanie Quintero Chacon, NYU Langone Health, East Elmhurst, NY, United States; Holly Herman, New York University Grossman School of Medicine, New York, NY, United States; Manuel A. Pena, NYU Langone Health, Brooklyn, NY, United States; Abigail Nita, Indiana University School of Medicine, Fort Wayne, IN, United States; Kelly Naranjo, New York University Grossman School of Medicine, New York, NY, United States; Joanna A. Madigan, NYU Langone Hospital- Brooklyn, Brooklyn, NY, United States; Carol Duh-Leong, Hassenfeld Children's Hospital at NYU Langone, New York, NY, United States; Robin Ortiz, New York University Grossman School of Medicine, New York, NY, United States

Background: Cardiovascular disease (CVD), though largely modifiable through lifestyle and environmental factors, is the number one cause of death in the United States and a looming crisis for future generations. A multidimensional understanding of the caregiver-child relationship is a critical step to build healthful lifestyle interventions that improve adult outcomes and provide a foundation for the primordial prevention of disease in their children.

Objective: We aimed to investigate how the adult child-caregiving role and context impacts lifestyle behaviors and behavior change.

Design/Methods: We conducted semi-structured interviews via secure video platform with caregivers (with English or Spanish preference) of children between the age of 3-10 years old. Participants were included if they were adults with CVD risk. A subset of participants included those recruited in partnership with a community-based organization that provides medically tailored meals (MTM) to individuals based on a qualifying medical condition (herein included if the medical condition was CVD or a related diagnosis). A qualitative thematic analysis was conducted using an iterative open coding approach with a 2-coder team using Atlas.ti software. Grounded subcategories were abstracted upwards to themes.

Results: Caregiver interviewees (n=19) were diverse in characteristics as per Table 1. Participants described a core theme of caregiving being core to their identity, captured by one participant stating, “caregiving is everything”. Identity as a caregiver was discussed in the context of being intimately linked with participants’ overall life goals, though they did not always see a link between their health and the health of their child. Other themes specifically related to behavior change, included accountability for behaviors, actions, and health as influenced by their child(ren), barriers to behavior change due to caregiving responsibilities (and, for some, related social needs), and intergenerational influences and aspirations in caregiving (Table 2). Those receiving MTM identified how being in the program took caregiving-related stress off their plate.

Conclusion(s): Caregivers must balance caregiving responsibilities and burdens with prioritizing their health and goals (Figure). Therefore, caregiving is an identity that if unacknowledged in the therapeutic encounter, is an opportunity missed. Creating interventions that address the social contexts and barriers to healthful behavior change in caregivers may unmask an innate and underlying driver of health: the caregiver-child relationship.

Table 1. Characteristics of the recruited sample for the caregiver qualitative study


Table 2. Themes Related to Behavior and Behavior Change in Caregivers


Figure. Summary of Caregivers’ Perspectives: Caregivers Balance Caregiving, Health, & Goals