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Miyawaki CE, McClellan A, Russell D, Bouldin ED. Comparing Unmet Service Needs Between Rural and Urban Family Caregivers of People Living With Alzheimer's Disease and Related Dementias: A Multisite Study. THE GERONTOLOGIST 2024; 64:gnae083. [PMID: 38946163 PMCID: PMC11308181 DOI: 10.1093/geront/gnae083] [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] [Received: 01/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The scarcity of resources and available caregiving services in rural areas in the United States has been well documented. However, less research has compared unmet service needs between caregivers of people with Alzheimer's disease and related dementias (ADRD) in rural versus urban areas. RESEARCH DESIGN AND METHODS Using semistructured interviews guided by theories of health service use and dependent care, we interviewed 20 family caregivers residing in rural areas of Western North Carolina and 18 caregivers within the urban setting of Houston, Texas, and compared their unmet service needs and contextual factors that facilitate their service use. RESULTS Thematic analyses revealed similar unmet service needs among rural and urban caregivers; however, the ways they approached and solved their challenges differed. Caregivers in rural areas wished for more information and caregiver support whereas urban caregivers looked for information they needed until they found the answers. Rural caregivers expressed guilt about using services because they felt they were limited and zero-sum whereas urban caregivers shared available resources so that other caregivers could use them as well. Unmet service needs for urban caregivers included more racially and ethnically specific services for people with ADRD in their ethnic-specific languages and foods while rural caregivers' cultural needs were not racially and ethnically specific but for more place-specific services. DISCUSSION AND IMPLICATIONS Recommendations for rural caregivers included utilizing online and virtual opportunities and expanding their reach across the United States. For urban caregivers, increasing culturally tailored service options would likely increase access and use.
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Affiliation(s)
| | - Angela McClellan
- Graduate College of Social Work, University of Houston, Houston, Texas, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, North Carolina, USA
| | - Erin D Bouldin
- Health Services Research & Development, Department of Veterans Affairs Medical Center, Salt Lake City, Utah, USA
- School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Watson J, Hanna K, Talbot C, Hansen M, Cannon J, Caprioli T, Gabbay M, Komuravelli A, Eley R, Tetlow H, Giebel C. A systematic review of digital access to post-diagnostic health and social care services for dementia. Int J Geriatr Psychiatry 2024; 39:e6119. [PMID: 39004777 DOI: 10.1002/gps.6119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/17/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES For many people with dementia and unpaid carers, using technology for care and support has become essential. Rapid proliferation of technology highlights the need to understand digital access to health and social care services for dementia. This mixed-methods systematic review aims to explore digital access to health and social care services for dementia, from the perspective of people with dementia and unpaid carers. METHODS Nine electronic databases were searched in May 2023 for qualitative, quantitative, or mixed-method studies, published in English or German, focused on experiences of using technology-delivered health and social care services for people with dementia and unpaid carers. After removal of duplicates and screening, 44 empirical papers were included. RESULTS From the 44 studies, findings were grouped into five categories, highlighting experiences for people with dementia and unpaid carers: (1) Adapting to technology, (2) Inequalities and variations in outcomes, (3) Impact on caring, (4) Impact on health, and (5) Impact on relationships. Proliferation of technology in care access emphasised the need for quick adaptation to technology and examination of its impact. The impact of such service delivery has evidenced mixed findings. There were improvements in the health and wellbeing of people with dementia and unpaid carers, and benefits for their dyadic relationship. However, using technology for health and social care access is not always possible and is often reliant on unpaid carers for support. Lower tech-literacy, lack of equipment or money to buy equipment and poor internet connection can impact the potential for positive outcomes. CONCLUSIONS Technology can bring great benefits: social inclusion, improved service access and care. However, using technology in service delivery in dementia needs careful thought. Professionals and service providers need to be cognizant of the complex nature of dementia, and the benefits and challenges of hybrid service delivery.
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Affiliation(s)
- James Watson
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
| | - Kerry Hanna
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Catherine Talbot
- Ageing and Dementia Research Centre, Bournemouth University, Bournemouth, UK
| | - Marcus Hansen
- Faculty of Business and Law, Liverpool John Moores University, Liverpool, UK
| | | | - Thais Caprioli
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
| | | | - Ruth Eley
- Together in Dementia Everyday (TIDE), Liverpool, UK
| | - Hilary Tetlow
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
- Together in Dementia Everyday (TIDE), Liverpool, UK
- Service User Reference Forum (SURF), Liverpool, UK
| | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR Applied Research Collaboration North West Coast, Liverpool, UK
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Vereen RN, Kurtzman R, Noar SM. Are Social Media Interventions for Health Behavior Change Efficacious among Populations with Health Disparities?: A Meta-Analytic Review. HEALTH COMMUNICATION 2023; 38:133-140. [PMID: 34148445 PMCID: PMC9238345 DOI: 10.1080/10410236.2021.1937830] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While prior reviews have identified positive effects of social media interventions for health behavior change generally, it is unclear whether these effects persist in traditionally underrepresented populations that are at disproportionate risk of disease. The current meta-analysis examined the effectiveness of social media interventions for health behavior change among populations with health disparities. We analyzed 17 studies with a cumulative N = 3,561. Social media interventions had a significant moderate-sized effect on behavior change among populations with health disparities (d = 0.303, 95% CI: 0.156, 0.460, p < .001), and there was significant heterogeneity across the studies (Q = 64.48, p < .001, I2 = 75.19). Exploratory moderator analyses revealed larger effects in studies with smaller sample size (p < .05) and those using additional intervention channels, including e-mail and telephone (p < .05). Findings suggest that social media interventions may be a promising intervention tool for stimulating behavior change among populations with health disparities, but several gaps remain in the literature. Public health professionals and other health communicators should further explore ways to increase both the reach and impact of social media interventions among populations with health disparities.
