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. Unfortunately, no studies have focused on support interventions specifically for Hispanic caregivers. The main objective 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 stroke caregivers will be randomly assigned to either an intervention or a standard care group. Study participants will be recruited from the VA Caribbean Healthcare System in San Juan, Puerto Rico (PR). 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 to improve stroke caregiver outcomes. The intervention will be conducted via telephone by a trained rehabilitation counselor. The intervention 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. The Advisory Consortium will collaborate in all aspects of the project. 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 measure the budgetary impact of providing intervention by comparing the costs of the intervention group to the costs of the control group.
The proposed study addresses an important and understudied area of caregiving research, Hispanic, Spanish-speaking caregivers of Veterans who have suffered a stroke. The proposed intervention is the first known to evaluate a telephone and online problem-solving intervention combined with the nationally available Spanish- language, evidence-based RESCUE website. The intervention has the potential to reduce stroke caregiver depression, improve the recovery of Veterans post-stroke, enable Veterans to remain in their homes, and reduce healthcare costs. Another outcome will be a state-of-the art, nationally available culturally-relevant website that both, family caregivers and health care providers can use for patient and caregiver education. Ultimately, the project will lead to an evidenced-based intervention that can be transportable for use with other Hispanic American groups and in other disease models.
