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

基于网络的移动行为干预可改善护理人员的福祉

• 批准号: 9789161
• 负责人: BRENT T MAUSBACH
• 金额: $ 52万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789161
• 关键词: Address; Affect; Aging; Alzheimer' s disease related dementia; Behavior Therapy; Behavioral; Bibliotherapy; Blood Pressure; Car Phone; Cardiovascular Diseases; Caregiver support; Caregiver well-being; Caregivers; Caring; Communities; Data; Dementia; Dementia caregivers; Distress; Educational process of instructing; Educational workshop; Elderly; Emotions; Ensure; Environment; Event; Evidence based intervention; Evidence based treatment; Family member; Feedback; Group Therapy; Health Services Accessibility; Home environment; Internet; Intervention; Intervention Studies; Intervention Trial; Intuition; Literature; Mental Depression; Methods; Morbidity - disease rate; Motion; Online Systems; Outcome; Participant; Personal Satisfaction; Persons; Population; Psyche structure; Public Health; Publishing; Quality of Care; Randomized; Randomized Clinical Trials; Reporting; Research; Research Personnel; Risk; Scientist; Services; Support Groups; Telephone; Testing; Therapeutic; Time; United States National Institutes of Health; Woman; base; blood pressure reduction; care recipients; caregiver interventions; caregiving; coping; cost; dementia care; depressive symptoms; design; effective intervention; efficacy testing; evidence base; experience; fitbit; follow-up; improved; informal caregiving; intervention program; meetings; men; negative affect; peer; physical conditioning; primary outcome; programs; psychosocial; recruit; skills; treatment adherence; web app

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.

项目总结 1500多万男女为患有痴呆症的家庭成员提供非正式的护理服务。 文献中充斥着照看会导致高抑郁和痛苦的证据，2和 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，无人照看的老年人中只有5%。5此外， 照顾者与患心血管疾病的风险增加有关。因此，有效 减少照顾者痛苦的干预措施似乎对精神和身体健康都有潜在的价值。 考虑到照顾者所经历的痛苦，难怪有80多项干预研究 照顾者的痛苦已经被公布。7这些研究的信息是照顾者干预，在 一般情况下，都是有效的减少痛苦。然而，循证治疗(EBTS)的实施 仍然是一个挑战。尽管确定了EBTS，但它们在社区一级的使用一直很少。 2007年，国立卫生研究院主办了一次关于照顾者使用EBTS的讲习班。结论是“大多数人 对照料者的有效干预没有通过老龄网络实施。 后来，这种缺乏落实的情况仍然存在。至关重要的是，科学家为患有癌症的照顾者开发干预措施 最大覆盖范围和最低成本。目前，大多数护理者干预框架要求护理者满足 以四种形式之一与治疗师会面：a)在照顾者家外与治疗师面对面会面，b) 在照顾者家中与治疗师面对面的会议，c)面对面的小组会议，或d)电话- 基于护理人员呼叫治疗师或支持小组的干预措施。虽然可能是有效的，但这些 治疗形式受到限制，因为：a)为照顾者提供服务的社区机构不提供EBTS，b) 居住在护理网络之外的照顾者通常无法获得干预措施，c)他们需要 照顾者在可能不方便的特定日期和时间参加治疗课程，或d)他们 可能要求护理者在接受治疗时为他们的护理对象寻找替代护理。致信地址 针对这些限制，我们采用了一种基于证据的、简短的行为激活(BA)计划 通过具有互联网功能的移动电话向照顾者提供服务，从而增加照顾者获得优质服务的机会 关心。这种移动干预在可行性测试中收到了积极的反馈，我们现在准备 对这一干预措施进行全面试验，以改善关键照顾者的福祉。此外，我们还将测试 作用机制，即增加行为激活促进照顾者的幸福感。要做到这一点， 我们将招募并随机选择200名护理者，让他们接受移动BA干预(N=100)，称为 移动愉快活动计划(MPEP)，或基于网络的阅读治疗条件(N=100)，教授技能 应付照顾他人的问题。参与者将被评估抑郁症状，积极和消极的情绪，以及- 以及基线、3个月、9个月和15个月的随访时间点的血压。