This study is a clinical trial of a multi-component telehealth intervention for informal caregivers of rural older adults, an understudied population thought to be at greater risk for negative physical and mental health outcomes. The intervention, based on the Perceived Stress Model of Caregiver Burden (Chwalisz, 1996) will be administered by telephone and includes components targeted to caregiver knowledge (caregiver role/process, knowledge of services/resources, information about care-recipient's condition), skills (social problem solving skills), behavior (enhancing social interaction/support), and affect (cognitive-behavioral therapy to manage negative affect). Two delivery mechanisms will be compared in a randomized controlled trial design: a 9-session structured telephone counseling intervention and a call-in help line (in which all treatment components are available but delivery is tailored to individual participants based on presenting concerns and assessed needs). Treatment outcome data will be compared with outcome data from a """"""""service-as-usual"""""""" control group. It is hypothesized that caregivers who receive the telehealth services will have greater improvement in physical health (self-assessed health, health care service utilization), mental health (caregiver burden, symptoms of depression and anxiety), and psychosocial functioning (social support, interpersonal relationship conflict, social role functioning) than controls. It is further hypothesized that caregivers who receive the entire treatment package will have better outcomes than help line participants, although there is a competing hypothesis that interventions tailored to caregivers' situations and need are more effective. The variable use of the help line treatment condition will allow for tests of dose-effect, and perhaps dismantling, relationships. Tracking help line usage, and comparisons between individuals who are referred for the intervention, but do not participate/dropout, will also provide information invaluable to developing services for rural caregivers. Other notable methodological features include treatment manualization, training, and implementation tracking. Specific treatment components (e.g., telehealth modality, culturally sensitive services/outreach, stakeholder involvement) have been designed in order to reach a more diverse group of caregivers, including caregivers who are underrepresented in research (e.g., racial/ethnic minorities, overburdened caregivers).
