Mindfulness Based Stress Reduction App for African American Caregivers

摘要 在美国，大约有4350万非正式(无偿)照顾者，其中560万是 非洲裔美国人1近三分之一的艾滋病毒/艾滋病患者(PLWHA)报告说，他们从 非正式照顾者，通常是朋友和家人。2非正式照顾者通常为 PLWHA，包括情感和工具、财政援助和健康建议。3-5名非裔美国人 PLWHA的照顾者有独特的需求，因为他们更有可能经历与 与艾滋病毒/艾滋病和种族有关的耻辱和歧视的交叉来源18、19以及无法获得 对文化敏感的卫生保健提供者和服务，20-22岁使他们面临更高的职业倦怠和不良风险 23因此，尽管非正式照顾者发挥着关键作用 在支持PLWHA的过程中，这样的照顾可能会造成巨大的损失。防止或减轻照顾者压力是 尤其重要的是要维持非正式护理及其对患者生活质量的诸多好处 和健康结果。 基于正念的压力减轻(MBSR)是一种在帮助方面显示出希望的干预方式 照顾者在管理压力的同时，随后提高他们的心理健康和幸福感。 心理教育的重点是减轻压力和发展接受和非评判的 对日常生活压力源的态度。11 MBSR干预可包括诸如指导冥想之类的活动 以及瑜伽练习，旨在帮助个人建立对当下的意识，并减少 对压力的反应。10-12 基于之前关于MBSR干预的研究，在第一阶段，我们成功地开发了一种 面向照顾者的原型移动应用程序(APP)，名为《非洲基于正念的压力减轻》 美国照顾者(MBSR-AAC)。根据健康污名和歧视框架，24个组成部分 这款应用程序的重点是减少与耻辱、歧视和 护理负担特别与PLWHA的护理有关。在目前的第二阶段SBIR研究中，我们 将在第一阶段调查结果的基础上，将研究驱动的增强纳入应用程序，进行可行性试验 ，并进行随机临床试验，以检查该应用程序在 减轻照顾者的压力。如果被证明是有效的，MBSR-AAC应用程序可能会对 非裔美国人照顾者的福祉是支持许多PLWHA的关键支柱。

Abstract There are approximately 43.5 million informal (unpaid) caregivers in the U.S., of which 5.6 million are African American.1 Almost one third of people living with HIV/AIDS (PLWHA) report receiving care from informal caregivers, typically friends and family.2 Informal caregivers often provide a variety of support to PLWHA, including emotional and instrumental, financial assistance, and health advice.3-5 African American caregivers of PLWHA have unique needs because they are more likely to experience stressors related to intersecting sources of stigma and discrimination related to HIV/AIDS and race18,19 and a lack of access to culturally sensitive health care providers and services,20-22 placing them at higher risk for burnout and adverse health outcomes for themselves and their care recipients.23 Thus, while informal caregivers play a critical role in supporting PLWHA, such caregiving can take a tremendous toll. Preventing or reducing caregiver stress is especially important in order to sustain informal caregiving and its myriad benefits for patients’ quality of life and health outcomes. Mindfulness-Based Stress Reduction (MBSR) is one type of intervention that has shown promise in helping caregivers manage stress while subsequently enhancing their mental health and well-being.9 MBSR consists of psychoeducation focused on stress reduction and the development of an accepting and non-judgmental attitude toward daily stressors of living.11 MBSR interventions can include activities such as guided meditations and yoga exercises designed to help individuals build awareness of the present moment, and decrease reactivity to stress.10-12,40 Building upon prior research regarding MBSR interventions, during Phase I, we successfully developed a prototype mobile application (app) for caregivers entitled Mindfulness Based Stress Reduction for African American Caregivers (MBSR-AAC). Based on the Health Stigma and Discrimination Framework,24 components of the app focus on decreasing stress associated with intersecting sources of stigma, discrimination, and caregiving burdens specifically associated with caregiving for PLWHA. In the present Phase II SBIR study, we will build on Phase I findings to incorporate research-driven enhancements to the app, conduct a feasibility trial of the enhanced app, and conduct a randomized clinical trial to examine the effectiveness of the app in reducing caregiver stress. If proven to be effective, the MBSR-AAC app could have a positive impact on the well-being of African American caregivers that serve as a critical pillar of support for many PLWHA.