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Lee S, Ory MG, Vollmer Dahlke D, Smith ML. Technology Use Among Older Adults and Their Caregivers: Cross-Sectional Survey Study. JMIR Aging 2024; 7:e50759. [PMID: 38717339 PMCID: PMC11084119 DOI: 10.2196/50759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/18/2024] [Accepted: 02/18/2024] [Indexed: 05/12/2024] Open
Abstract
Background Informal caregivers are called upon to provide substantial care, but more needs to be known about technology use among older adult and caregiver dyads. Objective This study described technology use among older adults and their caregivers, explored potential correlates of technology use, and highlighted implications for practice. Methods A cross-sectional survey was conducted among unpaid caregivers of older adults (n=486). Primary outcomes were self-reported technology (devices and functions) use among caregivers and their oldest care recipient. The concordance of technology use among caregivers and care recipients was also examined. Multivariable regression models were conducted separately for caregivers and care recipients. Results Greater proportions of caregivers used all examined technologies, except for the medication alerts or tracking function, than care recipients. Caregivers used an average of 3.4 devices and 4.2 functions, compared to 1.8 devices and 1.6 functions used by their care recipients. Among caregivers, younger age, higher income, and higher education were associated with more technology use (P<.05). Among care recipients, younger age, not having cognitive dysfunction, and caregiver's technology use were associated with more technology use (P<.05). Conclusions Understanding technology use patterns and device adoption across diverse caregiver and care recipient populations is increasingly important for enhancing geriatric care. Findings can guide recommendations about appropriate technology interventions and help providers communicate and share information more effectively with patients and their caregivers.
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Affiliation(s)
- Shinduk Lee
- College of Nursing, University of Utah, Salt Lake City, UT, United States
| | - Marcia G Ory
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX, United States
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
| | - Deborah Vollmer Dahlke
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- DVD Associates, LLC, Austin, TX, United States
| | - Matthew Lee Smith
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Health Behavior, Texas A&M University, College Station, TX, United States
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Soares S, Hoffmeister LV, Fernandes MDF, Henriques A, Costa A. The Use of Digital Technologies in the Promotion of Health Literacy and Empowerment of Informal Caregivers: Scoping Review. JMIR Aging 2024; 7:e54913. [PMID: 38683655 DOI: 10.2196/54913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/24/2024] [Accepted: 01/24/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND Informal caregivers (IC) play an important role in the community as health care providers for people who are dependent on self-care. Health literacy contributes to empowerment, better care, and self-management of one's own health and can be developed using digital technologies. OBJECTIVE This study aims to map scientific evidence about the use of digital technologies to promote health literacy and the empowerment of ICs. METHODS We conducted a scoping review following the Joanna Briggs Institute methodology. The CINAHL, MEDLINE, Scopus, and PubMed databases were searched to find primary studies on the theme. Inclusion criteria were based on the Population, Concept, and Context logic. To be selected for analysis, studies must have involved informal or family caregivers aged ≥18 years who provide care to dependent persons and who have access to the internet and digital devices (computer, smartphone, and tablet). A total of 2 independent researchers (SS and LVH) performed the screening process. This study is part of a main project that was approved by the Ethics Committee for Health of the Regional Health Administration of Lisbon and Tagus Valley (reference 058/CES/INV/2022). RESULTS A total of 9 studies were included in the review. The analysis of the studies showed that ICs use digital tools, such as computers and smartphones, with smartphones being the preferred tool. ICs use the internet to access information; manage home tasks; communicate with relatives, their peers, and health care professionals; and take part in forums. Due to difficulties in leaving their houses, forums are highly valued to preserve human connections. CONCLUSIONS The use of digital technologies to convey clear, objective, reliable, and accessible information is a strategic action for promoting health literacy and for contemplating the variable care needs of ICs. By working with ICs in the development of new technologies, researchers are building a new tool that meets ICs' needs.
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Affiliation(s)
- Suzete Soares
- Nursing School of Lisbon, Lisbon, Portugal
- Family Health Unit Carnide Quer, North Lisbon Health Center Cluster, Lisbon, Portugal
| | - Louíse Viecili Hoffmeister
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
- National School of Public Health, NOVA University, Lisbon, Portugal
| | - Maria de Fátima Fernandes
- Nursing School of Lisbon, Lisbon, Portugal
- Community Care Unit Integrar na Saúde, Administração Regional de Saúde de Lisboa e Vale do Tejo, Lisbon, Portugal
| | - Adriana Henriques
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
- Institute of Environmental Health, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
| | - Andreia Costa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, Lisbon, Portugal
- Institute of Environmental Health, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
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Ferguson L, Kürüm E, Rodriguez TM, Nguyen A, Lopes de Queiroz IF, Lee J, Wu R. Impact of community-based technology training with low-income older adults. Aging Ment Health 2024; 28:638-645. [PMID: 37702149 DOI: 10.1080/13607863.2023.2256271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/25/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVES Compared with younger and middle-aged adults, older adults are less likely to adopt new computer technology, potentially limiting access to healthcare and many other important resources available online. This limitation could impact cognitive abilities, well-being, and mental health outcomes of older adults. The aims of the present study were to increase access to online county and healthcare resources, while also assessing the impact of technology access on cognitive functioning and multiple well-being domains. METHODS A pilot community collaboration provided a two-month tablet training intervention, focused on increasing digital independence via tablet navigation, resources access, and fraud and scam prevention, to 20 low-income older adult participants (75% female, Mage = 70.85). Pre- and post-test phone interviews were conducted to measure any changes in digital independence, cognitive abilities, well-being, mental health, and mindset. RESULTS Linear mixed effects models revealed no significant changes in outcome measures from pre- to post-test. However, we found effects of digital independence on several well-being measures, providing important information for the impact of technology access and training for low-income older adults. CONCLUSION This pilot intervention offers limited but promising results, inspiring further investigations that may inform public health and policy services to address barriers to access and potentially improve psychological health.
