1
|
Damant J. Unpaid carers of people with dementia and information communication technology: Use, impact and ideas for the future. DEMENTIA 2024; 23:779-799. [PMID: 38664990 PMCID: PMC11163843 DOI: 10.1177/14713012241249793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
OBJECTIVES Several 100,000s of people living with dementia in the UK are cared for at home by a spouse or relative. Few studies have considered the ICT needs and experiences of unpaid carers. This study explores the types of ICT unpaid carers use, the ways they use ICT, the impact of ICT-use, and their ideas for how ICT could be more supportive of their role as a carer. METHODS Six focus groups with 32 unpaid carers of people living with dementia discussed their experiences of - and barriers to - using ICT. Transcripts were analysed thematically according to three types of ICT (mainstream, accessible and formal) and five functions (supporting domestic tasks, care management, monitoring, communication and information and education). RESULTS Participants predominantly used mainstream ICT devices such as laptops and smartphones and internet-enabled applications including videoconferencing and social media platforms to support their daily activities and assist them in their caring role. A few participants discussed using accessible devices such as memory clocks and formal telecare and care-phone services for care management and monitoring functions. Participants' ideas for improvements centred on personalised communication applications that facilitate remote interactions and promote persons living with dementia's independence. Others expressed concerns about the growing need to use ICT to access formal care services and the inadequacy of the ICT infrastructure in some care homes. CONCLUSIONS Unpaid carers mostly turn to readily available mainstream ICT to support their personal and care activities. Further research is required to understand the social impact of the increasing reliance of ICT across health, social and residential care service sectors. Improved cooperation between unpaid carers, technology developers and care services providers could align ICT development to the needs and experiences of families living with dementia and assist unpaid carers with identifying ICTs that optimally support their personal circumstances.
Collapse
Affiliation(s)
- Jacqueline Damant
- Care Policy and Evaluation Centre of the London School of Economics and Political Science, London, UK
| |
Collapse
|
2
|
Coumoundouros C, Mårtensson E, Ferraris G, Zuidberg JM, von Essen L, Sanderman R, Woodford J. Implementation of e-Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis. JMIR Ment Health 2022; 9:e41891. [PMID: 36314782 PMCID: PMC9752475 DOI: 10.2196/41891] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Informal caregivers commonly experience mental health difficulties related to their caregiving role. e-Mental health interventions provide mental health support in a format that may be more accessible to informal caregivers. However, e-mental health interventions are seldom implemented in real-world practice. OBJECTIVE This mixed methods systematic review aimed to examine factors associated with the effectiveness and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e-mental health interventions for informal caregivers were explored using thematic synthesis. METHODS We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies reported on the effectiveness or implementation of e-mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers' mental health outcomes were included in a crisp-set qualitative comparative analysis. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation. RESULTS Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored. CONCLUSIONS e-Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers to and facilitators of implementing e-mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators. TRIAL REGISTRATION PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2019-035406.
