30 June 2014, University of Sheffield Presented by Huiying Ng

1. Practices, Norms and Options: a Mixed Methods Study on the Efficacy of a Support Group Programmefor Cancer Caregivers On behalf of the research team at the National University Hospital: A/P RathiMahendran A/P KonstadinaGriva Joanne Chua Haikel Lim Joyce Tan Supported by National University Cancer Institute (Singapore) Seed Fund 30 June 2014, University of Sheffield Presented by Huiying Ng

2. 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

3. Self-realisation Fulfillment Collective identity Individual identities

4. Norms • Options • Habitus

5. Caregiving in Singapore • “Family” / “informal” caregivers • Low public awareness of caregivers’ psychological support need • Filial piety and family obligation • Disinclination to speak about cancer

6. Self-determination Theory • Motivation • Autonomy • Competence • Relatedness Basic Psychological Needs

7. Research Aims • 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 • How these aspects of the social environment interact with caregiving motivations to result in psychological outcomes • The qualitative form that such a social environment would take.

8. Methodology Qualitative Quantitative • Semi-structured interview • Pre-intervention • Challenges faced • Family support • Caregiving disruption to life goals • Expectations of group • Post-intervention • “What did you like or not like about the support group?” • Improvements • Met expectations?

9. Quantitative Measures

10. Thematic Analysis

11. Challenges and Solutions Qualitative: • Citing family ties as a reason for caregiving—not explicitly value-laden • Citing filial obligation—which is value-laden—how do we decide if someone is falling on the maladaptive side of a social norm? • Choice to use semantic meanings rather than latent meanings Mixed methods: • People mention different motivations all across the duration of the interview. How do we rank people by their level of motivation? • Goals: goal alignment, goal conflict, reprioritization, shifting goals, goals are unclear. Can we code these into analyzable categories? • How to relate personal goals todesires and motivation?

12. Ng, J. Y. Y., Ntoumanis, N., Thogersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-Determination Theory Applied to Health Contexts: A Meta-Analysis. Perspectives on Psychological Science, 7(4), 325–340. doi:10.1177/1745691612447309

13. Preliminary Findings • Preliminary analysis focuses on motivations and cultural issues • Does the group relate to better wellbeing? • Yes: group provides caregivers with expert information, reminders of self-care tips, role models and downward social comparison, and an understanding that they are not alone. • Yes; quantitatively, the group increased positive adaptation scores.

14. Preliminary Findings • How do our qualitative and quantitative findings complement each other? • Qualitative findings suggest that caregivers’ motivations for caregiving may influence the benefits they draw from the group, as well as their support needs • Motivations for caregiving fell under two broad categories: externally regulated motivations (FP or family obligations) and intrinsic motivation (pleasure of caring). • Quantitatively, more internal motivations correlated with more positive outcomes and fewer negative outcomes

15. Pre-intervention Post-intervention Motivations for caregiving r = .856 r = -.799 + Basic Psychological Needs + Basic Psychological Needs r = .910 + Autonomy r = .812 - Financial Concerns + Relatedness r = .969 - Stress r = -.917

16. 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: • 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

17. Thank you for listening! Questions?