The Multi-Caregiver Role and Its Relationship to Behavioral Adherence and Weight Among Treatment Engaged Black Women

Purpose To examine the relationship between the multiple caregiver role and its perceived barriers to self-care on behavioral adherence in a weight loss intervention. Design A secondary analysis of data from a behavioral weight loss intervention. Setting The study was conducted in two cohorts from March 2016 to February 2017 at the University of North Carolina at Chapel Hill. Subjects Eighty-one Black women with overweight/obesity (age = 48.4 +/- 10.9 years [M +/- SD], BMI = 36.4 +/- 4.5 kg/m(2) [M +/- SD]). Measures Identification with the multiple caregiver role and barriers was assessed with the Multiple Caregiving Measurement Instrument. Weight was measured with a digital scale and height with a stadiometer. The Block food frequency questionnaire evaluated dietary intake. Moderate-to-vigorous physical activity (MVPA) was measured objectively with an accelerometer. Study adherence was measured by session attendance, self-weighing, and self-monitoring (diet and physical activity) frequency. Analysis Generalized linear models were used to examine the relationship between the multiple caregiver scales and the outcomes of interest, controlling for study arm, cohort, and income. Chi-square tests tested correlations. Results Greater identification with the multiple caregiver role was associated with decreased session attendance (beta = -.56 [SE = .27], P < .05) and a trend towards weight gain (beta = .36, [SE = .19], P = .07). Greater multiple caregiver barriers score predicted a decrease in fruit/vegetable intake (beta = -.17 [SE = .07], P < .05). All regression results are unstandardized. Negative correlations between multiple caregiver barriers and MVPA (r = -.24, P = .06) and daily self-weighing (r = -.19, P = .10) approached significance. Conclusions Participants' identification with multiple caregiving role and barriers can reduce adherence, behavior and weight change. Interventions to address Black women's multiple roles and barriers during weight loss are needed to maximize outcomes.