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Affiliation(s)
- Leah Ferguson
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Esra Kürüm
- Department of Statistics, University of California, Riverside, Riverside, CA, USA
| | - Tania M Rodriguez
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Alexander Nguyen
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
| | - Isadora Farias Lopes de Queiroz
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
- Department of Psychology, Hollins University, Roanoke, VA, USA
| | - Jewel Lee
- Riverside County Office on Aging, Riverside, CA, USA
| | - Rachel Wu
- Department of Psychology, University of California, Riverside, Riverside, CA, USA
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Zarzycki M, Vilchinsky N, Bei E, Ferraris G, Seddon D, Morrison V. Cross-country variations in the caregiver role: evidence from the ENTWINE-iCohort study. BMC Public Health 2024; 24:898. [PMID: 38532418 DOI: 10.1186/s12889-024-18302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Globally, economically developed countries face similar ageing demographics and the challenge of a 'care gap', yet they vary due to different care and formal support systems, and different cultural and societal norms around illness and care. The aim of this exploratory study was to examine cross-country variations in caregiver motivations, willingness, values, meaning in life, illness beliefs, and experiences of wellbeing, gain, health-related quality of life, burden and depression, across 6 European countries and Israel. Cross-country differences in the above-mentioned informal caregiver experiences are rarely described. METHODS An online survey (ENTWINE-iCohort) was conducted using validated measures wherever possible. This paper utilises data from 879 caregivers and seven countries (Greece, Italy, the Netherlands, Poland, Sweden, the UK, and Israel). RESULTS No consistent finding supporting the concurrent relationship between caregiver support policies/country culture and caregiver motivations/willingness was found. Caregivers in countries typically characterised by individualist cultures reported lower familism, higher self-enhancement values, and greater perceived illness threat compared to more collectivist countries. Search for meaning was higher in poorer countries than in wealthier countries. Higher negative caregiver experiences (e.g., burden) and lower positive experiences (e.g., wellbeing) were generally observed in countries with underdeveloped caregiver support as compared to countries with more developed formal support systems. CONCLUSIONS Cross-country variations can be explained to varying degrees by national policies around care (or their absence) and country cultural contexts. The results emphasise the importance of formal support services for achieving positive caregiver experiences, and help inform the development of policies and measures to support caregivers in Europe and Israel.
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Affiliation(s)
- Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom.
- School of Psychology and Sports Sciences, Bangor University, Bangor, Wales, United Kingdom.
| | - Noa Vilchinsky
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Eva Bei
- Department of Psychology, Faculty of Social Sciences, Bar-Ilan University, Ramat Gan, Israel
- Department of Political and Social Sciences, University of Bologna, Bologna, Italy
| | - Giulia Ferraris
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Diane Seddon
- School of Medical and Health Sciences, Bangor University, Bangor, Wales, United Kingdom
| | - Val Morrison
- School of Psychology and Sports Sciences, Bangor University, Bangor, Wales, United Kingdom
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Campbell JC, Canick JE, Chen PG, Hachem RA, Jang DW. Barosinusitis due to routine weather changes: A cross-sectional analysis of public websites. World J Otorhinolaryngol Head Neck Surg 2024; 10:18-23. [PMID: 38560031 PMCID: PMC10979036 DOI: 10.1002/wjo2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 04/04/2024] Open
Abstract
Background Sinusitis is a common diagnosis that can be erroneously associated with routine weather-related barometric pressure changes. In actuality, these pressure changes likely exacerbate migraine headaches, which can cause facial pain and pressure rather than true sinus inflammation. Objective The present study sought to characterize the representation of both sinusitis and migraine in association with barometric pressure changes across websites on the Internet. Methods An Internet search for relevant terms was conducted, and content of the resulting pages was assessed for associations between weather-related pressure changes and either sinusitis or migraine. Variations in reported results across different subtypes of Internet sources were analyzed. The primary outcomes measured were (1) whether a given media source associated barometric weather changes with sinusitis, (2) whether that source associated barometric weather changes with migraine, and (3) treatment options offered by that source. Results Of the 116 included webpages, 36 (31.03%) associated sinusitis and routine barometric pressure changes. Of these, 10 (27.77%) were otolaryngology practice sites. Sixty-seven webpages (57.76%) associated migraine and routine barometric pressure changes. Of these, nonotolaryngology webpages were more likely to report this link. Conclusions Otolaryngology practice sites were observed to be the most frequent professional medical resource reporting the unsubstantiated claim that routine barometric pressure changes are associated with sinusitis. Nonotolaryngology sources were more likely to link weather-related pressure changes to migraine. These results suggest that opportunities exist for otolaryngology practice sites to educate patients about nonrhinogenic headache etiologies.
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Affiliation(s)
- James C. Campbell
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | | | - Philip G. Chen
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Texas Health Science Center San AntonioSan AntonioTexasUSA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
| | - David W. Jang
- Department of Head and Neck Surgery & Communication SciencesDuke University School of MedicineDurhamNorth CarolinaUSA
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Kim YK, Ang S, Fingerman KL. Older Adults' and Family Caregivers' Technological Arrangements on Risk of Institutionalization. WORK, AGING AND RETIREMENT 2024; 10:51-56. [PMID: 38196826 PMCID: PMC10772965 DOI: 10.1093/workar/waad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Internet-enabled resources could facilitate older adults' ability to live in the community longer, but studies have often overlooked how family caregivers utilize the internet to assist older care recipients. We examined whether different family-level arrangements of internet use may affect the risk of institutionalization among older adults. Using the National Health and Aging Trends Study (2015-2020) and National Study on Caregiving (2015), we estimated multinominal logistic regression and inverse-probability weighted Cox proportional hazard models to investigate the determinants of technological arrangements in 2015 (i.e., no internet use, only caregiver use, only care recipient use, both caregiver and care recipient internet use) and how they may affect the risk of moving to an assisted living or nursing facility between 2015 and 2020. The most prevalent technological arrangement in 2015 was the one where neither the care recipient nor their caregiver reported using the internet. Relatively disadvantaged older care recipients (e.g., people of color, fewer years of education, less income, worse cognitive functioning) and caregivers (e.g., older, fewer years of education) were more likely to be in a non-internet use arrangement. Compared to older adults in other categories, older adults who were internet users and had a family caregiver who also used the internet in their caregiving tasks had a much lower risk of relocation during the study period. Findings suggest that digital interventions aimed at serving the older adult population should assess the gap in access and utilization at a family level and consider the role of older adults' social partners.
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Affiliation(s)
- Yijung K Kim
- Texas Aging & Longevity Center, The University of Texas at Austin, Austin, TX, USA
| | - Shannon Ang
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Karen L Fingerman
- Department of Human Development and Family Sciences, The University of Texas at Austin, Austin, TX, USA
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Buckinx F, Adam S, Aubertin-Leheudre M, De Saint Hubert M, Mouton A, Potier F, Reginster JY, Bruyere O. Quality of Life and Health Determinants of Informal Caregivers Aged 65 Years and Over. EPIDEMIOLOGIA 2023; 4:464-482. [PMID: 37987311 PMCID: PMC10660726 DOI: 10.3390/epidemiologia4040039] [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: 10/02/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Informal caregivers' own quality of life, health status, and determinants are poorly understood despite their concern for the health of the individuals they assist. To compare the quality of life and the health determinants of older informal caregivers with those of older adults without caregiving responsibilities. An online survey was designed to investigate the quality of life and the health determinants of people aged 65 years and over, with a focus on informal caregivers. In addition to socio-demographic data, the number of informal caregivers was ascertained and the Zarit scale of caregiver burden was applied. Quality of life (SF-12) and health determinants (access to technology and level of physical activity (IPAQ)) were assessed and compared between informal caregivers and non-caregivers. A total of 111 participants were included in the study (70 ± 3.83 years, 71.2% women). The majority of respondents (91.8%) were Belgian. One-third of the respondents identified themselves as informal caregivers and declared themselves as having a severe burden (61.9 ± 15.2/88). Socio-demographic characteristics and access to technology were similar between informal caregivers and non-caregivers (p > 0.05). However, informal caregivers had a lower SF-12 score in the mental score domain (44.3 ± 10.2 vs. 50.7 ± 7.0; p = 0.004) and a lower level of physical activity (434 ± 312 METS/min/week vs. 1126 ± 815 METS/min/week; p = 0.01) than their peers. Informal caregivers reported a lower quality of life and a lower level of physical activity than their peers. Given the recognized importance of physical activity for overall health, this survey highlights the need to promote physical activity among older informal caregivers.
