Herth’s results, however, suggested that a hope intervention may have longitudinal effects. More research is needed with larger sample sizes and possibly viewing the film more than once and extending the journaling exercise of the Living with Hope Program over time. The testing of the model suggests that the possible mechanism by which the Living with Hope Program increases hope was through increasing feelings of self –efficacy (confidence in the ability to deal with difficult Inhibitors,research,lifescience,medical situations) and decreased feelings of loss and grief. The model also suggested

that hope predicted mental health summary scores. This hypothesis was supported in the data. Loss and grief were also predictors of mental health summary scores. The qualitative data from the journals supported this finding, with participants, suggesting that the Living with Hope Inhibitors,research,lifescience,medical Program helped them to address their fears and find the positive in their situation. The model representing the mechanisms through which the Living with Hope Program was effective was revised based on these findings. The model Inhibitors,research,lifescience,medical did not include demographic variables and physical health as there were no statistically significant associations found among the demographic variables with the main variables and no significant

changes over time in participants’ physical health summary scores. Of concern in this study is the negative relationship of general afatinib cancer self-efficacy and hope with physical health summary scores and the positive loss and grief relationship. Two other studies have reported unexplainable relationships with the SF-12 physical health summary scores and other psychological measures [39,40]. These authors suggest that SF-12 physical health summary scores does not correlate with psychological measures. Inhibitors,research,lifescience,medical As a result, these results were not added to the revised model. Future studies should use more valid and reliable quality of life measures. The physical and mental health summary scores clearly indicate the poor physical and mental health of the participants. Although research studies have established the impact of family Inhibitors,research,lifescience,medical caregiving on caregivers and rural Canadians have reported Batimastat poorer

health status than their urban counterparts [41], this is the first study to compare their health to population norms. Physical and mental health scores using the SF-12v2 compared to normative population scores in the United States, suggest that the participants’ physical and mental health were well below population norms (at the 25 percentile or less). These findings underscore the need to monitor the effects of caregiving on rural caregivers’ physical and mental health and for Belinostat solubility practical support of rural women caregivers of persons with advanced cancer. Fostering their inner resource of hope is only one mechanism to achieve that goal. Limitations There are several limitations to this study that include study design and sample characteristics.