Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson; Caroline Etland, PhD, RN, ACHPN, Committee member; Razel Bacuetes Milo PhD, DNP, FNP-C, Committee member.


Caregiver Burden, Health Literacy, Caregiver, Chronic illness


Background/Rationale: Greater attention is needed on factors effectively supporting caregivers because poor well-being of caregivers can hamper overall patient outcomes. Lack of awareness of caregiver burden has implications for healthcare systems globally. Caregivers may encounter various levels of burden as a result of providing long-term care to individuals diagnosed with one or more chronic illnesses. Caregivers with inadequate health literacy are more likely to experience feelings of uncertainty, and as a result, caregiver burden. Little is known about the impact of the health literacy of caregivers on the level of burden when providing care to individuals with complex care needs as a consequence of chronic disease. Purpose: the purpose of this study was to examine the association between level of health literacy and degree of burden among caregivers of patients diagnosed with chronic illnesses. Conceptual basis: This study is informed by two theories, the Modified Stress Process Model by Roland & Chappell (2017) and Tsai’s (2003) caregiver stress middle range theory. These two theories were well aligned with the constructs involved in understanding the experience of burden caregivers may encounter when responding to the task load and stressful situations. Methodology: a descriptive correlational cross-sectional design was used for this study. A convenience sample of 161 caregivers was recruited from four community centers located in southern California. Findings: Two thirds (63.4%, n = 102) of the study participants (caregivers) self-reported female (63.4%, n = 102); 36.6% (n = 59) male. Caregivers’ age ranged from 19 to 62 years with a mean age of 36.8 (SD = 9.8). One-Way ANOVA results showed ZBI scores were significantly higher for female caregivers (M = 35.43, SD = 20.08) when compared to male caregivers (M = 17.10, SD = 17.10); F(1, 159) = 7.53, p = .007. Pearson correlation showed moderate negative association between ZBI score and Health Literacy score (r = -.416, p < .001). The multiple regression model significantly predicted caregivers’ burden (ZBI scores), F(14, 146) = 5.89, p < .001, adj. R2 = .299, a medium effect size. Three predictors: pneumonia (p = .008), duration of caregiving (p = .031) and caregivers’ health literacy (p = .008) added significantly to the prediction; Health literacy (Beta = -.260) was the strongest unique contribution to the caregiver burden score, followed by pneumonia (Beta = .170) and the duration of caregiving hours per day (Beta = .171). Implications for Nursing: caregivers encounter various levels of burden resulting from providing long-term care to individuals diagnosed with one or more chronic illnesses. Nursing researchers and clinicians should be mindful of increased burden with older caregiver age and develop strategies to engage appropriate support systems. Include caregivers in education programs and interventions designed to optimize their health literacy and self-efficacy.

Document Type

Dissertation: Open Access



Available for download on Saturday, October 29, 2022