Author ORCID Identifier

Date of Award

Spring 5-5-2022

Degree Type


Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Kimberly Hire

Second Advisor

Lisa Cranwell-Bruce


Purpose: This project sought to determine if a combination of stress reduction, self-guided bibliotherapy, and health literacy training is an effective way to reduce stress and role strain of informal caregivers and improve their quality of life.

Background: The value of the unpaid labor performed by caregivers is estimated to be at least $306 billion annually that is nearly double the combined costs of $43 billion in home health care and $115 billion in nursing home care. Numerous studies posit caregivers are at risk of developing high levels of physical, emotional, and mental strain, which can negatively impact their role, quality of life, and increase medical costs.

Methods: A mix-method design was employed focusing on the role strain and quality of life of relatives and friends assisting individuals with neurocognitive or mental health disorders. A pretest-posttest survey design and an educational intervention was used. Subjects were recruited from family support groups, social media, and different organizations in Georgia. The subjects engaged in weekly online self-guided activities for eight-weeks and responded to survey questions regarding demographics, depression, anxiety, and stress levels. Eligible subjects were English-speaking adults from 18 years and older with or without comorbid conditions who assisted with daily living activities for a relative or friend for more than one month. The intervention included an educational resource kit with information on self-guided bibliotherapy and psychiatric medications for participants who scored high on the depression, anxiety, and stress scales.

Results: Four women completed the project. Descriptive statistics and qualitive data from surveys and emails were employed for the data analysis due to the small sample size. A non-parametric test was used given small sample size (Kruskal-Wallis tests for variables with 3 response categories and Mann-Whitney tests for variables with 2 response categories). The non-parametric test showed no statistical significance between the pre and post-test with a p-value of 0.05. We did not identify significant differences in DASS-21 scores based on any of the variables assessed.

Conclusion: The project’s findings indicated decreasing caregiver stress may lead to improved quality of life and fewer stress-related health problems. The findings strongly imply interventions to reduce the negative impact of caregiving may be effective if participants fully engage and adhere to the directions given by the researcher. All the participants reported their care recipient's ill-health affected their social lives and ability to engage in self-care activities.


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