Subjective well-being in informal caregivers during the COVID-19 pandemic

For nursing students

Study summary

This study looked at whether a short nurse-led education program could improve the emotional well-being of informal caregivers during the COVID-19 pandemic. Informal caregivers (ICGs) are family members or friends who provide unpaid care to a dependent relative, often an older adult. The researchers, working through a Community Care Unit in Amarante, Portugal, wanted to know whether teaching caregivers about COVID-19 infection control could also boost their subjective well-being (SWB), a concept that captures how positively or negatively a person feels about their life day to day.

The study used a quasi-experimental, single-group, longitudinal design, meaning the same 31 caregivers were measured twice, with no separate comparison group. Most participants were women (90.3%), aged 45 to 64 (61.3%), married (67.7%), and adult children of the person they cared for (61.3%). Nearly three-quarters (74.2%) were not employed outside the home, which suggests caregiving was a major, if not the primary, activity in their daily lives.

Well-being was measured using the PANAS (Positive and Negative Affect Schedule), a validated 20-item tool that asks people to rate how strongly they feel ten positive emotions (like "interested" or "proud") and ten negative emotions (like "afraid" or "upset"). The difference between positive and negative scores gives a picture of a person's overall affective balance. Caregivers completed the PANAS at Moment 1 (April 1-9, 2021), then received two individual, home-based education sessions delivered by community nurses between April 12 and 16, 2021. These sessions covered COVID-19 signs and symptoms, infection control practices, hand hygiene, and proper use of personal protective equipment, and were reinforced with a take-home flyer. Caregivers then completed the PANAS again at Moment 2 (April 19-30, 2021).

At baseline, the caregivers' well-being was almost evenly split: 48.4% had a negative affect balance, 48.4% had a positive one, and only 3.2% were neutral. This shows how much emotional strain caregiving during a pandemic was placing on this group before any intervention. After the two education sessions, the picture changed: the mean difference between positive and negative affect moved from -0.058 at Moment 1 to +0.046 at Moment 2, and a statistical test (Wilcoxon signed-rank test) showed this shift was significant (p < 0.000), with the average rank of improvement at Moment 2 (16.93) far higher than at Moment 1 (2.50). In practical terms, 29 of the 31 caregivers (93.5%) showed an increase in subjective well-being after the intervention, while only 2 caregivers showed a decrease.

The authors concluded that a brief, nurse-delivered educational intervention, focused specifically on practical COVID-19 knowledge and skills, was associated with a meaningful improvement in caregivers' emotional well-being. They frame this as evidence that community nursing has a role to play not just in disease prevention, but in supporting the mental and emotional health of the informal caregivers who make home-based care possible.

For nursing students, this study is a useful example of how a relatively simple, low-cost intervention, two short home visits plus a flyer, can be tied to a measurable outcome using a recognized psychological scale. It also illustrates the value of measuring caregiver well-being directly rather than assuming that education about disease control only affects physical health outcomes. At the same time, students should read the findings cautiously. The design was quasi-experimental with only one group and no control group for comparison, so we cannot be certain that the education sessions, rather than some other factor (such as improving pandemic conditions, seasonal changes, or simply completing the study), caused the improvement in well-being. The sample was also small (31 people) and drawn from a single community setting in Portugal, mostly women and adult children, so the findings may not apply equally to spousal caregivers, male caregivers, or caregivers in other health systems, including Canada.

Overall, this study offers a promising but preliminary signal: structured, nurse-led education about infection control may support not only physical safety but also the emotional well-being of informal caregivers during a public health crisis, an idea that is relevant well beyond COVID-19 to future outbreaks and ongoing home-care support.

For educators

Teaching and appraisal notes

Guedes, Gomes, and Carvalho examine whether a brief nurse-led educational intervention could improve the subjective well-being (SWB) of informal caregivers (ICGs) during the COVID-19 pandemic, using a Community Care Unit setting in Amarante, Portugal. The study is quasi-experimental, single-group, and longitudinal: 31 ICGs and their care-dependent relatives were assessed before and after a two-session home-based health education intervention delivered in April 2021. Eligible caregivers had provided care for at least six months; those whose dependent died or who went on sick leave during the study were excluded. The sample skewed heavily female (90.3%), middle-aged to older (61.3% aged 45-64), married (67.7%), adult children of the care recipient (61.3%), and largely unemployed (74.2%) - a demographic profile consistent with much of the informal-caregiving literature.

The intervention itself was modest in scope: two individual, home-based sessions (April 12-16, 2021) covering COVID-19 signs and symptoms, infection control, hand hygiene, and PPE use, reinforced by a take-home flyer. SWB was operationalized using the Portuguese-validated PANAS (Positive and Negative Affect Schedule), with the outcome measure being the difference between positive and negative affect scores, collected at Moment 1 (April 1-9) and Moment 2 (April 19-30, after the intervention).

At baseline, the sample was almost evenly divided between negative (48.4%) and positive (48.4%) affect balance, with only 3.2% neutral - a useful reminder that pandemic-era caregiver distress was not universal but was substantial. Post-intervention, the mean affect-balance score shifted from -0.0581 (SD 0.716) to +0.0465 (SD 0.533), and a Wilcoxon signed-rank test found this shift statistically significant (p < 0.000), with the mean rank of Moment 2 (16.93) markedly exceeding Moment 1 (2.50). Descriptively, 29 of 31 participants (93.5%) showed an increase in SWB, with only two showing a decline - a striking proportion worth flagging for discussion, since near-universal individual-level improvement is unusual in behavioral intervention research and merits scrutiny.

For classroom appraisal, this is a good case for teaching the strengths and limits of pre-post, single-group designs. Ask students what threats to internal validity are not ruled out here: maturation (caregivers adapting to pandemic conditions over time regardless of intervention), history (improving regional COVID-19 conditions, vaccine rollout progress, or policy changes between M1 and M2), testing effects (completing the PANAS twice within three weeks), and regression to the mean (given the very short interval and the extreme initial "negative" subgroup). The authors themselves acknowledge the absence of a control group as a limitation, which should anchor any discussion of causal inference. The very short follow-up window (roughly three weeks total) also limits any claims about durability of effect.

Discussion should also address measurement and sampling: a convenience sample of 31 from one community unit constrains generalizability, and the demographic homogeneity (mostly female adult-child caregivers) means findings may not transfer to spousal or male caregivers, or to different health systems (including Canada's, where community/home-care nursing structures differ from Portugal's). The PANAS is a well-validated affect measure, but self-report measures of this kind are subject to social desirability and demand characteristics, particularly when caregivers know they are being assessed shortly after a nurse-delivered intervention they may feel obliged to rate favourably.

Despite these constraints, the study offers a plausible, pedagogically useful example: a low-cost, nurse-delivered educational intervention tied to infection-control content was associated with improved caregiver affect during a public-health crisis. It supports discussion of community nursing's dual role in disease prevention and psychosocial support, and it is a reasonable prompt for students to design a stronger follow-up study (e.g., adding a comparison group, extending follow-up, diversifying the sample) to test whether the association reflects a genuine intervention effect.