Collapse
Affiliation(s)
- Chelsea Coumoundouros
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Erika Mårtensson
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Centre for Gender Research, Uppsala University, Uppsala, Sweden
| | - Giulia Ferraris
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Linden MA, Forbes T, Brown M, Marsh L, Truesdale M, McCann E, Todd S, Hughes N. Impact of the COVID-19 pandemic on family carers of those with profound and multiple intellectual disabilities: perspectives from UK and Irish Non-Governmental Organisations. BMC Public Health 2022; 22:2095. [PMID: 36384516 PMCID: PMC9668390 DOI: 10.1186/s12889-022-14560-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Family carers of people with profound and multiple intellectual disabilities (PMID) experienced a reduction in healthcare services due to the COVID-19 pandemic. Many subsequently turned to Non-Governmental Organisations who worked to support families. However, little research has sought to capture the experiences of family carers or identify effective interventions which might support them. To address these concerns we explored the views of Non-Governmental sector workers across the UK and Ireland who supported families people with PMID during the COVID-19 pandemic. We also sought to explore their views on the characteristics of online support programmes for family carers. METHODS: This study employed a qualitative design using focus groups with participants (n = 24) from five Non-Governmental Organisations across the UK and Ireland. A focus group guide included questions on challenges, supports, coping and resources which helped during lockdown restrictions. Focus groups were held online, were audio recorded and transcribed verbatim. The resulting transcripts were pseudonymised and subjected to thematic analysis. FINDINGS Four themes were identified (i) 'mental and emotional health', (ii) 'they who shout the loudest' (fighting for services), (iii) 'lack of trust in statutory services' and (iv) 'creating an online support programme'. Mental and emotional health emerged as the most prominent theme and included three subthemes named as 'isolation', 'fear of COVID-19' and 'the exhaustion of caring'. CONCLUSIONS The COVID-19 pandemic has increased the vulnerability of family carers who were already experiencing difficulties in accessing services and supports for their families. While Non-Governmental Organisations have been a crucial lifeline there is urgent need to design services, including online support programmes, in partnership with family carers which adequately address their needs.
Collapse
Affiliation(s)
- M A Linden
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland.
| | - T Forbes
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - M Brown
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - L Marsh
- School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland
| | - M Truesdale
- School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - E McCann
- Division of Nursing at City, University of London, London, UK
| | - S Todd
- School of Care Sciences, University of South Wales, Caerleon, Wales
| | - N Hughes
- Department of Sociological Studies, University of Sheffield, Sheffield, England
| |
Collapse
|
4
|
Waddington C, Harding E, Brotherhood EV, Davies Abbott I, Barker S, Camic PM, Ezeofor V, Gardner H, Grillo A, Hardy C, Hoare Z, McKee-Jackson R, Moore K, O'Hara T, Roberts J, Rossi-Harries S, Suarez-Gonzalez A, Sullivan MP, Edwards RT, Van Der Byl Williams M, Walton J, Willoughby A, Windle G, Winrow E, Wood O, Zimmermann N, Crutch SJ, Stott J. The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation. JMIR Res Protoc 2022; 11:e35376. [PMID: 35857375 PMCID: PMC9350818 DOI: 10.2196/35376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/10/2023] Open
Abstract
Background People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID) DERR1-10.2196/35376
Collapse
Affiliation(s)
- Claire Waddington
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emma Harding
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Emilie V Brotherhood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Ian Davies Abbott
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Suzanne Barker
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Paul M Camic
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Victory Ezeofor
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Hannah Gardner
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Adetola Grillo
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Chris Hardy
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Zoe Hoare
- School of Health Sciences, Bangor University, Bangor, United Kingdom
| | - Roberta McKee-Jackson
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Kirsten Moore
- Division of Psychiatry, University College London, London, United Kingdom
| | - Trish O'Hara
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Jennifer Roberts
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Samuel Rossi-Harries
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Aida Suarez-Gonzalez
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Mary Pat Sullivan
- School of Social Work, Faculty of Education and Professional Studies, Nipissing University, North Bay, ON, Canada
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | | | - Jill Walton
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Alicia Willoughby
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Gill Windle
- Dementia Services Development Centre, Bangor University, Bangor, United Kingdom
| | - Eira Winrow
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, United Kingdom
| | - Olivia Wood
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Nikki Zimmermann
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Sebastian J Crutch
- Dementia Research Centre, Institute of Neurology, University College London, London, United Kingdom
| | - Joshua Stott
- Psychology and Language Sciences, University College London, London, United Kingdom
| |
Collapse
|
5
|
Adapting the Namaste Care Program for Use with Caregivers of Community-Dwelling Older Adults with Moderate to Advanced Dementia: A Qualitative Descriptive Study. Can J Aging 2022; 42:271-283. [PMID: 35722973 DOI: 10.1017/s0714980822000174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Family/friend caregivers are highly involved in supporting older adults with dementia who are 65 years of age or older with daily activities, especially when these older adults with dementia are living at home. There is a need for psychosocial interventions for caregivers of older adults with moderate to advanced dementia, as most interventions focus on persons at earlier stages. Namaste Care is a psychosocial, multisensory program intended to enhance quality of life for people with advanced dementia and their caregivers; however, it has not yet been adapted for use in a home setting. In this study, caregivers collaborated in adapting Namaste Care during workshops so that it could be delivered by caregivers of older adults with moderate to advanced dementia at home. Key findings were that Namaste Care resonated with the daily activities of caregivers, but that the intervention required modifications to ensure that it could be tailored to the needs and realities of caregivers and persons with dementia.
