In the patient-family caregiver dyad, emphasis traditionally has been on the patient or on helping the caregiver take care of the patient. This approach ignores the health of the caregiver. Family caregivers of patients with chronic disease are at uniquely high risk for development of cardiovascular disease (CVD). Because of the environment they share with the patient, lack of time for personal care due to caregiving demands, and persistent psychological distress, caregivers of patients with chronic illness have substantially higher risk for CVD than non-caregivers. To reduce this risk, cardiovascular health interventions aimed at (1) CVD risk reduction (2) improving adherence to self-management of CVD risk reducing behaviors, and (3) preventing and managing depressive symptoms are required. Rural caregivers are particularly at risk for poor health. Most rural areas are characterized by marked health disparities, including elevated CVD risk, persistent poverty, and lack of social and healthcare resources. As such, innovative intervention programs are needed to improve cardiovascular health among rural caregivers while overcoming personal and environmental barriers to achieving this goal. The Rural Intervention for Caregivers? Heart Health (RICHH) program proposed in this study will address the important components of CVD risk reduction for rural caregivers of patients with chronic illness ? most notably improved self-management of CVD risk reduction efforts, including prevention and management of depressive symptoms. We propose an innovative delivery modality designed to overcome environmental barriers in socioeconomically austere rural areas. The purpose of the proposed 2-group (RICHH vs control) randomized clinical trial is to examine short- and long-term effects of the RICHH intervention on CVD risk (i.e., lipid profile, body mass index, and blood pressure), self-care behaviors (i.e., diet quality, physical activity level, self-reported adherence to health behaviors), and depressive symptoms, compared to usual care control in rural caregivers of persons with chronic disease. A total of 280 caregivers of patients with chronic illness will be enrolled. Rural caregivers will be randomly assigned to either the RICHH intervention group or a usual care control group. We will stratify caregivers by gender in order to examine the moderating effect of gender on intervention outcomes, given the many differences between male and female caregivers. The RICHH intervention (6 interactive modules) will be delivered for 12 weekly sessions (30- to 45 minutes per session). In order to enhance maintenance of behaviors, we will also deliver 8 biweekly (every other week) booster sessions (20-30 minutes per sessions) for 2 months and then 6 monthly sessions. All sessions are delivered individually using a video-conferencing program on a multimedia digital device (i.e., mini iPad). Data on outcomes will be collected at baseline, 4 months and 12 months.

Public Health Relevance

Rural caregivers of individuals with chronic illness are at uniquely high risk for development of heart disease. We propose to test the Rural Intervention for Caregivers? Heart Health program, an innovative self- management program designed to lower heart disease and depression risk, and overcome environmental and personal barriers to self-management. This innovative intervention program will improve physical and psychological health for rural caregivers of chronically ill patients in rural Kentucky.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
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Special Emphasis Panel (ZNR1)
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Huss, Karen
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University of Kentucky
Schools of Nursing
United States
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