{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:29:16Z","timestamp":1786476556106,"version":"build-2736575974"},"reference-count":73,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Advanced Nursing"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To assess caregiver burden and its relationship with health literacy, self\u2010efficacy, stigma, and social support among caregivers of children with tuberculosis in Shanghai, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Explanatory sequential mixed\u2010methods design.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In the quantitative phase, 132 caregivers were recruited from a Shanghai Hospital, and 21 participated in the qualitative interviews. Data were collected (April 2023\u2013April 2025) using the Zarit Burden Interview scale, Chinese Health Literacy Scale for Tuberculosis, General Self\u2010Efficacy Scale, Tuberculosis\u2010related Stigma Scale, Multidimensional Scale of Perceived Social Support, and semi\u2010structured interviews. Quantitative data were analysed using descriptive statistics and multiple regression analyses, and qualitative data were analysed using content analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Most caregivers were mothers (72.7%). Burden levels were classified as mild (58.3%), moderate (27.3%), or severe (2.3%). The quantitative analysis identified lower health literacy, limited social support, reduced self\u2010efficacy, and being a female caregiver as significant predictors. Social support partially mediated and self\u2010efficacy mediated the effect of perceived stigma and health literacy on caregiver burden, respectively. Qualitative themes revealed psychological and physical effects, impact on social life, and coping strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Caregiver burden in paediatric tuberculosis is multidimensional and influenced by complex mechanisms. Interventions should address health literacy gaps, enhance self\u2010efficacy, strengthen social support systems, and implement targeted stigma\u2010reduction strategies while considering developmental\u2010stage\u2010specific needs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications for Patient Care<\/jats:title>\n                    <jats:p>Healthcare systems should routinely assess caregiver burden, and multidisciplinary teams should be trained to provide integrated targeted support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Impact<\/jats:title>\n                    <jats:p>This study demonstrates distinct stigma pathways and comprehensively shows that caregiver burden is significantly associated with modifiable psychosocial factors. Consequently, healthcare providers should develop targeted support interventions that address both psychological and practical caregiving challenges, ultimately contributing to improved patient care outcomes and caregiver well\u2010being in tuberculosis management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Reporting Method<\/jats:title>\n                    <jats:p>This study adheres to the Good Reporting of A Mixed Methods Study checklist.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient or Public Contribution<\/jats:title>\n                    <jats:p>None.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jan.70509","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:55:26Z","timestamp":1779944126000},"page":"8782-8801","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Caregiver Burden Among Families of Paediatric Patients With Tuberculosis: A Mixed\u2010Methods Study"],"prefix":"10.1111","volume":"82","author":[{"given":"Ning","family":"Dong","sequence":"first","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaowen","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhao","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Nursing, Shanghai Public Health Clinical Center Fudan University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2010-8188","authenticated-orcid":false,"given":"Rachel H. 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