JMIR Publications

ABSTRACT

Background:

Clients with severe to profound intellectual disabilities (SPID) and challenging behavior (CB) and the professional caregivers that support them are vulnerable to experience high levels of stress, which negatively impacts their well-being and the quality of care. CB is thought to result from clients’ increased and frequent stress experiences. In turn, staff members experience stress in dealing with this behavior. Stressed staff members, in turn, might behave in ways that increase client stress levels and contribute to the origin and maintenance of CB. Research into these dyadic interactions between clients and staff is scarce for people with SPID, especially in real-life situations. Problems in studying stress in this population include clients’ difficulties in communicating stress experiences, and a lack of an objective, continuous measure of stress.

Objective:

This paper present the protocol of a study into patterns of physiological stress in 15 client-caregiver dyads in the 30 minutes preceding incidents of CB compared to control periods without CB, and the interplay between the stress levels of clients and professional caregivers.

Methods:

Fifteen single case studies will be conducted to assess patterns of physiological stress in dyads of clients with SPID and professional caregivers prior to CB, in a number of Dutch residential institutes. Client-caregiver dyads will wear the Empatica E4 wristband on 20 sessions of three to eight hours without interruptions of daily routines while caregivers report clients’ CB. Physiological measures obtained are electrodermal activity (EDA; microSiemens) and heart rate (HR; beats per minute). A multilevel model with repeated measures at the incident level nested within the person level will be applied, employing separate models for EDA and HR to compare stress levels in the 30 minutes prior to incidents with control epochs. Covariates in the models include movement, temperature and gender. Cross-Recurrence Quantification Analyses (CRQA) will be performed to study the (de)synchronization between the stress levels of clients and professional caregivers.

Results:

The faculty Ethics Committee of the Radboud University (NL-number: NL71683.091.19) approved the study on February 12, 2020. In total, 15 organizations have declared their commitment to participate in the study. First result are expected in the spring of 2022.

Conclusions:

Study results will demonstrate whether changes in patterns of EDA and HR are apparent in the 30 minutes preceding an incident of CB compared to baseline levels when the client does not engage in CB, and the (de)synchronization between caregivers’ and clients’ physiological stress levels is explored with CRQA. Insights in the physiological stress levels of clients and caregivers may contribute to a reduction of CB and an improvement of both clients’ and caregivers’ safety and well-being.