Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)

The Effect of a Self-Management Program Based on the 5A Model on Caregiver Burden of Family Caregivers and Illness Perception of Patients with Colorectal and Lung Cancers Referred to Hospitals Affiliated with Shahrekord University of Medical Sciences

Document Type : Original Article

Authors

Marzieh Bahrami 1
Ali Hassanpourdehkordi 2
Shahriyar Salehitali 3

1 Shahrekord University of Medical Sciences

2 Shahrekord University of medical sciences

3 Community-oriented Nursing Midwifery Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran

https://doi.org/10.22034/jampbr.2026.582729.1102
Abstract
Background and Aim: Illness perception and caregiver burden in cancer patients represent a serious challenge in the healthcare system. This study aimed to investigate the effect of implementing a self-management program based on the 5A model on caregiver burden of family caregivers and illness perception of patients with colorectal and lung cancers.

Methods: This quasi-experimental study was conducted with a sample size of 56 patients with colorectal and lung cancers and their family caregivers. Caregiving interventions based on the 5A model were delivered in five stages to the intervention groups through in-person and virtual sessions. The intervention''s effect was then followed up for two months. Data collection instruments included demographic information questionnaires, the Zarit Caregiver Burden Inventory, and the Brief Illness Perception Questionnaire (B-IPQ). Data were analyzed using SPSS software (version 26) and independent t-tests, Fisher''s exact test, chi-square test, and analysis of covariance (ANCOVA).

Results: The mean and standard deviation of caregiver burden scores before the intervention showed no statistically significant difference between the intervention group and the control group (p > 0.85). However, this score immediately after the intervention and two months post-follow-up showed a statistically significant difference in the intervention group compared to the control group (p < 0.001). The mean and standard deviation of illness perception scores before the intervention, after the intervention, and after the follow-up did not show any statistically significant difference (p > 0.39).

Conclusion: The findings indicate that the 5A model can be effective in reducing caregiver burden among family caregivers of cancer patients; however, its effect on patients'' illness perception requires more time.

Graphical Abstract

The Effect of a Self-Management Program Based on the 5A Model on Caregiver Burden of Family Caregivers and Illness Perception of Patients with Colorectal and Lung Cancers Referred to Hospitals Affiliated with Shahrekord University of Medical Sciences

