Effectiveness of an Online Educational Intervention on Improving Stress and Coping among Chinese Family Caregivers of Institutionalised Older Adults with Dementia: A Randomised Controlled Trial

BackgroundAfter institutionalising a relative with dementia, family caregivers can still experience stress, potentially adversely affecting their health and well-being. Therefore, effective interventions should be developed to support the family caregivers.AimsThis study aimed to develop a supportive intervention for Chinese family caregivers of institutionalised older adults with dementia and to examine its effects.MethodsThis study was conducted in three phases. The first phase systematically reviewed the effectiveness of non-pharmacological interventions on improving stress-related outcomes of family caregivers after institutionalisation of a relative with dementia. The second phase involved qualitative interviews to explore the sources of stress and coping strategies adopted by 17 Chinese family caregivers of institutionalised older adults with dementia. Underpinned by the Stress and Coping Model, an online educational intervention tailored to this population was then developed. The third phase was a randomised controlled trial (RCT) to examine the intervention effects among Chinese family caregivers (perceived stress, use of coping strategies, caregiver burden, and family involvement in relative care) and their relatives with dementia (behavioural and psychological symptoms of dementia [BPSD]). Outcomes were measured at the baseline (T0), immediately post-intervention (T1) and six weeks after the intervention (T2). Generalised estimating equation (GEE) models were used to estimate the intervention effects at different time points.Main FindingsThe systematic review in the first phase included six RCT studies, all of which were identified as having high risk of bias. Interventions were categorised as education/skills training and psychoeducation. Intervention components, dose and delivery methods differed, and led to mixed results. Nevertheless, most interventions were delivered weekly and educational interventions showed beneficial effects for both family caregivers and their relatives with dementia.In the second phase, the qualitative interviews revealed that after institutionalising a relative with dementia, Chinese family caregivers experience stress due to socioeconomic pressures, hassles arising from continuing caregiving and suboptimal care provided by the facility. Faced with the stress, these family caregivers adopted both emotion-focused and problem-focused coping strategies. Additionally, benefit finding was used to alleviate the stress after institutionalisation.During the third phase, 148 Chinese family caregivers of institutionalised older adults with dementia were recruited and randomly allocated to either the intervention (n = 73) or control group (n = 75). A total of 111 participants completed this study (attrition rate = 25.0%). Using the GEE model, significant group-by-time interaction effects were observed for the use of problem-focused coping strategies, caregiver burden, communication with facility staff and BPSD (Wald chi-square: 6.058-23.619, p-values: 0.05). At T2, no statistically significant intervention effects were observed for any of the outcome variables.Conclusions第一階段的系統評價納入六項隨機對照試驗，偏倚風險均較高。干預分為教育/技能培訓和心理教育。干預內容、劑量和方式各異，結果不一。然而，多數干預每週實施一次，並且教育干預對家庭照顧者和失智長者均有益。第二階段的訪談結果表明，機構內失智長者家庭照顧者的壓力來源包括：社會經濟壓力、持續照顧引起的煩擾以及機構照顧欠佳。面對壓力，家庭照顧者採取了情緒應對和問題應對。此外，好處尋找也被採用。第三階段招募到148名失智長者家庭照顧者，隨機分為干預組（n = 73）或對照組（n = 75），共有111人完成了研究（損失率 = 25.0%）。在廣義估計方程中，問題應對、照顧者負擔、與機構人員的交流以及精神運動行為的分組-時間交互效應具有統計學意義（Wald卡方值：6.058至23.619，p值： < 0.001至0.048）。T1時，與對照組相比，干預組家庭照顧者情緒應對（p = 0.039）、問題應對（p < 0.001）和照顧者負擔（p = 0.014）顯著改善，失智長者的精神運動行為水準也較低（p = 0.008）。然而，家庭照顧者的壓力知覺、功能失調性應對和家屬參與組間無統計學差異。T2時，所有結局變量的干預效果均無統計學意義。結論儘管本研究有局限（如干預者和參與者未實施盲法），結果表明在長期照護機構內失智長者家庭照顧者中實施線上教育干預有益。以後的研究應探索更多干預形式，並將研究對象擴展至其他慢性疾病患者的家庭照顧者。背景失智長者家庭照顧者在機構照護後仍面臨壓力，這將威脅到家庭照顧者的健康福祉。因此，應該制訂有效的干預措施支持家庭照顧者。目的本研究旨在為中國機構內失智長者家庭照顧者制定支援性措施，並檢驗其效果。方法本研究分三階段進行。第一階段系統性回顧非藥物干預對改善機構內失智長者家庭照顧者壓力相關結局的有效性。第二階段對17名中國家庭照顧者進行質性訪談，探討其在機構照護後的壓力來源和應對策略。基於壓力與應對模型，為此人群發展了一項線上教育干預措施。第三階段進行了隨機對照試驗檢驗其對中國家庭照顧者（壓力知覺、應對策略、照顧者負擔和家屬參與）及失智長者（精神運動行為）的效果。在基線（T0）、干預後（T1）和干預後6週（T2）測量結局，採用廣義估計方程分析不同時間點的干預效果。主要結果Although several limitations existed in this study (e.g., non-blinding of the interventionist and participants), findings support the implementation of online educational interventions for Chinese dementia family caregivers in a residential care context. Future research should explore other potential modalities for intervention delivery and expand their study samples to family caregivers of patients with other chronic health conditions.HUI, Zhaozhao.Ph.D. Chinese University of Hong Kong 2021.Includes bibliographical references (leaves )Abstracts in English and Chinese.Title from PDF title page (viewed on ...