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

项目摘要 阿尔茨海默病或相关疾病患者的护理人员的英语水平有限（LEP） 痴呆症（ADRD）对护理人员获得循证干预措施（EBI）构成了严重障碍。 文化适应是缩小差距的一种有希望的方法，需要一种系统的方法来确保文化适应的有效性。 在忠诚度和适合度之间取得平衡。以韩裔美国人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，可以应用于其他 EBI和其他LEP组。作为实现这一目标的第一步，我们将使用R21赠款奖励雇用一个三- 文化适应的步骤模式：（1）信息收集，（2）初步适应设计和测试， （3）全适应性设计与测试。基于团队先前在信息收集方面的工作，我们 目的是设计和测试初步适应（表层语言协调）和完全适应（深层 结构级修改）。通过专家评审后的回译方法，我们将 准备一份韩语版的SCP看护者/培训师手册。我们将招募并训练两名会说韩语的 干预者，他们中的每一个将提供语言协调的SCP六个参与者（共n = 12）。 资格标准包括为ADRD家庭成员提供初级保健的韩裔美国人， 英语说得不太好每个参与者将接受12小时（每周2小时，持续6周）的- 人组SCP会话，并评估依从性、可接受性和满意度。此外，我们将 开发SCP关键原则测试，以评估SCP核心原则在适应后的完整性 修改.我们将采用定量和定性相结合的方法， 参与者和干预者对每个方案组成部分的相关性。所有SCP会话将 视频记录的保真度评估和随后的文化适应。我们将建立一个完整的文化 适应性评估通过数据驱动的文化评估（例如， 视频记录的会议分析，初步测试参与者的反馈，以及文化的例子 文献综述中的适应），然后是涉及多个利益相关者（SCP）的迭代反馈循环 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提供给三组新的六名护理人员（总共n = 10）。 18)遵循完善的协议。虽然这项研究本质上是探索性的，但我们预计， 语言协调将有助于SCP接触患有LEP的ADRD护理人员，但我们将更好地观察 在完全适应SCP的参与成果。我们将汇编文化适应的整个过程， 沿着一份工作表和评估工具，合并成一本手册，供其他LEP小组使用。其成果将 为更大规模的、确定性的临床试验研究奠定坚实的基础（例如，R 01）检查项目有效性 并为不同LEP组提供了减少EBI障碍的转化模型。

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.