Keywords

Family caregivers
Cancer
Illness perception
Caregiver burden
5A self-management model
Subjects
[1]       Maruthappu, M., Watkins, J., Noor, A. M., Williams, C., Ali, R., Sullivan, R., Zeltner, T., & Atun, R. (2016). Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: A longitudinal analysis. The Lancet, *388*(10045), 684-695.
[2]       Curado, M. P., Edwards, B., Shin, H. R., Storm, H., Ferlay, J., Heanue, M., & Boyle, P. (Eds.). (2007). Cancer incidence in five continents (Vol. IX). IARC Scientific Publications No. 160. International Agency for Research on Cancer.
[3]       Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, *71*(3), 209-249.
[4]       Chen, W., Zheng, R., Zeng, H., & Zhang, S. (2015). Epidemiology of lung cancer in China. Thoracic Cancer, *6*(2), 209-215.
[5]       Siegel, R. L., Miller, K. D., Fuchs, H. E., & Jemal, A. (2021). Cancer statistics, 2021. CA: A Cancer Journal for Clinicians, *71*(1), 7-33.
[6]       Ellis, J. (2012). The impact of lung cancer on patients and carers. Chronic Respiratory Disease, *9*(1), 39-47.
[7]       Abad, M., Gangy, R., Sharifian, E., Nikdel, R., Jafarzadeh, M., & Jafarzadeh, F. (2015). Epidemiologic distribution of cancer in a 10-year study: Retrospective review of hospital records and pathology centers of North Khorasan Province from 2003 to 2012. Journal of North Khorasan University of Medical Sciences, *6*(4), 705-712.
[8]       avanbakhsh Esmaeili1 , Fazlollah Ahmadi , Eesa Mohammadi , Abdolhakim Tirgari Seraj. (2012), Support: The Major Need of Patients Confronting with Cancer Diagnosis .J Mazand Univ Med Sci; 22(89): 21-30 (Persian).
[9]       Nijboer, C., Tempelaar, R., Sanderman, R., Triemstra, M., Spruijt, R. J., & Van Den Bos, G. A. (1998). Cancer and caregiving: The impact on the caregiver''s health. Psycho‐Oncology, *7*(1), 3-13.
[10]    Kizza, I. B., & Nakitende, G. (2018). Roles of family caregivers and perceived burden when caring for hospitalized adult cancer patients. SAGE Open Nursing, *4*, 1-10.
[11]    Mitschke, D. B., & Petrovic, K. (2016). Cancer in the family: Review of the psychosocial perspectives of patients and family members. Journal of Family Social Work, *19*(3), 166-184.
[12]    Kim, Y., & Schulz, R. (2008). Family caregivers'' strains: Comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. Journal of Aging and Health, *20*(5), 483-503.
[13]    Chen, M. C., & Chen, K. M. (2015). Caregiver burden, health status, and learned resourcefulness of older caregivers. Western Journal of Nursing Research, *37*(6), 767-780.
[14]    Östlund, U., Wennman-Larsen, A., Persson, C., Gustavsson, P., & Wengström, Y. (2010). Mental health in significant others of patients dying from lung cancer. Psycho‐Oncology, *19*(1), 29-37.
[15]    Braun, M., Mikulincer, M., Rydall, A., Walsh, A., & Rodin, G. (2007). Hidden morbidity in cancer: Spouse caregivers. Journal of Clinical Oncology, *25*(30), 4829-4834.
[16]    Kadan-Lottick, N. S., Vanderwerker, L. C., Block, S. D., Zhang, B., & Prigerson, H. G. (2005). Psychiatric disorders and mental health service use in patients with advanced cancer. Cancer, *104*(12), 2872-2881.
[17]    Given, B. A., & Given, C. W. (1993). The cost of cancer home care to families. Cancer, *71*(S5), 1866-1874.
[18]    Brazil, K., Bainbridge, D., & Rodriguez, C. (2010). The stress process in palliative cancer care: A qualitative study on informal caregiving and its implication for the delivery of care. American Journal of Hospice and Palliative Medicine, *27*(2), 111-116.
[19]    Grunfeld, E., Coyle, D., Whelan, T., Clinch, J., Reyno, L., Earle, C. C., Willan, A., Viola, R., Coristine, M., Janz, T., & Glossop, R. (2004). Family caregiver burden: Results of a longitudinal study of breast cancer patients and their principal caregivers. CMAJ, *170*(12), 1795-1801.
[20]    Hudson, P., Remedios, C., Zordan, R., Thomas, K., Clifton, D., Crewdson, M., Bauld, C., & Clarke, D. M. (2012). Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. Journal of Palliative Medicine, *15*(6), 696-702.
[21]    Li-Chieh Wang , Wei-Yu Chen, Shu-Chan Chang, On-Nin John Wong, Rong-Jyun Hong, Ruey-Hsia Wang. (2011), Caregiving burden and associated factors among caregivers of terminally ill gastrointestinal cancer patients. Hu Li Za Zhi.  Dec;58(6):54-64.PMID: 22113634
[22]    Given, B. A., & Given, C. W. (2001). Family support in advanced cancer. CA: A Cancer Journal for Clinicians, *51*(4), 213-231.
[23]    Mendez-Luck, C. A., Kennedy, D. P., & Wallace, S. P. (2008). Concepts of burden in giving care to older relatives: A study of female caregivers in a Mexico City neighborhood. Journal of Cross-Cultural Gerontology, *23*(3), 265-282.
[24]    Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980). Relatives of the impaired elderly: Correlates of feelings of burden. The Gerontologist, *20*(6), 649-655.
[25]    Milbury, K., Badr, H., Fossella, F., Pisters, K. M., & Carmack, C. L. (2013). Longitudinal associations between caregiver burden and patient and spouse distress in couples coping with lung cancer. Supportive Care in Cancer, *21*(9), 2371-2379.
[26]    Hodgkinson, K., Butow, P., Hunt, G. E., Wyse, R., Hobbs, K. M., & Wain, G. (2007). Life after cancer: Couples'' and partners'' psychological adjustment and supportive care needs. Supportive Care in Cancer, *15*(4), 405-415.
[27]    Li-Chieh Wang , Wei-Yu Chen, Shu-Chan Chang, On-Nin John Wong, Rong-Jyun Hong, Ruey-Hsia Wang. (2011), Caregiving burden and associated factors among caregivers of terminally ill gastrointestinal cancer patients. Hu Li Za Zhi.  Dec;58(6):54-64.PMID: 22113634
[28] ]Torkmandi H,  Heidaranlu  E,  Firouzbakht M ,  Tahmasbi B,  Ziyari M,  Yaghoobzadeh, A , M.A Goudarzian ,A.M  . Sharifnia H  ,  Mohammadinezh M. (2022), The relationship between social support and quality of life in Iranian clients with Cancer. IJCA; 1 (2) :9-15