Collapse
|
6
|
Cost-Effectiveness of an Online Intervention for Caregivers of People Living With Dementia. J Am Med Dir Assoc 2022; 23:1468-1473. [PMID: 35395216 DOI: 10.1016/j.jamda.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/15/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Little evidence exists on costs or cost-effectiveness of online interventions for caregivers of people living with dementia. We aimed to assess cost-effectiveness of online cognitive behavioral therapy (CBT) for dementia caregivers with mild-to-moderate depression/anxiety, with or without telephone support, relative to a psychoeducational control treatment. DESIGN Cost-effectiveness study of data from 3-armed randomized controlled trial comparing computerized CBT (cCBT) or telephone-supported cCBT (cCBT+Telephone) to modular online educational program on dementia (Psychoeducation). SETTING AND PARTICIPANTS UK-resident adult dementia caregivers with mild-to-moderate anxiety/depression. COST-EFFECTIVENESS ANALYSIS We calculated health and social care costs, from participant-reported data collected at baseline, 12, 26 weeks, costs of intervention delivery. We examined 3 outcomes: cost of one-point reduction in General Health Questionnaire-12 (GHQ-12) rating at 26-weeks, cost of prevented "caseness" on GHQ-12 at 26 weeks, and cost per quality-adjusted life year (QALY) based on Short Form-6 Dimensions (SF-6D) over 26 weeks. RESULTS Data from 176 participants (44 cCBT, 91 cCBT+Telephone, 41 Psychoeducation) were analyzed. Costs did not differ between cCBT and Psychoeducation; costs were £125 higher in cCBT+Telephone. Control and intervention groups did not differ on GHQ-12. Caseness was lower in cCBT+Telephone than Psychoeducation; cost of preventing a case was £610, and probability of cost-effectiveness on this outcome reached 98.5% at willingness to pay (WTP) of £12,900. Mean QALY did not differ between cCBT+Telephone and Psychoeducation. QALY gain in cCBT was 0.01 (95% CI 0.001, 0.021). Cost per QALY was £8130. Although base case probability of cost-effectiveness of cCBT was 93% at WTP-per-QALY of £27,600, sensitivity analyses suggested cCBT+Telephone was the more cost-effective. CONCLUSIONS AND IMPLICATIONS We report preliminary evidence for adopting telephone-supported online CBT. This may be cost-effective in preventing a case of mental health disorder if, absent a societally accepted WTP threshold for this outcome, payers are willing to pay £12,900. Future research should investigate whether supported/unsupported online CBT improves health-related quality of life.
Collapse
|
7
|
Cowdell F, Dyson J, Sykes M, Dam R, Pendleton R. How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: A scoping review with narrative summary. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:776-798. [PMID: 33103313 DOI: 10.1111/hsc.13199] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer-reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta-analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances.
