Expanding Access to Care for Marginalized Caregivers through Innovative Methods for Multicultural and Multilingual Adaptation of AI-Based Health Technologies

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Project Summary and Relevance Care for children with chronic conditions impacts 10 million family caregivers, who provide an estimated $100 billion in unpaid care services in the U.S. annually. This is a significant burden for caregivers physically, mentally, and financially. The burden of care is particularly prevalent among Latino communities, the largest and fastest-growing minority population in the U.S. Despite the overwhelming and disproportionate need, the use of supportive healthcare services is lower among Latino caregivers due to barriers including the lack of accessible and culturally and linguistically appropriate programs. Those, if available, could reduce the multifaceted caregiving burden, and improve the overall health of the caregiver and child. Language translations and cultural adaptations have been resource-intensive, and recent technological advancements in machine learning and AI have the potential to automate labor-intensive work. However, machine translations, if used without careful intention, also may exacerbate biases and existing inequities for marginalized groups. This proposal will culturally and linguistically adapt, develop, and pilot test an innovative, accessible, and cost-effective artificial intelligence (AI)-based intervention currently available for English-speaking caregivers of children with chronic health conditions - “Caring of Caregivers Online” (COCO) - for Latino family caregivers in Spanish. COCO is an innovative mobile application with an embedded chatbot leveraging cutting-edge technologies to deliver evidence-based interventions that were previously limited in terms of their ability to reach caregivers due to resource-intensive requirements both on the caregiver side and provider side. Our preliminary work, in tandem with evidence from the research literature about specific intervention components COCO delivers (e.g., daily wellness check-in, symptom self-monitoring, and problem-solving therapy), point to COCO's potential as a high-impact and scalable tool for expanding access to care. The development of an accessible, and culturally and linguistically appropriate intervention has the potential to improve the health outcomes of Latino family caregivers caring for children with chronic conditions, as well as establish long-term self-management and caregiving skills. Results from this study will guide future intervention refinement, inform assessment and recruitment strategies, and provide preliminary efficacy for the design of a full-scale clinical trial. Latino COCO is an accessible and scalable intervention that addresses a critical clinical gap in supporting family caregivers in marginalized communities. Through adapting COCO, we will develop novel multicultural and multilingual methods that can be transferable and have the potential to be applied in adapting other dialog-based health interventions for use among other culturally and linguistically marginalized populations in a scalable and cost-efficient manner.