Validación del Programa de Competencia Familiar Universal Auto (PCF-U-Auto)implicación familiar para la promoción de la autonomía individual de adultos mayores

Abstract

The promotion of personal autonomy is established as a key element to guarantee active aging. The family is often the social system in charge of caring for older adults when they are unable to fend for themselves; provides affective, relational and emotional bonds necessary to guarantee the well-being of the elderly. To guarantee the quality of life in the elderly, both health care should be considered, as well as care that facilitates the maintenance of family stability. That is why this system will require relational and social skills that allow them to successfully face the changes of aging; changes that will impact on coexistence, the relationships between its members and on each of the members themselves. To support individuals and families to maintain an active role in promoting the autonomy and health of their members, emphasis will be placed on empowerment, a process by which individual, family and social care skills are encouraged. In this sense, adaptive coping styles have proven to be the engine for improving adaptability to aging changes, enabling proper conflict management and enhancing family resilience. Evidence-based family competencies programs have proven to be an efficient and effective strategy for developing resilience-promoting family relationship skills. However, among the main weaknesses for the effectiveness of the implementation of this type of programs, the difficulties to maintain family involvement throughout the process are identified; It refers both to the difficulties for family recruitment and retention at the beginning of the process, for the maintenance of family commitment throughout the sessions and the difficulties to overcome the barriers to participation. This doctoral thesis was born within the framework of the Research Project “Validation of the 10-14 Universal Family Competence Program in Spain (EDU2016-79235-R - R&D related to Social Sciences financed with FGU)”. This doctoral thesis was initially aimed at evaluating which are the techniques that give the best results of adherence to the program, in response to objective 4 of the Research Project that is operationalized in "Evaluating the adherence of participating families, throughout the sessions that make up the program”. Since the evidence indicates that the work on communication skills, social skills, family coping strategies, skills in caregivers and older adults related to effective care, self-esteem or self-efficacy, among other skills that the Program works on of Family Competence, promote autonomy and help prevent dependency situations, it was decided to adapt its contents, since the Family Competence Program is oriented towards socio-educational intervention with and between parents and minors. Until now, a socio-educational intervention had not been defined that would allow the preventive work of potential dysfunctional family dynamics linked to the appearance of situations of dependency and chronicity. Previous versions of the Family Competence Program have demonstrated its long-term effectiveness in the main factors that make up positive family dynamics (resilience, communication, family organization and cohesion, positive discipline and other factors) (Orte et al., 2015) and given the variables on which it works, the characteristics - evidence-based practice - and the following evidence: 1. The relationship between the lack of social and family support, social relationships, communication problems and the influence of the environment on the processes of loss of autonomy and acceleration of progress towards forms of severe dependency. 2. The lack of guarantee of the right included in article 1 of Law 39/2006, to have resources to promote autonomy and the lack of attention to national and international recommendations regarding active aging. We proceeded to adapt the Family Competence Program given its proven results in improving family coping strategies, improving family dynamics and both family and individual protection factors in each of its members. The Universal-Auto Family Competence Program was designed around the same tools and structure as the Universal Competence Program. The same generic objective was taken as a reference - to work on communication and family relationship patterns - although with a different final objective: to promote family dynamics that allow an optimal functioning of each of its members, where appropriate, to promote active aging. Through a set of socio-educational interventions applied in the family environment, the permanence of the person in a situation of dependency in their family environment is promoted under conditions of well-being and quality of life. In addition, primary and secondary prevention measures for dependency situations are reinforced by targeting families with older adults without dependency or with incipient symptoms of it. The program and its materials were designed, a group of social workers from the Individual Care Plan (PIA) of the Fundació d'Atenció i Suport a Dependencia i de Promoció de l'Autonomia Personal of the General Directorate of Dependency of the Govern Balear, for its implementation and it was applied, in 2019 on a sample of 75 families from different territorial areas of Palma de Mallorca. A second pilot was started in 2020, again on a sample of 75 families, which had to be interrupted as a result of the declaration of the state of alarm by COVID-19, on March 14, 2020. The study had a quasi-experimental design with pre-post evaluations of the participants in the program. The tools for measuring the effects of the program on the families under intervention were carried out using validated questionnaires for their application on said population. They were adapted to the characteristics of the population under investigation and, prior to the start, participants were informed about their rights and provided with an informed consent form. Specifically, the instruments were: the Pfeiffer Questionnaire, to identify the symptoms of dementia not diagnosed in the initial screening, the Social Resources Scale (OARS), to evaluate the levels of social support, the Family Function Questionnaire (APGAR) to evaluate the dynamics and family functioning, the Questionnaire of Quality of Life in Old Age in Different Contexts, to evaluate the levels of quality of life of the elderly participants, the Geriatric Depression Scale - Yesavage Test, to evaluate the levels of depression in older adults, the participant satisfaction