The overall aim of this application is to increase caregivers' access to quality care by adapting an evidence- based, brief Behavioral Activation program to be delivered via internet-based applications (i.e., mobile phones; personal computers). Over 15 million individuals provide informal caregiving services to family members with dementia.1 Caregiving results in high rates of distress,2 and potentially high rates of physical morbidity.3,4 For example, 40% of caregivers are at risk for depression compared to just 5% of non-caregiving older adults. Further, increased distress in caregivers is associated with risk for developing cardiovascular disease5 and institutionalization of the care recipient.6,7 Thus, interventions for reducing caregiver distress and health risk should be valuable for improving overall quality of life of the caregiver, and enable more effective, less stressful caregiving that benefits the dementia patient and reduces societal cost due to institutionalization. Multiple intervention studies for reducing caregiver distress have been published over the past 3 decades.8 Despite evidence of efficacy, the majority of effective interventions for caregivers have not been implemented through the aging network.9 This lack of adoption likely reflects that most frameworks require spatial (e.g., face to face meetings outside the home with a therapist or group) or temporal (e.g., be available at specified times for home visits or phone appointments) accommodations that are problematic for caregivers without good support systems; or because community resources lack the trained therapists or finances to implement some of the EBTs. Thus, it is critical to develop methods for delivering efficacious interventions to caregivers with maximal reach and minimal cost. To address these limitations, we propose in this R21 application to use community-based participatory research methods to adapt an evidence-based, brief Behavioral Activation program to be delivered via multiple web-based platforms (i.e., mobile phones; personal computers). We have the following aims in this proof of principle for web-based Behavioral Activation (wBA): a) to utilize focus groups of spousal dementia caregivers to inform our web-based protocol; b) to alpha test the protocol with a group of 10 caregivers to refine the web-based application; and c) to pilot (beta test) wBA with a group of 44 caregivers over 6 weeks to determine feasibility, acceptability, adherence, and evidence of differential efficacy on measures of distress as compared to a more standard information based ?bibliotherapy? approach. The results can guide future applications on more refined, fully developed and suitably powered clinical trials and implementation research to determine utility, economy, and scalability of wBA.

Public Health Relevance

Caregivers of persons with dementia suffer great amounts of distress that significantly impacts their mental and physical well-being, and ability to care for the patient at home without resort to nursing home placement. Yet, caregivers' access to quality, evidence-based interventions to assist them is currently very limited. We propose to develop a web-based modification of an intervention called Behavioral Activation that has potential to significantly reduce caregiver distress, significantly improve caregivers' overall quality of life, and dramatically increase caregivers' access to high quality, evidence-based care at relatively low cost.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1-HDM-Y (57)R)
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Onken, Lisa
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University of California San Diego
Schools of Medicine
La Jolla
United States
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