Collapse
Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Judith Dyson
- School of Health Sciences, City University, London, UK
| | - Michael Sykes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rinita Dam
- Department of Zoology, University of Oxford, Oxford, UK
| | | |
Collapse
|
8
|
Sztramko R, Levinson AJ, Wurster AE, Jezrawi R, Sivapathasundaram B, Papaioannou A, Cowan D, St Onge J, Marr S, Patterson C, Woo T, Mosca L, Lokker C. Online Educational Tools for Caregivers of People with Dementia: A Scoping Literature Review. Can Geriatr J 2021; 24:351-366. [PMID: 34912490 PMCID: PMC8629496 DOI: 10.5770/cgj.24.506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Informal caregivers of people with dementia provide the majority of health-based care to people with dementia. Providing this care requires knowledge and access to resources, which caregivers often do not receive. We set out to evaluate the effect of online educational tools on informal caregiver self-efficacy, quality of life, burden/stress, depression, and anxiety, and to identify effective processes for online educational tool development. METHODS We conducted a scoping review of articles on online educational interventions for informal caregivers of people with dementia searching CINAHL, MEDLINE, EMBASE, and PubMed from 1990 to March 2018, with an updated search conducted in 2020. The identified articles were screened and the data were charted. RESULTS 33 articles that reported on 24 interventions were included. There is some evidence that online interventions improve caregiver-related outcomes such as self-efficacy, depression, dementia knowledge, and quality of life; and decrease caregiver burden. Common findings across the studies included the need for tailored, stage-specific information applicable to the caregiver's situation and the use of psychosocial techniques to develop the knowledge components of the interventions. CONCLUSION We demonstrate the importance of having caregivers and health-care professionals involved at all stages of tool conceptualization and development. Online tools should be evaluated with robust trials that focus on how increased knowledge and development approaches affect caregiver-related outcomes.
Collapse
Affiliation(s)
- Richard Sztramko
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Anthony J. Levinson
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Andrea E. Wurster
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - Rita Jezrawi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | | | - Alexandra Papaioannou
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| | - David Cowan
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Joye St Onge
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Sharon Marr
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Christopher Patterson
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Tricia Woo
- Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton
- GERAS Centre, St. Peter’s Hospital, Hamilton
| | - Lori Mosca
- Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, Hamilton
| | - Cynthia Lokker
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON
| |
Collapse
|
9
|
Dodd E, Ismail S, Christopher G, Wildschut T, Sedikides C, Cheston R. Nostalgic conversations: The co-production of an intervention package for people living with dementia and their spouse. DEMENTIA 2021; 21:489-502. [PMID: 34625006 PMCID: PMC8811318 DOI: 10.1177/14713012211047350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objectives Nostalgic memories are more social than other forms of autobiographical recall, often refer to atypical events, express more positive affect and reflect life as meaningful. Recalling a nostalgic (compared to ordinary) memory increases self-esteem, self-growth, meaning in life and social connectedness for people living with dementia. We set two objectives: to work with people living with dementia to develop an intervention based on nostalgia, and to assess whether couples could engage in nostalgic conversations. Method Our research fell into three phases. Initially, we consulted with people living with dementia and with carers to identify the parameters for a nostalgic intervention. From this, we drafted a workbook that contained triggers for nostalgic conversations, which we then took back to the public contributors for refinement. Finally, we trialled the workbook over 5 weeks with six couples, each of which included a person living with dementia. We assessed pre- and post-intervention self-esteem, self-growth, meaning in life and social connectedness for participants with dementia and social connectedness for carers. We then calculated Reliable Change Index scores and established levels of clinically significant change. We also interviewed couples at the end of the intervention to explore its implementation and acceptability. Results All six couples could identify nostalgic memories, with five couples successfully integrating the nostalgic conversations into their day-to-day lives. A sixth couple found it difficult to engage fully with the intervention, but still considered it useful. All six couples manifested a reliable change in at least one outcome, with one couple showing reliable change across three outcomes. Conclusion The psychological benefits of nostalgia have been robustly demonstrated in laboratory-based studies. This co-production of an intervention that sets nostalgic recall into the context of a conversation has clinical potential but requires further investigation through a larger study.
