1101 — Implementation Evaluation of a National Online Course for Family Caregivers of Veterans: Targets for Optimizing Web-Based Program Dissemination

Yank V, VA Palo Alto Health Care System; Koenig CJ, San Francisco VA Medical Center; Gale RC, VA Palo Alto Health Care System; Nevedal A, VA Palo Alto Health Care System; Okwara L, VA Palo Alto Health Care System; Trivedi R, VA Palo Alto Health Care System; Rosen CS, VA Palo Alto Health Care System; Sayer NA, Minneapolis VA Health Care System; Asch SM, VA Palo Alto Health Care System;

Objectives:
Family caregivers provide crucial assistance to Veterans with serious chronic conditions but require skills and support to optimize care and avoid burnout. In 2013 VA's Caregiver Support Program began national rollout of the Building Better Caregivers (BBC) online course to address these needs but observed lower than expected enrollment. We performed an implementation evaluation using the PARIHS framework to identify targets for interventions to expand program dissemination.

Methods:
We assessed administrative data and performed"”using purposive sampling"”surveys and semi-structured interviews with caregivers (n = 32) and interviews with local (n = 13), regional (n = 5), and national (n = 4) VA staff involved in BBC rollout. We coded interview data with descriptors for rollout characteristics that were successful versus unsuccessful. Descriptors were grouped to identify common themes.

Results:
Six percent (n = 1265) of VA-registered family caregivers have enrolled in BBC (facility-level range 0% to 37%; median 5%). Among Veteran partners of surveyed caregivers (n = 22; 69% response rate), 95% have > = 3 serious chronic conditions (e.g., PTSD, TBI). All surveyed caregivers reported suffering stress and other health effects as a result of becoming caregivers. Among the 45% enrolled in BBC, all would recommend it to other caregivers. Interviews with staff and caregivers identified positive overall BBC feedback, appreciation of its availability, and suggestions for enhancements. Caregivers reported that caregiver/Veteran stories and multiple outreach contacts increased likelihood of enrollment. Staff identified early-rollout staff training and technical assistance as successful but lack of receipt among newer staff. Rollout characteristics that were unsuccessful included ineffective outreach (e.g., to caregiver/Veteran sub-groups), poor technology optimization (e.g., lack of online links), underdeveloped data management capabilities (e.g., for data tracking and caregiver follow-up), and lack of external facilitation (e.g., regional staff were not fulfilling this role).

Implications:
Our evaluation of the ongoing national BBC rollout has identified dissemination strengths and weaknesses. Implementation interventions targeting weaknesses have the potential to boost enrollment in this crucial program for Veteran caregivers.

Impacts:
Findings have guided design of an adaptive implementation intervention trial that will compare strategies to boost BBC dissemination to thousands of Veterans who might benefit from improved family caregiving. They also can inform dissemination strategies for other national, web-based programs.