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Affiliation(s)
- Fanny Buckinx
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
| | - Stéphane Adam
- Psychology of Aging Unit, University of Liège, 4000 Liège, Belgium
| | - Mylène Aubertin-Leheudre
- Département des Sciences de L'activité Physique & Centre de Recherche de L'institut Universitaire de Gériatrie de Montréal, Faculté des Sciences, Université du Québec à Montréal, Montréal, QC H3W 1W5, Canada
| | - Marie De Saint Hubert
- Department of Geriatric Medicine, CHU UCL Namur, Institut de Recherche Santé Société, UCLouvain, 5530 Yvoir, Belgium
| | - Alexandre Mouton
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Department of Sports Sciences, University of Liège, 4000 Liège, Belgium
| | - Florence Potier
- Department of Geriatric Medicine, CHU UCL Namur, Institut de Recherche Santé Société, UCLouvain, 5530 Yvoir, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
| | - Olivier Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, 4000 Liège, Belgium
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Department of Sports Sciences, University of Liège, 4000 Liège, Belgium
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Wong AKC, Ng NP, Hui VCC, Montayre J. Effect of a telecare-based intervention on stress levels in informal caregivers of older adults: protocol for a randomized controlled trial. Front Psychiatry 2023; 14:1167479. [PMID: 37377468 PMCID: PMC10292626 DOI: 10.3389/fpsyt.2023.1167479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
Significance Due to caregiving commitments, caregivers of older adults may not have the time to make use of the onsite community services available to them during the day. With the support of advanced technology, telecare could be a convenient and easily accessible channel for providing individualized caregiving advice to caregivers. Objective The aim of the study is to describe a research protocol that highlights the development of a telecare-based intervention program for reducing stress levels in informal caregivers of community-dwelling older adults. Methods It is a randomized controlled trial. The study is supported by two community centers. The study participants will be randomly assigned to either the telecare-based intervention group or the control group. The former will receive a 3-month program comprised of three components: online nurse case management supported by a health and social care team, an online resource center, and a discussion forum. The latter will receive the usual services that provided by the community centers. Data will be collected at two time points - pre-intervention (T1) and post-intervention (T2). The primary outcome is stress levels, while secondary outcomes include self-efficacy, depression levels, quality of life, and caregiving burden. Discussion Besides taking care of one or more older adults, informal caregivers have to deal with work, chores, and take care of their children. This study will add valuable information to the knowledge gap on whether telecare-based interventions with the support of an integrated health-social team can alleviate the stress levels of informal caregivers of community-dwelling older adults. If successful, policymakers and healthcare professionals should consider incorporating telecare modalities in a primary health setting for informal caregivers to correspond with them, to relieve their caregiving stress and promote a healthy life. Clinical trial registration https://www.clinicaltrials.gov/, NCT05636982.
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Hassan AYI, Cucculelli M, Lamura G. Caregivers' willingness to pay for digital support services: Comparative survey. Health Policy 2023; 130:104751. [PMID: 36857837 DOI: 10.1016/j.healthpol.2023.104751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Considering the substantial information needs experienced by informal caregivers, the increased availability of digital support services for caregivers as well as the potential they offer, further understanding of caregivers' willingness to pay for digital support services is needed. OBJECTIVE The aim of this study is to identify associations between informal caregiver's characteristics and their willingness to pay for digital support services in two countries: Italy and Sweden. METHODS A sample of 378 respondents participated in a cross-sectional survey. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. A two-part regression model was used. In the first part, logistic regression analysis was applied to investigate the association between willingness to pay and sets of independent variables (caregiver's demographics, caregiver's socioeconomic resources and caregiving context). In the second part, a generalized linear model (log-link and gamma distribution) was applied to determine the adjusted mean willingness to pay. RESULTS More than half of the participants from both countries of our study were willing to pay out of pocket for digital support services. A recommendation by a healthcare professional was the top factor that may motivate caregivers' willingness to pay an additional amount for a paid version of a digital support service. In both countries, the majority of the respondents believe that the government should allocate more funds for digital support services and for improving digital infrastructures. Caregiver' s gender, care recipient relationship to the caregiver, care duration, the total household income and the amount spent per month on professional caregiving services are all associated with willingness to pay. For every additional 10 Euro increase in the amount spent per month on professional caregiving services, the odds of willingness to pay an additional Euro for a digital support service increased by 0.60 % in the Italian sample (p= 0.002, 95% CI: 1.002, 1.009) and 0.31% in the Swedish sample (p=0.015, 95% CI: 1.006, 1.057). CONCLUSIONS Factors such as demographics, socioeconomic resources and the caregiving context may play a role in caregivers' willingness to pay for digital support services. The digital and social divide may negatively affect caregivers' willingness to pay for digital support services. Policy makers and insurance providers should consider innovative policies to fund digital support services that have been shown to be effective at supporting and improving caregivers' health outcomes via subsidies or other incentives. Future research that evaluates the cost-effectiveness of digital support services is needed in a context of a growing number of informal caregivers and ever scarcer resources.