Collapse
Affiliation(s)
- Emily Dodd
- Department of Health and Social Sciences, 1981University of the West of England, Bristol, UK
| | - Sanda Ismail
- Department of Health and Social Sciences, 1981University of the West of England, Bristol, UK
| | - Gary Christopher
- Department of Health and Social Sciences, 1981University of the West of England, Bristol, UK
| | - Tim Wildschut
- Department of Psychology, 7423University of Southampton, Southampton, UK
| | | | - Richard Cheston
- Department of Health and Social Sciences, 1981University of the West of England, Bristol, UK
| |
Collapse
|
10
|
Fossey J, Charlesworth G, Fowler JA, Frangou E, Pimm TJ, Dent J, Ryder J, Robinson A, Kahn R, Aarsland D, Pickett J, Ballard C. Online Education and Cognitive Behavior Therapy Improve Dementia Caregivers' Mental Health: A Randomized Trial. J Am Med Dir Assoc 2020; 22:1403-1409.e1. [PMID: 33288467 DOI: 10.1016/j.jamda.2020.10.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/06/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare online cognitive-behavioral therapy (CBT) with and without telephone support respectively to online psychoeducation in a randomized controlled trial (RCT) in caregivers of people with dementia with mild anxiety or depression. DESIGN Three-arm parallel-group RCT comparing online CBT with and without telephone support respectively to online psychoeducation. SETTING AND PARTICIPANTS Online study with caregivers of people with dementia. MEASURES The primary outcome measure was mental health measured by General Health Questionnaire-12 (GHQ-12) at 26 weeks. Secondary outcomes included the Hospital Anxiety and Depression Scale (HADS); the Relative Stress Scale (RSS) and the Short Sense of Competency Questionnaire. The primary analysis focused on people completing GHQ-12 at both baseline and 26 weeks, evaluated using analysis of covariance. RESULTS 638 people were randomized to the 3 treatment arms, of whom 208 were included in the analysis population. There were significant improvements in GHQ-12 in all treatment arms compared to baseline (P < .001 for all interventions), but neither CBT with nor without telephone support conferred any significant advantage compared to psychoeducation. For the secondary outcomes, there were no significant differences between CBT with telephone support and psychoeducation, but CBT without telephone support was less effective than psychoeducation with respect to HADS depression subscale [mean difference 1.86, 95% confidence interval (CI) 0.61, 3.11; P = .004] and caregiver stress (RSS mean difference 3.11, 95% CI 0.13, 6.09; P = .04). Good safety was achieved in all 3 treatment arms, with no deaths or serious adverse events. CONCLUSIONS AND IMPLICATIONS Online CBT with telephone support and psychoeducation both achieved significant benefits over 26 weeks compared with baseline in mental health and mood, but there were no advantages for CBT compared with the psychoeducation intervention. CBT without telephone support was less effective with respect to mood outcomes than psychoeducation and should not be recommended based on current evidence.
Collapse
Affiliation(s)
- Jane Fossey
- Fulbrook Centre, Oxford Health NHS Foundation Trust, Oxford, United Kingdom; University of Exeter Medical School, Exeter, United Kingdom
| | - Georgina Charlesworth
- Research and Development, North East London NHS Foundation Trust, Ilford, United Kingdom; Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Jo-Ann Fowler
- Fulbrook Centre, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Elena Frangou
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom; MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, London, United Kingdom
| | - Theo John Pimm
- Whiteleaf Centre, Oxford Health NHS Foundation Trust, Aylesbury, United Kingdom
| | - June Dent
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, United Kingdom; Oxford VR, Oxford Centre for Innovation, Oxford, United Kingdom
| | - Joanne Ryder
- Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Amanda Robinson
- TalkingSpace Plus, Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Robert Kahn
- Alzheimer's Society Research Network Volunteer, Warrington, United Kingdom
| | - Dag Aarsland
- Wolfson Centre for Age Related Diseases, Kings College London, United Kingdom
| | | | - Clive Ballard
- University of Exeter Medical School, Exeter, United Kingdom.
