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

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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.