Abstract
<title>Abstract</title> <p>Background The palliative care of family members of cancer patients is constantly challenged in various ways (physically and emotionally, as well as financially), increasing psychological stress. Coping strategies may be culturally located, and in a Muslim majority country like Pakistan, religiosity might be a culturally located coping strategy, but there is scant evidence of its relationship to coping burden and distress of caregivers. Objective To examine the associations among caregiver burden, Muslim religiosity, and psychological distress, and to test whether caregiver burden mediates the relationship between religiosity and distress among family caregivers of cancer patients in Pakistan. Methods A cross sectional survey was done with N = 160 informal caregivers, which were purposively selected from public and private chemotherapy day-care centers in Faisalabad, Pakistan. The Modified Zarit Burden Interview (MZBI, α = .85), the Belief into Action Scale (BIAC, α = .76), and the Kessler Psychological Distress Scale (K10, α = .90) were used for the assessment of caregiver burden, Muslim religiosity, and psychological distress respectively. Pearson correlations, hierarchical regression, independent-samples t-tests, one-way ANOVA and bias-corrected bootstrapped mediation (5,000 resamples) were used for data analysis. Results Internal consistency of all three scales was acceptable to excellent. Caregiver burden showed a significant positive correlation with psychological distress (r = .49, p < .001) and Muslim religiosity was negatively correlated with both burden (r = − .27, p < .001) and psychological distress (r = − .21, p < .01). Hierarchical regression yielded an R² of .336 (R = .579) for the final model which accounted for about 34% of the variance in distress; the unique contribution of the variable of religiosity was small and not significant after the variable of caregiver burden was entered in the model (β = −.05, p = .484), while the unique contribution of caregiver burden was the strongest (β = .42, p < .001). Standardised bootstrap mediation revealed that the association of religiosity with lower distress was mediated indirectly through the association of religious beliefs with lower burden (indirect effect = − .128; bias-corrected 95% CI [− .210, − .055], excluding zero). Female caregivers also experienced significantly more distress than male caregivers (M = 24.15 vs. 20.95, t(158) = − 2.52, p = .013) and there was a significant difference between the burden experienced by caregivers living in villages as compared to those living in cities (M = 45.91 vs. 40.28, t(158) = − 2.42, p = .017). There was a non-significant trend for association with religiosity and caregivers' occupation, F(3, 156) = 2.38, p = .071. Conclusions In the Pakistan context, the main determinant of psychological distress among family carers of cancer patients is caregiver burden. The effect of Muslim religiosity seems to be a protective one as it is related to a decreased perceived burden, but not to a direct effect on distress. Interventions that are culturally responsive, incorporating burden reduction strategies and religious and spiritually based coping resources may be especially helpful, particularly for female and rural caregivers.</p>