questionnaires, to evaluate the level of satisfaction of families with the contents, trainers and results of the program and the evaluation and follow-up questionnaire so that the trainers could evaluate the suitability of the contents of the program for their implementation and evolution of the participants in each of the sessions. The evaluation of the tools were redesigned, preparing a single questionnaire with the main information and results evaluation scales, adapting the information to its recipients and with the pertinent evaluation measures for each evaluation group, forming a questionnaire for relatives, one for adults, a questionnaire for evaluating the progress of the participants, a questionnaire for evaluating the family sessions, a questionnaire for evaluating the caregiver sessions, another for evaluating the sessions for the elderly, and a satisfaction questionnaire. The analysis of the quantitative data focused on the results of the factors and scales considered for each of the instruments, in accordance with the research hypotheses. The analysis was carried out with SPSS 25. A descriptive analysis of each of the scales considered was carried out, according to the protocols established by instrument, establishing the group results and differentiating the results by variable. A mean difference analysis (t-test) and non- parametric tests (Mann-Whitney U) were performed, checking differences (pre-post, between quasi-experimental group and control and the sex variable by means of checks based on the analysis of variance: MANOVA), reproducing the analysis sequence for each of the data collection stages. The results of the recruitment strategies, identified in the systematic reviews and applied in the first piloting of PCF-Auto, the analysis of adherence, through the control of attendance and participation, analyzing the follow-up of the indications and behavioral resources introduced by the program, by following the recommendations by the participants in the short and medium term, the fidelity of the trainers in the application of the program was analyzed, and the evaluation of the program and satisfaction were analyzed competitor. The initial hypotheses were contrasted by means of the study of the dependent variables, according to the rest of the variables considered, carrying out an individual and relational study of the explanatory variables. The results show the adequate achievement of the validation of the content of the program, although certain modifications identified in the evaluations are required. The evaluation of the adherence, showed the need to implement strategies to encourage the realization of practices at home, since they constitute an important part of the assimilation of program content. The satisfaction results proved to be very positive. In this doctoral thesis, family involvement techniques applied in family risk prevention interventions were defined. The results of the systematic reviews indicated the need to consider involvement techniques related to the families, the trainer, the program and the organization, to guarantee the effectiveness of the results of the family programs, in relation to the participation and maintenance of families throughout the program sessions. These results are demonstrated in the first two systematic reviews published in Octaedro and in Social Work and Social Sciences Review. On the other hand, the Family Competence Program, in its universal version, was adapted to the needs of families with older adults, with the aim of promoting their autonomy, active aging and quality of life. For the adaptation, a descriptive observational study was previously carried out, aimed at defining the sociodemographic, health, social support, dependency variables and those relating to the interaction between the caregiver and the elderly. Cluster analysis was applied to define the profiles of the dependent population and adapt the program design according to the needs defined in the study. At the same time, a drafting of plans, programs, protocols, guides and official documents of the different Spanish autonomies and of the main international entities on aging and dependency was carried out, to identify (1) the family variables that promote autonomy (2) measures to promote autonomy implemented. After defining (1) the profile of dependent older adults, (2) the family variables that affect the autonomy of older adults, and (3) the implemented measures to promote autonomy, the Family Competency Program was designed. The first piloting was carried out. Regarding the procedure followed for the piloting, a total of 16 social workers from the Fundació d'Atenció i Suport a la Dependencia y de Promoció de l'Autonomia Personal de les Illes Balears - Direcció General de Dependencia were trained (10h.) By University professors in the contents –theoretical and practical foundation- of the PCF-U-Auto. During two weeks, a group of beneficiaries of the Economic Benefit for Care in the Family Environment (PECEF) of the Balearic Government were selected by the reference Social Workers authorized to apply the PCF-U-Auto; the main screening requirement was that they had received the Grade I assessment within the 6 months immediately prior to selection. The goal was to avoid including in the sample people whose assessments required updating due to having contracted more symptoms of dependence. The pilot sample consisted of 5 groups of ± 15 families per group: one group in Manacor, one in Inca and three in Palma – Santa Catalina / Son Espanyolet, Ciutat Antiga and Son Cladera- forming an initial sample of 75 families. From the analysis of a first piloting, it was identified how certain social and family factors include, in a significant way, (p ≤ 0.05) on dependency situations, allowing to define intervention proposals to apply in the Family-Auto Competence Program. Significant changes in family dynamics (family functionality (APGAR), t = -2.426, p = 0.018 *, d = 0.307; family resilience, t = -2.283, p = 0.026 *, d = 1.007) and significant changes in older adults (social resources (OARS): t = -2.032, p = 0.046 *, d = 0.445; assessment of social situation: p = 0.055 *; assessment of social relationships: p ≤ 0.05 in relation to grandchildren and with the neighbors). Conclusively, the effectiveness of PCF-Auto in responding to the need for measures to promote autonomy and active aging in older adults is demonstrated, indicated by the main national and international entities, laws and studies on aging and dependency. The PCF-Auto confirms its validity as a preventive tool for situations of dependency through work on the family environment.