Mobile application for early detection and intervention to reduce psychological distress in informal family caregivers of community dwelling adults with chronic disorders in Thailand

项目摘要 在像泰国这样的中低收入国家，为成年人提供护理的家庭成员 慢性精神障碍的精神健康风险水平与收入较高的人群相似 但获得精神卫生保健的机会要有限得多。尽管有类似的精神障碍 健康疾病，LMIC中的家庭照顾者获得精神卫生保健的机会明显有限--原因是 若干因素，包括接受过精神卫生保健提供培训的人员数量有限，以及 社会文化因素，如耻辱和隐私问题，可能会阻止有需要的人寻求护理， 和/或导致在获得诊断和治疗方面的重大延误。缺乏对照顾者精神疾病的治疗 健康可能会给照顾者和患者带来其他不利后果，包括照顾者职业倦怠， 虐待病人，失去工作，增加经济压力。尽管有大量证据表明 基于移动技术的创新在治疗和预防精神健康方面的前景 LMIC中的精神障碍，以及改善家庭照顾者心理健康结果的承诺，有 循证数字健康的发展、提炼和实施的有限研究 将科技融入家庭照顾者的日常护理中。 这项为期5年的项目的目标是开发和测试一款了解文化知识的护理者心理健康手机 应用程序(以下称为CAMMA)计划将提供基于证据的干预 减少泰国患有慢性疾病的成年人的家庭照顾者的心理健康问题。R21 该项目将使我们能够系统地调整最初开发的循证自我护理干预内容 在西方世界，并使其与泰国的社会文化和技术背景相兼容 通过定性和形成性研究。R33将允许我们测试的可用性和有效性 减少泰国家庭照顾者负面心理健康后果的移动技术支持的干预。 R21的具体目标包括：1)对患有以下疾病的人的家庭照顾者进行定性研究 慢性疾病，关注他们在心理健康问题上的经历，照顾实践，应对 机制，以及阻碍技术接受和使用的社会技术障碍；2)开发一种 申请提供CAMMA干预措施；3) 对CAMMA进行形成性评估 干预组件，以确保单个干预组件的可接受性和可用性 。 特定的 R33的目标包括：1)评估CAMMA干预措施的可用性(包括所有干预措施 2)进行随机临床试验(RCT)以评估CAMMA的有效性 减少心理困扰(抑郁、焦虑、心理压力)的干预。我们假设 接受CAMMA干预的参与者将显示出显著更高的抑郁减少 症状、焦虑和心理压力，与对照组相比。

Project Summary In lower-and-middle income countries (LMICs) like Thailand, family members providing care for adults with chronic disorders experience similar levels of mental health risks to that of their counterparts in higher income countries but have significantly more limited access to mental health care. Despite comparable rates of mental health illness, family caregivers in LMICs have significantly more limited access to mental health care—due to a number of factors, including the limited number of providers trained in mental health care delivery, as well as sociocultural factors, such as stigma and privacy concerns, that may prevent those in need from seeking care, and/or result in significant delays in obtaining diagnosis and treatment. Lack of treatment for caregiver mental health can lead to other adverse consequences for both caregivers and patients, including caregiver burnout, patient abuse, losing employment and elevated financial strain. Despite an accumulating body of evidence of the promise of mobile technology-based innovations for the treatment and prevention of mental health disorders in LMICs, as well the promise for improving mental health outcomes for family caregivers, there is limited research on the development, refinement, and implementation of evidence-based digital health technology into the routine care of family caregivers. The goal of the 5-year project is to develop and test a culturally informed Caregiver Mental Health Mobile Application (hereafter referred to as CAMMA) program that will deliver an evidence-based intervention to reduce mental health problems in family caregivers of adults with chronic disorders in Thailand. The R21 project will allow us to systematically adapt evidence-based self-care intervention contents developed originally in the Western world, and to make it compatible with the sociocultural and technological context in Thailand through qualitative and formative research. The R33 will allow us to test the usability and effectiveness of the mobile technology-enabled intervention in reducing negative mental health outcomes in Thai family caregivers. Specific Aims of the R21 include: 1) Conducting qualitative research on family caregivers of persons with chronic disorders, focusing on their experience with mental health problems, caregiving practice, coping mechanisms, and socio-technological barriers to technology acceptance and use; 2) Develop a mobile application for the delivery of the CAMMA intervention; 3) Conduct a formative evaluation of the CAMMA Intervention Components to ensure acceptability and usability of individual intervention components . Specific aims for the R33 include: 1) Assessing usability of the CAMMA intervention (including all intervention components); 2) Conducting a randomized clinical trial (RCT) to evaluate effectiveness of the CAMMA intervention in reducing psychological distress (depression, anxiety, psychological stress). We hypothesize that participants who receive the CAMMA intervention will show significantly higher reduction in depressive symptoms, anxiety, and psychological stress, compared to controls.