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Affiliation(s)
- Alhassan Yosri Ibrahim Hassan
- INRCA IRCCS - National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy; Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Marche Polytechnic University, Ancona, Italy.
| | - Marco Cucculelli
- Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Lamura
- INRCA IRCCS - National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy
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Mendez KJW, Labrique AB, Budhathoki C, Sadak T, Tanner EK, Cotter VT, Han HR. Use of mobile applications and health technologies among dementia caregivers with chronic conditions: A cross-sectional study. Digit Health 2023; 9:20552076231181213. [PMID: 37361436 PMCID: PMC10286551 DOI: 10.1177/20552076231181213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Almost 80% of people, who are caring for someone with dementia, have one or more chronic conditions and require self-management support. New technologies offer promising solutions; however, little is known about what technologies caregivers use for their health or in general. This study aimed to describe the prevalence of mobile application (app) and health-related technology use among caregivers who have chronic conditions and care for someone with dementia. Methods A cross-sectional study was conducted with 122 caregivers recruited online and from communities in the Baltimore-metropolitan area. Data were collected with online surveys and computer-assisted telephone interviews. Descriptive and inferential statistics were used to analyze survey data. Results Study participants were primarily female (95 of 122, 77.9%), middle-aged (average 53 years, standard deviation (SD) 17), well educated (average 16 years, SD 3.3), an adult child of the person with dementia (53 of 122, 43.4%), and had 4 chronic conditions on average (SD 2.6). Over 90% of caregivers used mobile apps (116 of 122), spending a range of 9 to 82 min on each app. Most caregivers reported using social media apps (96 of 116, 82.8%), weather apps (96 of 116, 82.8%), and/or music or entertainment apps (89 of 116, 76.7%). Among caregivers using each app type, more than half of caregivers used social media (66 of 96, 69%), games (49 of 74, 66%), weather (62 of 96, 65%), and/or music or entertainment apps (51 of 89, 57%) daily. Caregivers also used several technologies to support their own health-the most common being websites, mobile devices, and health-related mobile apps. Conclusion This study supports the feasibility of using technologies to promote health behavior change and support self-management among caregivers.
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Affiliation(s)
| | - Alain Bernard Labrique
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Tatiana Sadak
- University of Washington School of Nursing, Seattle, WA, USA
| | | | | | - Hae-Ra Han
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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11
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Teles S, Paúl C, Costa-Santos C, Ferreira A. Use of dementia and caregiving-related internet resources by informal caregivers: A cross-sectional study. Front Med (Lausanne) 2022; 9:978635. [PMID: 36186787 PMCID: PMC9518752 DOI: 10.3389/fmed.2022.978635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
Informal dementia caregivers are at greater risk of experiencing physical and mental health issues as compared to the general population. Internet-based resources may provide accessible opportunities to backing informal dementia caregivers by addressing their information and support needs. This cross-sectional study aims to characterize the use of dementia and caregiving-related internet resources by caregivers and identify variables associated with such use. Primary data were collected through a web-based survey (N = 158). Linear regression models were used to assess the associations of predisposing, enabling, and need variables with the frequency of using the internet for caregiving-related purposes. Most caregivers (93%) have ever used the internet to gather general information about dementia. The frequency of using internet resources was, however, moderate. The multivariable linear regression model suggests that being younger (β = −0.110, p = 0.009), not having a source of support to provide care (β = −2.554, p = 0.012), having used a face-to-face psychosocial intervention at some point (β = 2.731, p = 0.003), being employed (β = 2.558, p = 0.013), and appraising one's own physical health negatively (vs. appraising it as similar; β = 3.591, p < 0.001), are associated with a higher frequency of using caregiving-related internet resources. Our findings confirmed the association of age and perceived health status with caregiving-related internet use reported in other studies. The role of enabling variables as lifetime access to psychosocial interventions and having a usual source of support to provide care was a new addition. This study informs the design and deployment of information and support to dementia caregivers.
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Affiliation(s)
- Soraia Teles
- Department of Behavioural Sciences, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- *Correspondence: Soraia Teles
| | - Constança Paúl
- Department of Behavioural Sciences, School of Medicine and Biomedical Sciences, University of Porto (ICBAS-UP), Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Cristina Costa-Santos
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Ana Ferreira
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
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Physical Activity and Nutrition-Related Beliefs, Behaviors, and Challenges in Individuals Living With Cancer and Their Caregivers. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Hassan AYI, Lamura G, Hagedoorn M. Predictors of digital support services use by informal caregivers: a cross-sectional comparative survey. BMJ Open 2022; 12:e059897. [PMID: 35487716 PMCID: PMC9058775 DOI: 10.1136/bmjopen-2021-059897] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Digital support services may provide informal caregivers with remote access to information and training about care issues. However, there is limited specific data on how factors such as demographics, socioeconomic resources and the caregiving context may influence caregivers' use of digital support services. The aim of this study is to identify associations between informal caregiver's characteristics and the use of the internet to access digital support services in two countries: Italy and Sweden. SETTING AND PARTICIPANTS A sample of 663 respondents who have access to the internet participated in a cross-sectional survey by completing the online questionnaire. Respondents were recruited by the Italian National Institute of Health and Science on Ageing and the Swedish Family Care Competence Centre. PRIMARY AND SECONDARY OUTCOME MEASURES Logistic regression analyses were performed to assess predictors of caregivers' frequent use of the internet to access digital support services. RESULTS Educational attainment (OR 3.649, 95% CI 1.424 to 9.350, p=0.007), hours per week spent caring (OR 2.928, 95% CI 1.481 to 5.791, p=0.002), total household income (OR 0.378, 95% CI 0.149 to 0.957, p=0.040), care recipient relationship to the caregiver (OR 2.895, 95% CI 1.037 to 8.083, p=0.042) and gender of care recipient (OR 0.575, 95% CI 0.356 to 0.928, p=0.023) were significant predictors in the multivariate analysis for the Italian caregivers group. Hours per week spent caring (OR 2.401, 95% CI 1.105 to 5.218, p=0.027) and age of caregiver (OR 2.237, 95% CI 1.150 to 4.352, p=0.018) were significant predictors in the multivariate analysis for the Swedish caregivers group. CONCLUSIONS Digital support services could be important tools to empower informal caregivers. When it comes to policy and practice in relation to caregivers, similarly to other broad vulnerable groups, there is no 'one-size-fits-all' approach, and it is therefore important to consider the specific characteristics and needs of both caregivers and care recipients.
