Mobile, Web-based Behavioral Intervention for Improving Caregiver Well-being

项目摘要 超过1 500万名男子和妇女为患有痴呆症的家庭成员提供非正式的康复服务。 文献中有大量证据表明，吸烟会导致高比例的抑郁和痛苦， 潜在的高身体发病率。3，4例如，40%的照顾者有患抑郁症的风险 相比之下，只有5%的非老年人。5此外， 照顾者与发展心血管疾病的加速风险相关。6因此， 减少照顾者痛苦的干预措施似乎对身心健康都有潜在价值。 考虑到护理人员所经历的痛苦，超过80项旨在减少痛苦的干预研究也就不足为奇了 7这些研究的信息是，照顾者的干预， 一般来说，它们对减轻痛苦是有效的。然而，循证治疗（EBT）的实施 仍然是个挑战尽管确定了基本技能，但社区一级没有使用这些技能。 2007年，国家卫生研究院主办了一个关于照顾者使用EBT的讲习班。结论是，“大多数人 没有通过老龄化网络实施对照顾者的有效干预。”8十年 后来，这种缺乏执行的情况依然存在。至关重要的是，科学家们为照顾者制定干预措施， 最大范围和最小成本。目前，大多数护理人员干预框架要求护理人员满足 以四种形式之一与治疗师会面：a）在护理者家外与治疗师面对面会面，B） 在护理者家中与治疗师进行面对面的会议，c）面对面的、基于小组的会议，或d）电话- 基于护理人员打电话给治疗师或支持小组的干预措施。虽然可能有效，但这些 治疗形式是有限的，因为：a）为护理人员服务的社区机构不提供EBT，B） 居住在护理网络之外的护理人员往往无法获得干预措施，c）它们需要 护理人员在可能不方便他们的特定日期和时间参加治疗课程，或d）他们 可能需要护理者在他们参加治疗时为他们的护理接受者寻找替代护理。解决 针对这些局限性，我们采用了一种基于证据的简短行为激活（BA）计划， 通过具有互联网功能的移动的电话， 在乎这种移动的干预在可行性测试中得到了积极的反馈，我们现在准备 对这种干预措施进行全面试验，以改善关键的照顾者福祉结果。此外，我们将测试 行动机制，即增加行为激活促进照顾者的福祉。为此， 我们将招募并随机分配200名护理人员，接受移动的BA干预（N = 100）， 移动的愉快活动计划（mPEP），或基于网络的阅读疗法条件（N = 100）的教学技能， 应付不了的事参与者将被评估抑郁症状，积极和消极的影响，以及- 在基线、3个月、9个月和15个月随访时间点测量血压。

PROJECT SUMMARY Over 15 million men and women provide informal caregiving services to family members who have dementia.1 The literature is replete with evidence that caregiving results in high rates of depression and distress,2 and potentially high rates of physical morbidity.3, 4 For example, 40% of caregivers are at risk for depression compared to just 5% of non-caregiving older adults.5 Further, increased symptoms of depression and distress in caregivers are associated with accelerated risk for developing cardiovascular disease.6 Thus, efficacious interventions for reducing caregiver distress appear potentially valuable for both mental and physical well-being. Given the distress experienced by caregivers, it is no surprise that over 80 intervention studies for reducing caregiver distress have been published.7 The message from these studies is that caregiver interventions, in general, are effective for reducing distress. Yet, the implementation of Evidence Based Treatments (EBTs) continues to be a challenge. Despite identification of EBTs, their use at the community-level has been absent. In 2007, NIH sponsored a workshop on the use of EBTs for caregivers. The conclusion was that “The majority of effective interventions for caregivers were not being implemented through the aging network.”8 Ten years later, this lack of implementation remains. It is critical that scientists develop interventions for caregivers with maximal reach and minimal cost. Currently, most caregiver intervention frameworks require caregivers to meet with a therapist in one of four formats: a) face-to-face meetings with a therapist outside the caregiver's home, b) face-to-face meetings with a therapist in the caregiver's home, c) in-person, group-based meetings, or d) phone- based interventions in which caregivers call a therapist or support group. While possibly efficacious, these therapeutic formats are limited because: a) community agencies serving caregivers do not offer EBTs, b) the interventions are often not accessible to caregivers who reside outside the care network, c) they require caregivers to attend therapy sessions on specific days and times that may not be convenient for them, or d) they may require caregivers to find alternate care for their care recipients while they attend the therapy. To address these limitations, we have adapted an evidence-based, brief Behavioral Activation (BA) program to be delivered to caregivers via mobile phones with internet-based capabilities, thereby increasing caregivers' access to quality care. This mobile intervention has received positive feedback in feasibility testing, and we are now poised to conduct a full-scale trial of this intervention for improving key caregiver well-being outcomes. Further, we will test mechanisms of action, namely that increased behavioral activation promotes well-being in caregivers. To do so, we will recruit and randomize 200 caregivers to receive either a mobile BA intervention (N = 100) known as the mobile pleasant events program (mPEP), or a web-based bibliotherapy condition (N = 100) teaching skills on coping with caregiving. Participants will be assessed for depressive symptoms, positive and negative affect, well- being, and blood pressure at baseline, 3-months, 9-months, and 15-months follow-up time points.