Adapting an Evidence-Based Intervention for ADRD Caregivers with Limited English Proficiency

项目总结 阿尔茨海默病或相关疾病患者照顾者的英语水平有限 痴呆症(ADRD)对照料者获得循证干预(EBI)构成了严重障碍。 文化适应是一种很有前途的缩小差距的方法，需要有系统的方法来确保 在保真度和适合度之间取得平衡。使用韩裔美国人作为目标群体和精明的照顾者计划 (SCP)作为一个目标EBI，我们计划测试一个系统的文化适应模型，该模型可以应用于其他 EBIS和其他LEP组。作为实现这一目标的第一步，我们将使用R21奖励金雇用三名- 文化适应的步骤模型：(1)信息收集，(2)初步适应设计和测试， (3)全适应设计和测试。基于团队先前在信息收集方面的工作，我们 目的设计和测试初步适应(表层语言调谐)和完全适应(深度适应 结构级修改)。通过回译和专家评审的方法，我们将 准备韩文版的SCP护理员/培训师手册。我们将招聘和培训两名会说韩语的人 干预者，他们每人将向6名参与者(总共n=12人)传递经过语言协调的SCP。 资格标准包括为患有ADRD的家庭成员提供初级护理的韩裔美国人以及 英语说得比“非常好”差。每位参与者将获得12小时(每周2小时，为期6周)- 对SCP会议进行分组，并评估其遵从性、可接受性和满意度。此外，我们还将 编制SCP关键原则测试，以评估适应后SCP核心原则的完整性 修改。我们将使用定量和定性相结合的方法来寻求对文化的反馈 来自参与者和干预者的每个计划组成部分的相关性。所有SCP会话都将 录像，用于保真度评估和随后的文化改编。我们将发展全面的文化 通过数据驱动的文化评估进行深层结构级适应的适应工作表(例如， 视频会议分析，来自初步测试参与者的反馈，以及文化 文献回顾中的适应)，随后是涉及多个利益相关者的迭代反馈循环(SCP 开发人员、具有文化能力的研究人员、内容和文化专家，以及社区咨询 董事会)。干预者将把完全适应的SCP交付给三组新的六名照顾者(总计n= 18)遵循完善的协议。虽然这项研究是探索性的，但我们预计初步 语言调谐将帮助SCP接触患有LEP的ADRD照顾者，但我们将更好地观察 完全适应的SCP中的参与度结果。我们将汇编整个文化适应的过程， 连同工作表和评估工具一起编入手册，供其他LEP小组使用。调查结果将 通过临床试验(例如R01)检查计划的有效性，为更大规模的决定性研究奠定坚实的基础 并为不同的LEP群体提供了降低EBI障碍的转换模型。

PROJECT SUMMARY Limited English proficiency (LEP) among caregivers for individuals with Alzheimer's disease or related dementias (ADRD) poses a critical barrier to the caregivers' access to evidence-based interventions (EBIs). Cultural adaptation, a promising method to close the gap, requires a systematic approach to ensure the balance between fidelity and fit. Using Korean Americans as a target group and the Savvy Caregiver Program (SCP) as a target EBI, we plan to test a systematic model of cultural adaptation that can be applied to other EBIs and other LEP groups. As a first step toward the goal, we will use the R21 grant award to employ a three- step model of cultural adaptation: (1) Information Gathering, (2) Preliminary Adaptation Design and Testing, and (3) Full Adaptation Design and Testing. Building on the team's prior work on Information Gathering, we aim to design and test preliminary adaptation (surface-level language attunement) and full adaptation (deep structure-level modification) of the SCP. Through a back-translation method followed by expert reviews, we will prepare a Korean version of the SCP caregiver/trainer manuals. We will recruit and train two Korean-speaking interventionists, and each of them will deliver the linguistically attuned SCP to six participants (total n = 12). Eligibility criteria include Korean Americans who provide primary care for a family member with ADRD and who speak English less than “very well.” Each participant will receive the 12-hour (2 hours weekly for 6 weeks) in- person group SCP sessions and be evaluated for adherence, acceptability, and satisfaction. In addition, we will develop an SCP Key Principles Test to assess the intactness of the SCP core principles after adaptation modifications. We will use a mixed quantitative and qualitative methodology to seek feedback on cultural relevance of each program component from both participants and interventionists. All SCP sessions will be video-recorded for fidelity assessment and subsequent cultural adaptations. We will develop a Full Cultural Adaptation Worksheet to conduct a deep structure-level adaptation via a data-driven cultural assessment (e.g., video-recorded session analysis, feedback from preliminary testing participants, and examples of cultural adaptation in literature review), followed by iterative feedback loops involving multiple stakeholders (SCP developer, researchers with cultural competence, content and cultural experts, and a community advisory board). The interventionists will deliver the fully adapted SCP to three new groups of six caregivers (total n = 18) following the refined protocols. Although the study is explorative in nature, we anticipate that preliminary linguistic attunement will help the SCP reach out to ADRD caregivers with LEP, but that we will observe better engagement outcomes in the fully adapted SCP. We will compile the entire process of cultural adaptation, along with a worksheet and evaluation tools, into a manual for use with other LEP groups. The findings will form a solid foundation for a larger, definitive study with a clinical trial (e.g., R01) to examine program efficacy and provide a translational model for reducing barriers to EBIs for diverse LEP groups.