Online Intervention to Improve Stroke Care From Spouses

描述(由申请人提供)：项目摘要：一个跨学科团队将开发、测试和改进一种创新的基于网络的干预措施，该干预措施将在四个关键方面扩展CG干预研究：1)该干预措施在通过提高他们各自的社会支持、掌握程度和自尊水平来同时缓解CG和中风幸存者的抑郁方面是开创性的；2)干预措施提供了一种独特的同行和专业支持的结合，最大限度地提高了老年人通过互联网交流和收集信息的日益增长的愿望；3)突出压力过程模型与家庭中风护理的文献相联系，得出了经验性和概念性良好的干预措施；4)采取新的方法，通过培养CG提供熟练护理的能力来改善中风幸存者的心理健康。干预措施由一名护士监督员组成，负责监督、促进和整合以下组件：视频教育模块旨在帮助CGs以增强中风幸存者的感知支持、掌握和自尊的方式提供护理；基于Web的信息，该信息是为满足CGs自我确定的需求而量身定做的；以及聊天室，为CGs提供实时同行互动，以获得护理建议和同伴支持。与R21奖项一致，这个探索性/开发项目包括三个阶段：开发；可用性研究；以及随机控制初步研究(RCPS)。发展阶段包括标准化干预和评估其感知的可接受性，通过对CGs、中风幸存者和卫生服务提供者的焦点小组研究。可用性研究是对7个CG的试运行，以确定和补救潜在的实施问题。RCPS将与32名女性(50岁)一起进行，以照顾首次中风幸存者的丈夫。DUAD将被随机分配到干预(n=16)或最小支持条件(n=16)。将收集数据以估计干预参数(例如，效果大小、消耗、执行初步功率分析)；调查CGs1在线信息搜索和沟通过程；以及在随后的全面R01受控结果研究中评估实施和评估干预的程序的可行性。将对非裔美国人和白人参与者进行抽样，以探索在接受度、感知价值和治疗方案、目标和结果的有效性方面的潜在种族/文化差异。相关性：这个项目很重要，因为有大量证据表明：(A)对中风幸存者的非正式护理是一个主要的公共卫生问题；(B)中风幸存者和他们的配偶CG都有患抑郁症的风险；(C)非正规护理质量差与护理二人组中的两个成员的抑郁症状有关。以往对非正式卒中脑瘫的心理社会干预研究很少，研究结果模棱两可，方法上有缺陷，也没有理论基础。

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.