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Affiliation(s)
- Alhassan Yosri Ibrahim Hassan
- Centre for Socio-Economic Research on Ageing, INRCA IRCCS, Italian National Institute of Health & Science on Ageing, Ancona, Italy
- Department of Economics and Social Sciences, Faculty of Economics "Giorgio Fuà", Marche Polytechnic University, Ancona, Italy
| | - Giovanni Lamura
- Centre for Socio-Economic Research on Ageing, INRCA IRCCS, Italian National Institute of Health & Science on Ageing, Ancona, Italy
| | - Mariët Hagedoorn
- University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Ozluk P, Cobb R, Hoots A, Sylwestrzak M. Association Between Mobile App Use and Caregivers’ Support System, Time Spent on Caregiving, and Perceived Well-being: Survey Study From a Large Employer. J Med Internet Res 2022; 24:e28504. [PMID: 35404266 PMCID: PMC9039821 DOI: 10.2196/28504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/30/2021] [Accepted: 01/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Mobile technology to address caregiver needs has been on the rise. There is limited evidence of effectiveness of such technologies on caregiver experiences. Objective This study evaluates the effectiveness of ianacare, a mobile app, among employees of a large employer. ianacare mobilizes personal social circles to help with everyday tasks. Through the use of ianacare, we evaluate the associations between coordinating caregiving tasks among a caregiver’s personal support network and outcomes related to the caregiver’s support system, time use, perceived productivity, and perceived health and well-being. Caregiver tasks include tasks such as meal preparation, respite care, pet care, and transportation. Time use is the measure of a caregiver’s time spent on caregiving tasks and how much time they had to take off from work to attend planned or unplanned caregiving tasks. Methods We conducted 2 surveys to assess within-participant changes in outcomes for the unpaid, employed, caregivers after 6 weeks of using the mobile app (n=176) between March 30, 2020, and May 11, 2020. The surveys contained questions in three domains: the caregiver’s support system, time use and perceived productivity, and perceived health and well-being. The results of the linear probability models are presented below. Results App use was significantly associated with decreasing the probability of doing most caregiving tasks alone by 9.1% points (SE 0.04; P=.01) and increasing the probability of at least one person helping the primary caregiver by 8.0% points (SE 0.035; P=.02). App use was also associated with improving the time use of the primary caregiver who took significantly less time off work to attend to caregiving duties by 12.5% points (SE 0.04; P=.003) and decreased the probability of spending more than 30 hours weekly on caregiving by 9.1% points (SE 0.04; P=.02). Additional findings on the positive impact of the app included a decrease in the probability of reporting feeling overwhelmed by caregiving tasks by 12.5% points (SE 0.04; P=.003) and a decrease in the probability of reporting negative health effects by 6.8% points (SE 0.04; P=.07) because of caregiving. Although subjects reported that COVID-19 increased their stress attributed to caregiving and prevented them from requesting help for some caregiving tasks, using the app was still associated with improvements in receiving help and lessening of the negative effects of caregiving on the caregivers. Conclusions App use was associated with improvements in 7 of 11 caregiver outcomes across three main categories: their support system, time spent on caregiving, and perceived health and well-being. These findings provide encouraging evidence that the mobile app can significantly reduce caregiver burden by leveraging a caregiver’s support network despite the additional challenges brought by COVID-19 on caregivers.
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Affiliation(s)
- Pelin Ozluk
- HealthCore Inc, Wilmington, DE, United States
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15
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Shaffer KM, Ritterband LM, You W, Buysse DJ, Mattos MK, Camacho F, Glazer JV, Klinger J, Donovan H. Single-Group Trial of an Internet-Delivered Insomnia Intervention Among Higher-Intensity Family Caregivers: Rationale and Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e34792. [PMID: 35019846 PMCID: PMC8792774 DOI: 10.2196/34792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Family caregivers are more likely to experience insomnia relative to noncaregivers but have significant barriers to accessing gold standard cognitive behavioral therapy for insomnia treatment. Delivering interventions to caregivers through the internet may help increase access to care, particularly among higher-intensity caregivers who provide assistance with multiple care tasks over many hours per week. Although there are existing internet interventions that have been thoroughly studied and demonstrated as effective in the general population, the extent to which these interventions may be effective for caregivers without tailoring to address this population’s unique psychosocial needs has not been studied. Objective The goal of this trial is to determine what tailoring may be necessary for which caregivers to ensure they receive optimal benefit from an existing evidence-based, internet-delivered cognitive behavioral therapy for insomnia program named Sleep Healthy Using the Internet (SHUTi). Specifically, we will test the association between caregivers’ engagement with SHUTi and their caregiving context characteristics (ie, caregiving strain, self-efficacy, and guilt) and environment (ie, proximity to care recipient; functional status, cognitive status, and problem behavior of care recipient; and type of care provided). Among caregivers using the program, we will also test the associations between change in known treatment mechanisms (sleep beliefs and sleep locus of control) and caregiving context factors. Methods A total of 100 higher-intensity caregivers with significant insomnia symptoms will be recruited from across the United States to receive access to SHUTi in an open-label trial with mixed methods preassessments and postassessments. At postassessment (9 weeks following preassessment completion), participants will be categorized according to their engagement with the program (nonusers, incomplete users, or complete users). Study analyses will address 3 specific aims: to examine the association between caregivers’ engagement with SHUTi and their caregiving context (aim 1a); to describe caregivers’ barriers to and motivations for SHUTi engagement from open-ended survey responses (aim 1b); and among caregivers using SHUTi, to determine whether cognitive mechanisms of change targeted by SHUTi are associated with differences in caregiving context (aim 2). Results Institutional review board approvals have been received. Data collection is anticipated to begin in December 2021 and is expected to be completed in 2023. Conclusions Findings will inform the next research steps for tailoring and testing SHUTi for optimal impact and reach among caregivers. Beyond implication to the SHUTi program, the findings will be translatable across intervention programs and will hold significant promise to reduce inefficiencies in developing digital health interventions for caregivers while also increasing their impact and reach for this underserved population. Trial Registration ClinicalTrials.gov; NCT04986904; https://clinicaltrials.gov/ct2/show/NCT04986904?term=NCT04986904 International Registered Report Identifier (IRRID) PRR1-10.2196/34792
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Daniel J Buysse
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meghan K Mattos
- School of Nursing, University of Virginia, Charlottesville, VA, United States
| | - Fabian Camacho
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Jillian V Glazer
- Center for Behavioral Health and Technology, University of Virginia, Charlottesville, VA, United States
| | - Julie Klinger
- National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.,National Center on Family Support, University of Pittsburgh, Pittsburgh, PA, United States.,School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
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Pryor TAM, Reynolds KA, Kirby PL, Bernstein MT. An examination of the quality of late-life depression websites on the Internet (Preprint). JMIR Form Res 2022; 6:e36177. [PMID: 36094802 PMCID: PMC9513688 DOI: 10.2196/36177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/12/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background The internet can increase the accessibility of mental health information and improve the mental health literacy of older adults. The quality of mental health information on the internet can be inaccurate or biased, leading to misinformation. Objective This study aims to evaluate the quality, usability, and readability of websites providing information concerning depression in later life. Methods Websites were identified through a Google search and evaluated by assessing quality (DISCERN), usability (Patient Education Materials Assessment Tool), and readability (Simple Measure of Gobbledygook). Results The overall quality of late-life depression websites (N=19) was adequate, and the usability and readability were poor. No significant relationship was found between the quality and readability of the websites. Conclusions The websites can be improved by enhancing information quality, usability, and readability related to late-life depression. The use of high-quality websites may improve mental health literacy and shared treatment decision-making for older adults.
