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A training intervention to reduce paternalistic care and promote autonomy: a preliminary study

Authors Sánchez-Izquierdo M, Santacreu M, Olmos R, Fernández-Ballesteros R

Received 27 April 2019

Accepted for publication 25 July 2019

Published 26 August 2019 Volume 2019:14 Pages 1515—1525

DOI https://doi.org/10.2147/CIA.S213644

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Melinda Thomas

Peer reviewer comments 3

Editor who approved publication: Dr Richard Walker


Macarena Sánchez-Izquierdo,1 Marta Santacreu,2 Ricardo Olmos,3 Rocío Fernández-Ballesteros4

1Department of Psychology, Universidad Pontificia Comillas, Madrid 28049, Spain; 2Department of Psychology, National Distance Education University of Spain – UNED, Madrid 28670, Spain; 3Department of Methodology, Autonomous University of Madrid, Madrid 28049, Spain; 4Department of Psychobiology and Health, Autonomous University of Madrid, Madrid 28049, Spain

Correspondence: Macarena Sánchez-Izquierdo
Department of Psychology, Comillas Pontifical University, C. Universidad Comillas, 3-5, Madrid 28049, Spain
Tel +34 91 734 3950
Email msizquierdo@comillas.edu

Introduction: Paternalism, assuming control of aged care, is a widespread orientation in older adults care. Paternalistic attitudes and practices are commonly understood as a threat to the freedom and autonomy of a person, making patients more dependent. Therefore, the reduction of these attitudes and behaviors is a primary goal for any older adult health and social care situation. The aim of this preliminary study is to develop a behavioral intervention to decrease paternalistic behaviors in formal caregivers and to increase those care behaviors which promote autonomy at post-intervention (1 week) and at follow-up (14 weeks).
Methods: A sample of 118 professional caregiver volunteers working in day care centers and nursing homes were assigned to quasi-experimental (N=47) and control (N=71) conditions. The intervention consisted of 3 weekly group sessions. Individual and contextual measures were collected: 1) the primary outcome variable was the type of care (paternalistic versus autonomist) measured through the self-report Paternalist/Autonomist Care Assessment (PACA); 2) A 10-item caregiver self-register of paternalistic behaviors was carried out, 3) Finally, in order to assess the potential effects on observed behavior both in caregiver and older adult functioning at a contextual level, the five institutions were assessed through the SERA-RS.
Results: Compared with the control group, caregivers in the behavioral intervention group displayed significantly lower paternalistic appraisals at posttest and follow-up. Regarding the intervention group, caregivers at posttest and follow-up showed significantly greater occurrence of autonomist behaviors being promoted and lower paternalistic appraisal. The results regarding the effect on the institutions showed better personnel performance and older adult functioning.
Conclusion: Caregivers who followed the intervention learned to better identify older adult needs; although we did not find significant differences in autonomy occurrence compared with the control group, a behavioral intervention may promote more autonomist environments and, therefore, better personnel and older adult functioning.

Keywords: paternalism, autonomy, caregivers, behavioral intervention

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