| |
Collapse
|
11
|
Giebel C, McIntyre JC, Alfirevic A, Corcoran R, Daras K, Downing J, Gabbay M, Pirmohamed M, Popay J, Wheeler P, Holt K, Wilson T, Bentall R, Barr B. The longitudinal NIHR ARC North West Coast Household Health Survey: exploring health inequalities in disadvantaged communities. BMC Public Health 2020; 20:1257. [PMID: 32811459 PMCID: PMC7436975 DOI: 10.1186/s12889-020-09346-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 08/04/2020] [Indexed: 11/28/2022] Open
Abstract
Background The Household Health Survey (HHS) was developed to understand the socioeconomic determinants of mental and physical health, and health inequalities in health and social care. This paper aims to provide a detailed rationale of the development and implementation of the survey and explore socio-economic variations in physical and mental health and health care. Methods This comprehensive longitudinal public health survey was designed and piloted in a disadvantaged area of England, comprising questions on housing, physical health, mental health, lifestyle, social issues, environment, work, and finances. After piloting, the HHS was implemented across 28 neighbourhoods – 10 disadvantaged neighbourhoods for learning (NfLs), 10 disadvantaged comparator sites, and eight relatively advantaged areas, in 2015 and 2018. Participants were recruited via random sampling of households in pre-selected neighbourhoods based on their areas of deprivation. Results 7731 residents participated in Wave 1 (N = 4319) and 2 (n = 3412) of the survey, with 871 residents having participated in both. Mental health, physical health, employment, and housing quality were poorer in disadvantaged neighbourhoods than in relatively advantaged areas. Conclusions This survey provides important insights into socio-economic variations in physical and mental health, with findings having implications for improved care provision to enable residents from any geographical or socio-economic background to access suitable care.
Collapse
Affiliation(s)
- Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, UK. .,NIHR ARC NWC, Liverpool, UK.
| | - Jason C McIntyre
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
| | - Ana Alfirevic
- NIHR ARC NWC, Liverpool, UK.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Rhiannon Corcoran
- Department of Primary Care & Mental Health, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, UK.,NIHR ARC NWC, Liverpool, UK
| | - Konstantinos Daras
- NIHR ARC NWC, Liverpool, UK.,Department of Geography and Planning, University of Liverpool, Liverpool, UK
| | - Jennifer Downing
- NIHR ARC NWC, Liverpool, UK.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, UK.,NIHR ARC NWC, Liverpool, UK
| | - Munir Pirmohamed
- NIHR ARC NWC, Liverpool, UK.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jennie Popay
- NIHR ARC NWC, Liverpool, UK.,Department of Health Research, Lancaster University, Lancaster, UK
| | - Paula Wheeler
- NIHR ARC NWC, Liverpool, UK.,Department of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Richard Bentall
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Ben Barr
- Department of Primary Care & Mental Health, University of Liverpool, Waterhouse Building B Block, Brownlow Street, Liverpool, L69 3GL, UK.,NIHR ARC NWC, Liverpool, UK
| |
Collapse
|
12
|
O'Connor S. Retracted:
Co‐designing technology with people with dementia and their carers: Exploring user perspectives when co‐creating a mobile health application. Int J Older People Nurs 2019; 15:e12288. [DOI: 10.1111/opn.12288] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/13/2019] [Accepted: 10/30/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Siobhan O'Connor
- School of Health in Social Science The University of Edinburgh Edinburgh UK
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW To summarize the latest evidence on patient and public involvement (PPI) in dementia research. To identify methodologies used to deliver and evaluate co-production, potential barriers to involvement, and effective strategies to enable meaningful involvement of PPI representatives in dementia research. RECENT FINDINGS PPI expertise in dementia research has been utilized to increase the acceptability of new interventions to end users and to interpret research findings from a PPI perspective. Practical adaptations to materials and meetings, and building relationships and trust were important facilitators for engagement. PPI has included caregivers, people living with dementia (PLWD) or both, with few studies involving the public or professionals. Engaging PLWD and hard-to-reach groups in PPI is challenging, with most current PPI representatives recruited from dementia organisations. Few studies have assessed the impact of PPI on study outcomes. SUMMARY In this relatively new field, methods that allow meaningful engagement are being iteratively developed. Greater community and patient engagement will be a prerequisite for increasing diversity of PPI, to ensure voices of a broader range of stakeholders are heard. Documenting and publicizing the impact of this work and engaging existing PPI representatives to support PPI recruitment could help with this.