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Affiliation(s)
- Rhyan N. Vereen
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, U.S
| | - Rachel Kurtzman
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, U.S
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, U.S
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, U.S
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, U.S
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Lyu M, Zhao Q, Yang Y, Hao X, Qin Y, Li K. Benefits of and barriers to telehealth for the informal caregivers of elderly individuals in rural areas: A scoping review. Aust J Rural Health 2022; 30:442-457. [PMID: 35460580 DOI: 10.1111/ajr.12869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Maintaining care for elderly individuals in rural areas is heavily dependent on support from informal caregivers. Many informal caregivers of the elderly in rural areas feel burdened and urgently require professional support. Interests in telehealth that can provide support irrespective of geographical location have been increasing. OBJECTIVE To identify the benefits of and barriers in telehealth engagement for rural caregivers to provide evidence for service improvement. DESIGN A scoping review method was used following PRISMA-ScR guidelines and Arksey and O'Malley's five-stage framework. Five databases were searched. The search terms were chosen based on the target intervention (i.e. telehealth), target population (caregivers of elderly individuals) and target context (rural areas). Two authors independently assessed the eligibility of studies and extracted data from eligible studies. FINDINGS Of 4220 retrieved studies, 19 articles met the inclusion criteria. This study identified four benefits of and two barriers to telehealth for rural caregivers. Four subthemes were identified as the key benefits in using telehealth for caregivers: decrease in psychological distress, increase in care efficiency, increase in social support and increase in access to resources, while inadequate telehealth infrastructures and caregivers' own reasons were the primary barriers in using telehealth for those populations. CONCLUSIONS Telehealth was shown to significantly benefit rural caregivers. Future research can be designed and conducted for overcoming the barriers to telehealth. Additionally, the benefits identified by this review need to be translated from research into practice for rural caregivers' care.
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Affiliation(s)
- Miaohua Lyu
- School of Nursing, Jilin University, Changchun, China
| | - Qiheng Zhao
- Orthopaedics Department, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Bundy H, Frazier L, Woodward JM, Liu TL, Taylor YJ, Rossman W, Mangieri DA. The benefits of virtual in-clinic memory care for rural patients with dementia: Preliminary data. J Am Geriatr Soc 2022; 70:1874-1876. [PMID: 35211952 DOI: 10.1111/jgs.17712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/30/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Henry Bundy
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Latonia Frazier
- Atrium Health Senior Care Charlotte, Atrium Health, Charlotte, North Carolina, USA
| | - Jennifer M Woodward
- Atrium Health Senior Care Charlotte, Atrium Health, Charlotte, North Carolina, USA
| | - Tsai-Ling Liu
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Yhenneko J Taylor
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Whitney Rossman
- Center for Outcomes Research and Evaluation, Atrium Health, Charlotte, North Carolina, USA
| | - Deanna A Mangieri
- Atrium Health Senior Care Charlotte, Atrium Health, Charlotte, North Carolina, USA
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Lindauer A, Messecar D, McKenzie G, Gibson A, Wharton W, Bianchi A, Tarter R, Tadesse R, Boardman C, Golonka O, Gothard S, Dodge HH. The Tele-STELLA protocol: Telehealth-based support for families living with later-stage Alzheimer's disease. J Adv Nurs 2021; 77:4254-4267. [PMID: 34288013 DOI: 10.1111/jan.14980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
AIMS We aim to establish the feasibility and acceptability of the Tele-STELLA (Support via Telehealth: Living and Learning with Advancing Alzheimer's Disease and Related Dementias) intervention. We will also assess the efficacy of the intervention in reducing the frequency of behavioural symptoms of dementia as well as family Care Partner reactivity to the symptoms. DESIGN This is a multi-component, quasi-experimental study that focuses on facilitating effective management of behavioural symptoms that occur in the later stages of dementia. METHODS Family Care Partners (n = 124) for persons with Alzheimer's disease will participate in two 8-week videoconferencing components that address behavioural symptoms-in both the persons with Alzheimer's disease and their Care Partners. In the first component ('Nova'), Care Partners work with one nurse for an hour/week for 4 weeks, then they join a small group for another 4 weeks. In the second component ('Constellation'), Care Partners work in a larger group to hone skills and knit supportive relationships. Behavioural symptom frequency and Care Partner reactivity to the behaviours will be measured prior to, during and after the intervention. The study is funded by the United States National Institute on Aging (R01AG067546); funding was initiated as on February, 2021. DISCUSSION Tele-STELLA fills a gap in current videoconference-based psychoeducational interventions in that it offers real-time interaction with nurses and peers. The intervention was designed with feedback by pilot participants. This study will assess Tele-STELLA in its current, novel format; thus, preparing it for a larger, future randomized controlled trial. IMPACT Tele-STELLA addresses symptoms that occur in the later stages of dementia, providing families with tools to facilitate effective behavioural management. Because Tele-STELLA is implemented via videoconferencing, it targets Care Partners who face barriers to support, such as cost and transportation. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov (#NCT04627662).
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Affiliation(s)
- Allison Lindauer
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Deborah Messecar
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Glenise McKenzie
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Allison Gibson
- School of Social Work, University of Kentucky, Lexington, KY, USA
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Allison Bianchi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Robin Tarter
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA.,School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ruth Tadesse
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Charles Boardman
- School of Nursing, Oregon Health & Science University, Portland, OR, USA
| | - Ona Golonka
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Gothard
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
| | - Hiroko H Dodge
- Layton Aging and Alzheimer's Disease Center, Oregon Health & Science University, Portland, OR, USA
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