[29]    Wang, L. Y., Chang, P. C., Shih, F. J., Sun, C. C., & Jeng, C. (2006). Self-care behavior, hope, and social support in Taiwanese patients awaiting heart transplantation. Journal of Psychosomatic Research, *61*(4), 485-491.
[30]    Goerling, U., Faller, H., Hornemann, B., Hönig, K., Bergelt, C., Maatouk, I., ... & Weis, J. (2020). Information needs in cancer patients across the disease trajectory. A prospective study. Patient Education and Counseling, *103*(1), 120-126.
[31]    Eydi, M., Ghezeljeh, T., Najafi, S., & Haghani, S. (2020), The prediction of self-care behaviors and quality of life based on disease perception in patients with heart failure. . Iran Journal of Nursing. Vol.33.No.124.. page.13-26.
[32]    Mirzaei, F., Nourizadeh, R., & Kazemzadeh, A. (2022), Illness perception and its predictors in Iranian women with breast cancer referred to oncology centers of Arak: 2017-2018. Journal of Urmia Nursing and Midwifery Faculty, vol. 18.No.8. Page. 662-671
[33]    Lindsay, S. (2008). How and why the motivation and skill to self-manage chronic disease are socially unequal. Research in the Sociology of Health Care, *26*, 17-39.
[34]    Bodenheimer, T., & Lorig, K. (2002). Patient self-management of chronic disease in primary care. JAMA, *288*(19), 2469-2475.
[35]    Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, *48*(2), 177-187.
[36]    White, C. L., Mayo, N., Hanley, J. A., & Wood-Dauphinee, S. (2003). Evolution of the caregiving experience in the initial 2 years following stroke. Research in Nursing & Health, *26*(3), 177-189.
[37]    Glasgow, R. E., Toobert, D. J., Hampson, S. E., & Strycker, L. A. (2002). Implementation, generalization and long-term results of the "choosing well" diabetes self-management intervention. Patient Education and Counseling, *48*(2), 115-122.
[38]    Xiangju Sun , Yang Jiang , Jing Wang , Siyuan Fan , Xinghua Fu , Zhi An , Xiaomei Zhu  Yibo Wu. (2024), Effects of a mobile health intervention based on a multitheoretical model of health behavior change on anxiety and depression, fear of cancer progression, and quality of life in patients with differentiated thyroid cancer: A randomized controlled trial. BMC Med. Oct 15;22:466.
[39]    Mollai, F., Borhani, F., & Abbazadeh, A. (2019). The dynamics of change: Cancer patients'' preferences for information, involvement and support. Journal of Urmia Nursing and Midwifery Faculty, *17*(5), 345-356.
[40]    Pahlavanzadeh, S., Navidian, A., & Yazdani, M. (2010), The effect of psycho-education on depression, anxiety and stress in family caregivers of patients with mental disorders. Journal of Kermanshah University of Medical Sciences, *14*(3),  228-236
[41]    ]Khalifezadeh, A., Gheisarian, Z., & Bigdelian, H. (2019), The effect of care program on caregiving burden of mothers of children undergoing congenital heart disease surgery. Journal of Pediatric Nursing, *4*(3), 41-46.
[42]    Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, *60*(6), 631-637.
[43]    . Kalhor, M., Fathi, M., Ghaderi, B., Roshani, D., Ozairi, S., & Rashidi, K. (2019), Effect of five a model self-management on quality of life in patients with breast cancer. Avicenna Journal of Nursing and Midwifery Care, *27*(4), 269-280.
[44]    Jean H Choi 1, Kyong-Mee Chung. (2012), Effectiveness of a college-level self-management course on successful behavior change. Behav Modif; 36(1):18-36.doi:
[45]    Heydari, M., Arsalani, N., Dalvandi, A., Noroozi, M., & Daneshvar, R. (2020). The effectiveness of self-management program based on 5A model on patient care burden for stroke patients. Iranian Journal of Rehabilitation Research in Nursing, *6*(4), 50-59.
[46]    Khoshkhoo, M., Sajjadi, M., Mansoorian, M. R., & Ajamzibad, H. (2021). Effects of 5A model-based intervention on self-care and quality of life in elderly people with hypertension. Salmand: Iranian Journal of Ageing, *16*(3), 342-355.
[47]    Bilgin, A., & Ozdemir, L. (2022). Interventions to improve the preparedness to care for family caregivers of cancer patients: A systematic review and meta-analysis. Cancer Nursing, *45*(3), E539-E551.
[48]    Bucher, J. A., Loscalzo, M., Zabora, J., Houts, P. S., Hooker, C., & BrintzenhofeSzoc, K. (2001). Problem-solving cancer care education for patients and caregivers. Cancer Practice, *9*(2), 66-70.
[49]    Aliakbarian, M., Karimi Moonaghi, H., Emadzade, A., & Behnam Vashani, H. (2019). The effect of group training on burden of caregivers of children with cancer. Medical Journal of Mashhad University of Medical Sciences, *62*(5), 1692-1699.
[50]    Hajloo, N., Barahmand, O., Adili, A., & Fathi, M. (2016). Role of disease stage illness perceptions, unmet needs and fatigue in predicting quality of life in patients with cancer. Health Psychology, *5*(3), 2016, 117-132
[51]    Abdollahi, F., Zare, T. M., & Rashvand, F. (2019). The relationship between perception of illness and health-related behaviors in patients with multiple sclerosis. Journal of Health Care, *21*(2),2019,  145-155
[52]    Richardson, A. E., Tennant, G., Morton, R. P., & Broadbent, E. (2017). A self-regulatory intervention for patients with head and neck cancer: Pilot randomized trial. Annals of Behavioral Medicine, *51*(5), 629-641.
[53]    ]Jadidmilani, M., Ashktorab, T., Abedsaeedi, Z., & Alavimajd, H. (2013). Promotion of illness perception and its aspects in a multiple sclerosis (MS) peer support groups. Knowledge and Health, *8*(1). 2013, 24-30
Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research (JAMPBR)
Volume 2, Issue 4
July and August 2026
Pages 409-417

Home

Editorial Board

Guide for Authors

Submit Manuscript

Reviewers

Contact Us