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Affiliation(s)
- Teaghan A M Pryor
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin A Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Paige L Kirby
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
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Wasilewski MB, Kokorelias KM, Nonoyama M, Dale C, McKim DA, Road J, Leasa D, Tandon A, Goldstein R, Rose L. The experience of family caregivers of ventilator-assisted individuals who participated in a pilot web-based peer support program: A qualitative study. Digit Health 2022; 8:20552076221134964. [DOI: 10.1177/20552076221134964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/05/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Family caregivers play an important role supporting the day-to-day needs of ventilator-assisted individuals (VAIs) living at home. Peer-to-peer communication can help support these caregivers and help them sustain caregiving in the community. Online peer-support has been suggested as a way to help meet caregivers’ support needs. Methods A qualitative descriptive approach was used to elicit the perspectives of support received from caregivers who participated in a pilot web-based peer support program from October to December 2018. Data were collected through the transcripts of weekly online peer-to-peer group chats. Data were analyzed using an integration of thematic and framework analysis. Results In total, eight caregivers and five peer mentors participated in the pilot. All five mentors and four of the caregivers participated in the weekly chats. We identified three themes, a) The experience of caregivers is characterized by unique challenges related to the complexity of VAI care including technology; b) Mentors and caregiver participants reciprocally share support; c) Despite hardships, there are things that make caregiving easier and joyful. Discussion Our results add to the growing body of evidence pointing to the importance of online communities for supporting vulnerable caregivers. The reciprocal element of peer support, where trained mentors and untrained participants both benefit from support, can help sustain peer-support interventions. Despite the challenges of providing care to a VAI, there are facilitators that may help ease the caregiving experience and caregivers can benefit from ongoing support that is tailored to their needs along the caregiving trajectory.
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Affiliation(s)
- Marina B. Wasilewski
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kristina M. Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mika Nonoyama
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
| | - Craig Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Douglas A McKim
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy Road
- Division of Respiratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Leasa
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Anu Tandon
- Division of Respiratory, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Roger Goldstein
- Respiratory Medicine, West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment. Palliat Support Care 2021; 18:405-412. [PMID: 31727187 DOI: 10.1017/s1478951519000853] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The present study examined the extent to which social support (SS) availability and satisfaction could predict the extent of caregiver burden (CB) among mothers of children with Acute Lymphocytic Leukemia (ALL). METHOD The study was a cross-sectional, descriptive-correlative study. It was conducted on a sample of 117 mothers whose children were undergoing treatment in a public hospital in Bam, Iran. The Norbeck Social Support Scale and the Caregiver Burden Scale were used to measuring study variables. The data were analyzed using Pearson's correlations, t-tests, ANOVAs, and linear regressions. RESULTS Significant correlations were observed between CB and SS availability (r = -0.499, p < 0.001), SS satisfaction (r = -0.543, p < 0.001), the age of the child with cancer (r = -0.22, p = 0.01), and duration of treatment (r = 0.336, p < 0.001). Married mothers experienced less CB than those that were widowed or divorced. Within the regression equation, SS satisfaction, SS availability, marital status, and duration of treatment were the predictors of CB. SIGNIFICANCE OF RESULTS Based on the results of the current study, mothers who have less SS, especially those who are single mothers, with younger children, and who have taken care of their child for an extended duration should be given special attention. Furthermore, it appears that there are distinct cultural variations amongst Iranian mothers which suggest that culture may impact upon SS availability. Results also suggest a need for interventions that enhance nurses' ability to provide support to caregivers and the broader family unit as a whole. Nurses in cancer care need to have psychological competencies to help family members of cancer patients especially mothers and more so those that are single mothers. As integral members of the patient care experience, nurses may be uniquely positioned to provide this needed psychosocial support.
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Sbaffi L, Hargreaves S. The information trust formation process for informal caregivers of people with dementia: a qualitative study. JOURNAL OF DOCUMENTATION 2021. [DOI: 10.1108/jd-01-2021-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper provides new insights on trust formation during information-seeking processes of informal caregivers of people with dementia and identifies the sources of information deemed as trustworthy by caregivers.
Design/methodology/approach
The study adopts a phenomenological qualitative approach in the form of in-depth, semi-structured interviews with a sample of 20 informal caregivers.
Findings
Caregivers trust sources that are perceived as authoritative and particularly value the information and advice provided by other caregivers. Trust in information can be divided into subjective and objective, but both are important precursors to the actual use of the information. The information available to caregivers is sufficient in quantity but inadequate in terms of ease of use, clarity and usefulness. Often, some key information needs remain unsatisfied due to the lack of timeliness, relevance and personalisation of the information.
Practical implications
This paper provides recommendations for information and healthcare providers on how to improve communication and information relevance for informal caregivers of people with dementia.
Originality/value
This paper contributes to a more comprehensive perspective on caregivers’ information trust formation processes, which takes into account both the characteristics of the information and caregivers’ individual factors.
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Ghahramani F, Wang J. Intention to Adopt mHealth Apps Among Informal Caregivers: Cross-Sectional Study. JMIR Mhealth Uhealth 2021; 9:e24755. [PMID: 33729166 PMCID: PMC8294641 DOI: 10.2196/24755] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/14/2020] [Accepted: 02/12/2021] [Indexed: 12/16/2022] Open
Abstract
Background Caregiving responsibility can change caregivers’ lives; modify their emotions; and make them feel frustrated, fearful, and nervous, thereby imposing physical and mental stress. Caregiving-related mobile apps provide a platform for obtaining valuable and trusted information, connecting more easily with other caregivers, monitoring medications, and managing appointments, and assessing health requirements and conditions of care receivers. Such apps also incorporate valuable resources that address care for the caregivers. Despite the potential benefits of caregiving-related apps, only a limited number of caregivers have adopted and used them.
Objective The aim of this study is to explore the important factors that affect caregivers’ intentions to integrate related mobile apps into their routine caregiving responsibilities.
Methods Using the protection motivation theory, we conducted a cross-sectional study among 249 participants. Purposive sampling was used to target participants who met 4 inclusion criteria: US residents, owning and using a smartphone, informal caregivers (individuals who give care to a friend or family member without payment) who provided at least 8 hours of care per week in the past year, and those currently not using any mobile app for caregiving purposes. We created a survey using Qualtrics and posted it on Amazon’s Mechanical Turk website. Participants received monetary compensation after successful completion of the survey.
Results We found that capabilities and skills of caregivers to use mobile apps, the app’s effectiveness in responding to the needs of caregivers, the degree of control of caregivers over their responsibilities, and the decisions they make for their care receivers can predict their willingness to adopt caregiving-related apps. In addition, the severity of health status and vulnerability of care receivers to unexpected health changes indirectly shape their caregivers’ decisions to adopt and use mobile apps for caregiving purposes.
