Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



Research Advisor

Mona N. Wicks, PhD, RN, FAAN


J. Carolyn Graff, PhD, RN, FAAIDD Belinda Hardy, LCSW Margaret Thorman Hartig, PhD, FNP-BC,FAANP Elizabeth A. Tolley, PhD


Caregiving, Coping, Grandparents, Health, Mixed Methods, Stress


Introduction: Grandparents are becoming increasingly responsible for raising their grandchildren. Previous studies have noted physical and mental health limitations for custodial grandparents. Grandparents face numerous challenges in raising grandchildren and consequently, experience high stress levels. However, coping and social support have been found to mediate grandparent stress. Rural custodial grandparents have been an understudied population. Using the Stress Process Model, this study extends the knowledge of rural grandparents raising grandchildren by describing the relationships among physical and mental health, stressors, coping, and social supports for custodial grandparents living in Western Kentucky.

Methods: A mixed methods approach was used to examine the physical and mental health, stress, coping, and social support of 21 custodial grandparents residing in rural Western Kentucky. The participants completed questionnaires as measures of physical and mental health, stress, coping, and social support. In addition, two focus groups were conducted to obtain the grandparents’ perceptions of the effects stressors, coping, and social supports have on their physical and mental health. SAS 9.2 was used for all quantitative data analyses and NVivo9 was used for thematic content analysis of all qualitative data.

Results: Rural custodial grandparents in this study had a mean age of 59.8 years and most had one grandchild living with them. Most were Caucasian, married, and unemployed. The participants were found to have below average physical health and low average mental health. Rural grandparent stress levels were in the normal range and they preferred coping strategies that promoted personal growth, problem solving, and controlling their emotions. They had low levels of social support. Five themes emerged from the qualitative analysis which included “Physical health isn’t a problem,” “Mental Health: I need me time,” “Stress, that’s the problem,” “Coping: I just have to talk to someone,” and “Informal supports: a necessity.” Finally, the quantitative and qualitative results were integrated for an in-depth description of this sample.

Discussion/Conclusion: While custodial grandparents in this study had below average physical health, they did not perceive that to be a concern. Mental health for the sample was average but participants reported periodic depression and required personal time to manage their mental health. They perceived stress to be their main problem but not from parenting, child behavior, or parent-child interactions. Grandparents in this study had three preferred coping strategies. However, no associations were found between their preferred coping strategies and their health. Grandparents discussed having someone to talk to as being paramount. The findings of this study contribute a deeper understanding of custodial grandparent health and support the use of the Stress Process Model with rural grandparents.