Online Intervention to Improve Stroke Care From Spouses

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DESCRIPTION (provided by applicant): Project Summary: An interdisciplinary team will develop, test, and refine an innovative web-based intervention that expands CG intervention research in four key ways: 1) The intervention is groundbreaking in alleviating depression in CGs and stroke survivors concurrently by enhancing their respective levels of social support, mastery, and self-esteem; 2) The intervention provides a unique blend of peer and professional support that maximizes older adults' increasing desire to communicate and glean information via the Internet; 3) The prominent Stress Process Model is linked with the literature on family stroke care to derive an empirically justified and conceptually sound intervention; and 4) A novel approach is taken to improve the stroke survivor's psychological well-being by fostering the CG's ability to provide skilled care. The intervention is comprised of a Nurse Monitor who oversees, facilitates, and integrates the following components: Video Education Modules designed to help CGs render care in ways that enhance the perceived support, mastery, and self esteem of the stroke survivor; Web-Based Information that is individually tailored to meet the self-identified needs of CGs; and a Chat Room that provides CGs with real- time peer interactions to obtain care advice and peer support. In line with an R21 award, this exploratory/ developmental project involves three phases: Development; Usability Study; and Randomized Control Pilot Study (RCPS). The Development Phase involves standardizing the intervention and assessing its perceived acceptability with a Focus Group Study of CGs, stroke survivors, and health providers. The Usability Study is a trial run with 7 CGs to identify and remedy potential implementation problems. The RCPS is to be conducted with 32 females (age > 50) caring for husbands who are first-time stroke survivors. Dyads will be randomly assigned to either the intervention (n=16) or to a Minimal Support Condition (n=16). Data will be gathered to estimate intervention parameters (e.g., effect size, attrition, perform preliminary power analyses); to investigate CGs1 online information-seeking and communication processes; and to evaluate the feasibility of procedures for implementing and evaluating the intervention in a subsequent full-scale R01 controlled outcome study. African American and White participants will be sampled to explore potential ethnic/ cultural differences in acceptance, perceived value, and effectiveness of treatment protocol, goals, and outcomes. Relevance: This project is important in view of substantial evidence that (a) informal care to stroke survivors is a major public health concern; (b) both stroke survivors and their spousal CGs are at risk for depression; and (c) poor quality of informal care is linked to depressive symptoms within both members of the caregiving dyad. Prior psychosocial intervention research with informal stroke CGs has been scarce, equivocal in findings, methodologically flawed, and without theoretical foundation.