Conclusions This study explores the important factors that affect informal caregivers’ intentions to adopt related mobile apps into their routine caregiving responsibilities. The results contribute to both mobile health adoption and the caregiving literature, and they offer significant implications for developers, health care practitioners, and policy makers.
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Affiliation(s)
- Fereshteh Ghahramani
- College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Jingguo Wang
- Department of Information Systems and Operations Management, University of Texas at Arlington, Arlington, TX, United States
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21
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Naqvi IA, Montiel TC, Bittar Y, Hunter N, Okpala M, Johnson C, Weiner MG, Savitz S, Sharrief A, Beauchamp JES. Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study. JMIR Form Res 2021; 5:e25123. [PMID: 33683206 PMCID: PMC7985796 DOI: 10.2196/25123] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke.
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Affiliation(s)
- Imama Ali Naqvi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
| | - Tahani Casameni Montiel
- Department of Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yazan Bittar
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, United States
| | - Norma Hunter
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Munachi Okpala
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Constance Johnson
- Department of Nursing Research, Cizik School of Nursing and School of Bioinformatics, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mark G Weiner
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Sean Savitz
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anjail Sharrief
- Department of Neurology, Institute for Stroke and Cerebrovascular Disease, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Elizabeth Sanner Beauchamp
- Department of Nursing Research, Cizik School of Nursing, Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center at Houston, Houston, TX, United States
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22
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Shaffer KM, Chow PI, Glazer JV, Le T, Reilley MJ, Jameson MJ, Ritterband LM. Feasibility of ecological momentary assessment to study depressive symptoms among cancer caregivers. Psychooncology 2021; 30:756-764. [PMID: 33432717 DOI: 10.1002/pon.5627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Ecological momentary assessment (EMA) may help with the development of more targeted interventions for caregivers' depression, yet the use of this method has been limited among cancer caregivers. This study aimed to demonstrate the feasibility of EMA among cancer caregivers and the use of EMA data to understand affective correlates of caregiver depressive symptoms. METHODS Caregivers (N = 25) completed a depressive symptom assessment (Patient Health Questionnaire-8) and then received eight EMA survey prompts per day for 7 days. EMA surveys assessed affect on the orthogonal dimensions of valence and arousal. Participants completed feedback surveys regarding the EMA protocol at the conclusion of the week-long study. RESULTS Of 32 caregivers approached, 25 enrolled and participated (78%), which exceeded the a priori feasibility cutoff of 55%. The prompt completion rate (59%, or 762 of 1,286 issued) did not exceed the a priori cutoff of 65%, although completion was not related to caregivers' age, employment status, physical health quality of life, caregiving stress, or depressive symptoms or the patients' care needs (ps > 0.22). Caregivers' feedback about their study experience was generally positive. Mixed-effects location scale modeling showed caregivers' higher depressive symptoms were related to overall higher reported negative affect and lower positive affect, but not to affective variability. CONCLUSIONS Findings from this feasibility study refute potential concerns that an EMA design is too burdensome for distressed caregivers. Clinically, findings suggest the potential importance of not only strategies to reduce overall levels of negative affect, but also to increase opportunities for positive affect.
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Affiliation(s)
- Kelly M Shaffer
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
- Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - Philip I Chow
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
- Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, USA
| | - Jillian V Glazer
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
| | - Tri Le
- Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Matthew J Reilley
- Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, USA
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Mark J Jameson
- Department of Medicine, Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia, USA
- Department of Otolaryngology, Division of Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Lee M Ritterband
- Department of Psychiatry and Neurobehavioral Sciences, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
- Emily Couric Clinical Cancer Center, University of Virginia, Charlottesville, Virginia, USA
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Hein AE, Vrijens B, Hiligsmann M. A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats. FRONTIERS IN MEDICAL TECHNOLOGY 2020; 2:604183. [PMID: 35047888 PMCID: PMC8757755 DOI: 10.3389/fmedt.2020.604183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 11/22/2022] Open
Abstract
Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective. Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis. Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations. Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.
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Affiliation(s)
- Anna-Elisa Hein
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands.,Faculty of Management, Economics and Social Sciences, University of Cologne, Cologne, Germany
| | - Bernard Vrijens
- AARDEX Group, Research and Development, Liège, Belgium.,Department of Public Health, University of Liège, Liège, Belgium
| | - Mickael Hiligsmann
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
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Nightingale CL, Sterba KR, McLouth LE, Kent EE, Dressler EV, Dest A, Snavely AC, Adonizio CS, Wojtowicz M, Neuman HB, Kazak AE, Carlos RC, Hudson MF, Unger JM, Kamen CS, Weaver KE. Caregiver engagement practices in National Cancer Institute Clinical Oncology Research Program settings: Implications for research to advance the field. Cancer 2020; 127:639-647. [PMID: 33136296 DOI: 10.1002/cncr.33296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Supportive care interventions have demonstrated benefits for both informal and/or family cancer caregivers and their patients, but uptake generally is poor. To the authors' knowledge, little is known regarding the availability of supportive care services in community oncology practices, as well as engagement practices to connect caregivers with these services. METHODS Questions from the National Cancer Institute Community Oncology Research Program (NCORP)'s 2017 Landscape Survey examined caregiver engagement practices (ie, caregiver identification, needs assessment, and supportive care service availability). Logistic regression was used to assess the relationship between the caregiver engagement outcomes and practice group characteristics. RESULTS A total of 204 practice groups responded to each of the primary outcome questions. Only 40.2% of practice groups endorsed having a process with which to systematically identify and document caregivers, although approximately 76% were routinely using assessment tools to identify caregiver needs and approximately 63.7% had supportive care services available to caregivers. Caregiver identification was more common in sites affiliated with a critical access hospital (odds ratio [OR], 2.44; P = .013), and assessments were less common in safety-net practices (OR, 0.41; P = .013). Supportive care services were more commonly available in the Western region of the United States, in practices with inpatient services (OR, 2.96; P = .012), and in practices affiliated with a critical access hospital (OR, 3.31; P = .010). CONCLUSIONS Although many practice groups provide supportive care services, fewer than one-half systematically identify and document informal cancer caregivers. Expanding fundamental engagement practices such as caregiver identification, assessment, and service provision will be critical to support recent calls to improve caregivers' well-being and skills to perform caregiving tasks.
