GIFT: Web Based Resourcefulness Training for Grandmother Caregivers The number of grandparent-headed homes has increased over the past two decades, primarily due to parental drug use leading to family instability, and an increase in multigenerational homes due to continuing effects of the economic downturn in 2008 and sustained unemployment and underemployment. Most grandmothers living with grandchildren report elevated stress and strain and are at risk of depression and poorer overall health than their non-caregiving peers. Stress and depressive symptoms can have a cascading effect on the family, creating an increased risk for problems in family functioning. The presence of positive coping skills, such as resourcefulness, may reduce or moderate the negative effects of caregiving and family-related stress on the well-being of the grandmother and her family. We have shown that face-to-face resourcefulness training in older adults, including grandmothers, improves both mental and physical health. The purpose of this study is to extend our previous face-to-face resourcefulness intervention to a web-based format focused on grandmothers who are either raising grandchildren or living in multigenerational homes and helping with their care, and to test its effects on health in this randomized clinical trial. The web-based online intervention, Grandmother Initiatives in Family Transformation (GIFT), tests online resourcefulness training with reinforcement of the resourcefulness skills through 4 weeks of structured journaling, against a 4 week online, unstructured journaling-only group. In this two-group randomized trial, we will randomly assign a national, convenience sample of 334 grandmothers to GIFT resourcefulness training (n=167) or the 4 week unstructured journal-only group (n=167).
Specific Aims are to determine 1) whether the 4-week GIFT intervention with structured journal reinforcement versus the 4-week unstructured journal-only group improves grandmothers' mental health and physical health and family well-being over time; 2) if a) problem solving/coping (resourcefulness), b) resources (subjective and instrumental social support), and c) situational appraisals (appraised stress, appraised reward, and depressive cognitions) mediate the relationships between GIFT and individual and family outcomes at 2 weeks, 12 weeks, and 24 weeks post-intervention; and 3) if a) grandmother demographics (age, race, education, marital status, employment status, family income, age and number of grandchildren in the household), b) caregiving status to grandchildren, and c) family demands (intra- family strains) moderate the relationship between the intervention and the outcomes in Aims 1 and 2. Repeated measures and structural equation modeling will be used to analyze these data, with content analysis of the journals to evaluate enactment fidelity and to uncover additional strategies used by grandmother caregivers. Given the limited interventions available to this group of women, an intervention that transcends time and place and is available 24 hours a day is expected to bolster the personal and social resourcefulness of grandmothers living with grandchildren, leading to improvements in grandmother and family well-being.

Public Health Relevance

This is a randomized clinical trial to compare GIFT, a web-based resourcefulness training intervention with skills' reinforcement through four week structured journals, against a four week web-based, unstructured journaling-only group, in a national convenience sample of 334 grandmothers raising grandchildren or living with them in a multigenerational home. Based on our prior work, the intervention is expected to improve mental and physical health and improve family functioning.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Huss, Karen
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Case Western Reserve University
Schools of Nursing
United States
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