Online Intervention to Improve Stroke Care From Spouses

描述（由申请人提供）：项目概要：一个跨学科的团队将开发、测试和改进一个创新的基于网络的干预，从四个关键方面扩展CG干预研究：1）通过提高CG和中风幸存者各自的社会支持、掌握和自尊水平，干预在同时缓解CG和中风幸存者的抑郁方面是开创性的; 2）干预提供了一种独特的同伴和专业支持的混合体，最大限度地提高了老年人通过互联网交流和收集信息的愿望; 3）突出的压力过程模型与家庭卒中护理的文献相联系，以获得经验合理和概念合理的干预; 4）通过培养CG提供熟练护理的能力，采取了一种新的方法来改善卒中幸存者的心理健康。干预措施由一名护士监督员组成，负责监督、促进和整合以下组成部分：视频教育模块，旨在帮助CG以增强卒中幸存者的感知支持、掌握和自尊的方式提供护理;基于网络的信息，为满足CG的自我识别需求而量身定制;以及聊天室，其为CG提供真实的时间同伴交互以获得护理建议和同伴支持。根据R21奖项，该探索性/开发性项目包括三个阶段：开发;可用性研究;和随机对照试点研究（RCPS）。开发阶段包括标准化干预措施，并通过CG、卒中幸存者和医疗服务提供者的焦点小组研究评估其可接受性。可用性研究是一项试验，有7个CG，以确定和补救潜在的实施问题。RCPS将在32名女性（年龄> 50岁）中进行，这些女性照顾首次中风幸存者的丈夫。将二人组随机分配至干预组（n=16）或最小支持条件组（n=16）。将收集数据以估计干预参数（例如，效应量、损耗、进行初步功效分析）;调查CG 1在线信息寻求和沟通过程;并在随后的全规模R 01对照结局研究中评估实施和评估干预措施的程序的可行性。将对非裔美国人和白色受试者进行抽样，以探索在接受、感知价值和治疗方案、目标和结局的有效性方面的潜在种族/文化差异。相关性：这个项目是重要的，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）非正式护理质量差与两个成员的抑郁症状有关。以前的心理社会干预研究与非正式中风CG一直是稀缺的，模棱两可的结果，方法上的缺陷，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.