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

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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.