Spiritual Well-Being in Appalachian Family Caregivers





spiritual well-being; rural Appalachia; home caregiving; preparedness; communication; palliative care


Introduction: Dementia and heart failure (HF) are the most common co-existing end-of-life conditions among rural older adults requiring extensive caregiving. Studies conducted in Appalachia have found that caregivers report a lack of information about palliative care and managing complex care at home. They also indicate the need for spiritual support. 

Purpose: This study aimed to assess the factors contributing to the spiritual well-being of caregivers in the rural Appalachian region. 

Methods: This descriptive correlational design allowed the collection of surveys from caregivers (N= 20) of loved ones with the diagnosis of HF and dementia. A multiple regression analysis was performed on caregivers’ spiritual well-being scores as the dependent variable. Factors impacting caregiving (i.e., measures of caregivers’ preparedness for HF and dementia home care and patients’ physical, emotional, and palliative care scale needs) were the independent variables.

Findings: The average age of these family caregivers was 64.95 years (SD =12.42). These caregivers had a high median score on the spiritual well-being scale (32.5 out of 45). In the regression analysis, a large amount (53%) of variance in spiritual well-being was explained by caregivers’ greater preparedness for HF and dementia home care (p < .01) and by informational communications about caregivers’ practical care concerns (p < .05).  These caregivers age, number of years of caregiving, and patients physical and emotional status did not statistically contribute to caregiver spiritual well-being.

Conclusion:  The rural Appalachian population values spiritual well-being. There is a need for nurse-led interventions specific to HF and dementia home care to support caregivers' spiritual well-being and provide information about managing in-home care practical concerns. Nurses may also support caregivers’ spiritual well-being by holding supportive caregiver discussion groups and setting up home visits and telephone contacts with their spiritual advocates.

Keywords: spiritual well-being, rural Appalachia, home caregiving, preparedness, communication, palliative care

DOI:  https://doi.org/10.14574/ojrnhc.v24i1.757

Author Biographies

  • Ubolrat Piamjariyakul, PhD, RN, West Virginia University

    Associate Dean of Research, Office of Research and Scholarly Activities

    Associate Professor, School of Nursing

  • Stephanie Young, PhD, MSN, RN, West Virginia University School of Nursing

    Clinical Assistant Professor, School of Nursing


  • Saima Shafique, PhD, MPH, West Virginia University School of Nursing

    Research Specialist, School of Nursing


  • Nathaniel Palmer, Student, West Virginia University

    Undergraduate Student,  School of Public Health

  • Kesheng Wang, PhD, West Virginia University School of Nursing

    Professor, School of Nursing