Collapse
|
14
|
Holter MT, Johansen AB, Ness O, Brinkmann S, Høybye MT, Brendryen H. Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality. J Med Internet Res 2019; 21:e10354. [PMID: 31066683 PMCID: PMC6526686 DOI: 10.2196/10354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 01/23/2023] Open
Abstract
Future development of electronic health (eHealth) programs (automated Web-based health interventions) will be furthered if program design can be based on the knowledge of eHealth’s working mechanisms. A promising and pragmatic method for exploring potential working mechanisms is qualitative interview studies, in which eHealth working mechanisms can be explored through the perspective of the program user. Qualitative interview studies are promising as they are suited for exploring what is yet unknown, building new knowledge, and constructing theory. They are also pragmatic, as the development of eHealth programs often entails user interviews for applied purposes (eg, getting feedback for program improvement or identifying barriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic) research questions of how such programs work, the knowledge base of eHealth’s working mechanisms can grow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that the interviews should generate enough data of sufficient quality relevant to the research question (ie, rich data). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging, as several of the authors have experienced. Moreover, when encountering difficulties as we did, there are few places to turn to, there are currently no guidelines for conducting such interview studies in a way that ensure their quality. In this paper, we build on our experience as well as the qualitative literature to address this need, by describing 5 challenges that may arise in such interviews and presenting methodological tools to counteract each challenge. We hope the ideas we offer will spark methodological reflections and provide some options for researchers interested in using qualitative interview studies to explore eHealth’s working mechanisms.
Collapse
Affiliation(s)
- Marianne Ts Holter
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ayna B Johansen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ottar Ness
- Department of Education and Lifelong Learning, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Svend Brinkmann
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Mette T Høybye
- Elective Surgery Centre, Regional Hospital Silkeborg, Silkeborg, Denmark.,Department of Clinical Medicine, Interacting Minds Centre, Aarhus University, Aarhus, Denmark
| | - Håvar Brendryen
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
15
|
Andréasson F, Aidemark J, Magnusson L, Strömberg A, Hanson EJ. Lifeworld in co-designing with informal carers. JOURNAL OF ENABLING TECHNOLOGIES 2019. [DOI: 10.1108/jet-05-2018-0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to reflect on carers’ experiences of being involved in the development of a web-based support programme for carers of people with heart failure (CPwHF), and discuss the challenges related to their involvement in the development process. The focus was on the different phases in the project as well as the methodological challenges and opportunities that occurred in the user group sessions conducted.
Design/methodology/approach
This research adopt an explorative design studying a co-design process to develop an information and communication technology based support programme for and with CPwHF. Habermas’ concepts of lifeworld and system are used as a theoretical framework to analyse the co-design process employed in the study.
Findings
Reflecting on the co-design approach adopted, the findings highlight the methodological challenges that arise with carer involvement and the possible tensions that occur between researchers’ ambitions to include users in the design process, and the goal of developing a product or service, in the different phases of the design process.
Originality/value
Findings highlight that there is a tension between the system and lifeworld in the co-design process which are not totally compatible. The paper highlights that there is a need to develop flexible and reflexive human-centred design methodologies, able to meet carers’ needs and ideas, and at the same time balance this with proposed research outcomes.
Collapse
|