Stroke is major cause of disability and a leading cause of outpatient medical utilization within the Veterans Health Administration (VHA). Non-paid caregivers, particularly family members, are the major sources of support for stroke survivors. Unlike other chronic diseases, strokes occur suddenly and family members have little time to prepare and adjust to their new caregiving roles. Previous research has found that family members, particularly Hispanics, have high rates of depression and burden when their stroke survivors return home. Providing caregivers with culturally-appropriate information, support, and skills has the potential to reduce negative caregiver outcomes and increase the likelihood that stroke survivors remain in the community. No studies have focused on support interventions specifically for Hispanic caregivers.
Our main goal is to test the efficacy of a brief, telephone and online problem-solving intervention using the Spanish version of the VA RESCUE stroke caregiver website. The objectives are: 1) reduce caregiver burden and depression; 2) improve caregivers' problem-solving abilities, self-efficacy, and quality of life; 3) improve Veterans' functional abilities and determine the intervention's impact on Veterans' healthcare utilization; 4) determine budgetary impact; and 5) determine caregivers' perceptions of the intervention. The long-term goal is to partner with leaders to implement a culturally relevant, accessible, and cost-effective intervention for caregivers of Veterans post-stroke throughout the VHA.
The project is guided by the relational/problem solving model of stress. A two-arm (8-session intervention vs. standard care), randomized controlled clinical trial with three assessment points will be conducted. A sample of 290 Hispanic stroke caregivers will be randomly assigned to either an intervention or a standard care group. The intervention consists of a problem-solving intervention and information/tools on the previously developed, evidenced-based Spanish-version of the RESCUE stroke caregiver website. The intervention will be conducted via telephone by a trained healthcare professional and consists of four components: 1. Introduction to the RESCUE website and the problem-solving method; 2. Illustrative example on how to use the problem-solving approach and the RESCUE website to address caregiving problems; 3. Individualized practice exercise to develop a personalized problem-solving plan; and 4. Summary of the problem-solving method. Baseline measurements will be conducted with the caregivers prior to the intervention. Post-test assessments will be collected at 1 and 12 weeks post-intervention. In addition, we will obtain pre- and post-test measures of Veteran-related variables via CPRS electronic health records. Qualitative interviews will be conducted to assess caregivers' perceptions of the intervention. A general linear mixed model for repeated measures will be used to examine the relationship between treatment assignment and each outcome over time. We will also measure the budgetary impact of providing intervention by comparing the costs of the intervention group to the costs of the control group.
We anticipate that caregivers in the intervention group will have improved caregiver outcomes (lower depressive symptoms and burden and increased problem-solving skills and health-related quality of life) and their Veterans with stroke will have reduced healthcare utilization and improved functional ability compared to the standard care group.
This study is the first known randomized control trial to test a Spanish-language telephone and online intervention for caregivers in the VA and addresses the need for culturally appropriate health information for an understudied population. If found effective, this intervention can serve as a model for caregivers of Veterans with other conditions by providing education and support and helping reduce caregiver depression and burden.
- Freytes MI, Schmitzberger M, Rivera-Rivera N, Lopez J, Mylott D, Motta-Valencia K, Uphold CR. Serving Underserved Veterans and Their Caregiver: Developing Tailored Culturally Relevant Interventions. [Abstract]. Innovation in aging. 2019 Nov 8; 3(Supp 1):S674.