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Affiliation(s)
- Chandylen L Nightingale
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Laurie E McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Alexandra Dest
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anna C Snavely
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christian S Adonizio
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Mark Wojtowicz
- Center for Oncology Research and Innovation, Geisinger Cancer Institute, Danville, Pennsylvania
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Matthew F Hudson
- NCORP of the Carolinas, Prisma Health Cancer Institute, Greenville, South Carolina
| | - Joseph M Unger
- SWOG Cancer Research Network Statistics and Data Management Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Charles S Kamen
- Department of Surgery, University of Rochester, Rochester, New York
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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25
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Shaffer KM, Tigershtrom A, Badr H, Benvengo S, Hernandez M, Ritterband LM. Dyadic Psychosocial eHealth Interventions: Systematic Scoping Review. J Med Internet Res 2020; 22:e15509. [PMID: 32130143 PMCID: PMC7081137 DOI: 10.2196/15509] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 01/03/2023] Open
Abstract
Background Dyadic psychosocial interventions have been found beneficial both for people coping with mental or physical health conditions as well as their family members and friends who provide them with support. Delivering these interventions via electronic health (eHealth) may help increase their scalability. Objective This scoping review aimed to provide the first comprehensive overview of dyadic eHealth interventions for individuals of all ages affected by mental or physical illness and their family members or friends who support them. The goal was to understand how dyadic eHealth interventions have been used and to highlight areas of research needed to advance dyadic eHealth intervention development and dissemination. Methods A comprehensive electronic literature search of PubMed, EMBASE, Cochrane, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO was conducted for articles published in the English language through March 2019. Eligible records described a psychosocial eHealth intervention that intervened with both care recipients and their support person. Results A total of 7113 records were reviewed of which 101 met eligibility criteria. There were 52 unique dyadic eHealth interventions identified, which were tested across 73 different trials. Of the unique interventions, 33 were conducted among dyads of children and their supporting parent, 1 was conducted with an adolescent-young adult care recipient population, and the remaining 18 were conducted among adult dyads. Interventions targeting pediatric dyads most commonly addressed a mental health condition (n=10); interventions targeting adult dyads most commonly addressed cancer (n=9). More than three-fourths of interventions (n=40) required some human support from research staff or clinicians. Most studies (n=64) specified one or more primary outcomes for care recipients, whereas less than one-fourth (n=22) specified primary outcomes for support persons. Where specified, primary outcomes were most commonly self-reported psychosocial or health factors for both care recipients (n=43) and support persons (n=18). Results of the dyadic eHealth intervention tended to be positive for care recipients, but evidence of effects for support persons was limited because of few studies specifying primary outcomes for supporters. Trials of dyadic eHealth interventions were most commonly randomized controlled trials (RCTs; n=44), and RCTs most commonly compared the dyadic eHealth intervention to usual care alone (n=22). Conclusions This first comprehensive review of dyadic eHealth interventions demonstrates that there is substantial, diverse, and growing literature supporting this interventional approach. However, several significant gaps were identified. Few studies were designed to evaluate the unique effects of dyadic interventions relative to individual interventions. There was also limited assessment and reporting of outcomes for support persons, and there were no interventions meeting our eligibility criteria specifically targeting the needs of older adult dyads. Findings highlight areas of research opportunities for developing dyadic eHealth interventions for novel populations and for increasing access to dyadic care.
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Affiliation(s)
- Kelly M Shaffer
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States.,Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Hoda Badr
- Baylor College of Medicine, Houston, TX, United States
| | | | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, New York, NY, United States.,CUNY School of Medicine/City College of New York, New York, NY, United States
| | - Lee M Ritterband
- Center for Behavioral Health and Technology, University of Virginia School of Medicine, Charlottesville, VA, United States
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26
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Chaar D, Shin JY, Mazzoli A, Vue R, Kedroske J, Chappell G, Hanauer DA, Barton D, Hassett AL, Choi SW. A Mobile Health App (Roadmap 2.0) for Patients Undergoing Hematopoietic Stem Cell Transplant: Qualitative Study on Family Caregivers' Perspectives and Design Considerations. JMIR Mhealth Uhealth 2019; 7:e15775. [PMID: 31651402 PMCID: PMC6913725 DOI: 10.2196/15775] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 09/23/2019] [Indexed: 01/26/2023] Open
Abstract
Background Hematopoietic stem cell transplantation (HCT), also referred to as blood and marrow transplantation (BMT), is a high-risk, but potentially curative therapy for a number of cancer and noncancer conditions. BMT Roadmap (Roadmap 1.0) is a mobile health app that was developed as a family caregiver–facing tool to provide informational needs about the health status of patients undergoing inpatient HCT. Objective This study explored the views and perceptions of family caregivers of patients undergoing HCT and their input regarding further technology development and expansion of BMT Roadmap into the outpatient setting (referred to as Roadmap 2.0). Methods Semistructured qualitative interviews were conducted among 24 family caregivers. Questions were developed from existing literature coupled with prior in-depth observations and interviews in hospital-based settings to explore the study objectives. Participants were recruited during routine outpatient clinic appointments of HCT patients, and all interviews were conducted in the participants’ homes, the setting in which Roadmap 2.0 is intended for use. A thematic analysis was performed using a consistent set of codes derived from our prior research. New emerging codes were also included, and the coding structure was refined with iterative cycles of coding and data collection. Results Four major themes emerged through our qualitative analysis: (1) stress related to balancing caregiving duties; (2) learning and adapting to new routines (resilience); (3) balancing one’s own needs with the patient’s needs (insight); and (4) benefits of caregiving. When caregivers were further probed about their views on engagement with positive activity interventions (ie, pleasant activities that promote positive emotions and well-being such as expressing gratitude or engaging in activities that promote positive thoughts, emotions, and behaviors), they preferred a “menu” of positive activities to help support caregiver health and well-being. Conclusions This study involved family caregivers as participants in the development of new components for Roadmap 2.0. Our research provided a further understanding of the many priorities that hematopoietic stem cell transplant family caregivers face while maintaining balance in their lives. Their schedules can often be unpredictable, even more so once the patient is discharged from the hospital. Our findings suggest that expanding Roadmap 2.0 into the outpatient setting may provide critical caregiver support and that HCT caregivers are interested in and willing to engage in positive activities that may enhance well-being and attenuate the stress associated with caregiving. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.4918
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Affiliation(s)
- Dima Chaar
- University of Michigan, School of Public Health, Department of Epidemiology, Ann Arbor, MI, United States
| | - Ji Youn Shin
- Michigan State University, College of Communication Arts and Sciences, Department of Media and Information, East Lansing, MI, United States
| | - Amanda Mazzoli
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Rebecca Vue
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Jacob Kedroske
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - Grant Chappell
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
| | - David A Hanauer
- University of Michigan, Medical School, Michigan Institute for Clinical and Health Research, Ann Arbor, MI, United States
| | - Debra Barton
- University of Michigan, School of Nursing, Ann Arbor, MI, United States
| | - Afton L Hassett
- University of Michigan, Medical School, Department of Anesthesiology, Ann Arbor, MI, United States
| | - Sung Won Choi
- University of Michigan, Medical School, Blood and Marrow Transplantation Program, Ann Arbor, MI, United States
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