Tailored Health Self-Management Interventions for Highly Distressed Family Caregivers

为高度痛苦的家庭护理人员量身定制健康自我管理干预措施

• 批准号: 9234352
• 负责人: JACLENE A ZAUSZNIEWSKI
• 金额: $ 53.66万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-27 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9234352
• 关键词: Accounting; Address; Adult; Adverse effects; Affect; Affective; American; Asthma; Biofeedback; Bipolar Disorder; Caregivers; Caring; Chronic; Chronic stress; Control Groups; Dementia; Diabetes Mellitus; Diagnosis; Distress; Dose; Education; Educational Intervention; Effectiveness; Family; Family Caregiver; Family member; Family psychotherapy; General Population; Health; Healthcare; Hospitalization; Hypertension; Individual; Individual Differences; Intervention; Knowledge; Lead; Longevity; Malignant Neoplasms; Measures; Mental Depression; Mental Health; Modeling; Moods; Multivariate Analysis; Neurologic; Persons; Population; Precision Medicine Initiative; Primary Health Care; Process; Psyche structure; Randomized; Randomized Controlled Trials; Reaction; Relapse; Research; Risk; Role; Self Care; Self Management; Services; Severities; Stress; Symptoms; Testing; Time; Training; United States; base; behavioral health; care recipients; caregiver interventions; caregiving; clinically significant; contextual factors; cost; design; disability-adjusted life years; disorder prevention; early onset; empowered; experience; help-seeking behavior; informal caregiver; innovation; novel; physical conditioning; preference; response; self help; skills; skills training; stress management; theories; treatment as usual

Tailored Health Self-Management Interventions for Highly Distressed Family Caregivers In the United States, family members serve as unpaid informal caregivers for more than 10 million adults with bipolar disorder. These family caregivers are highly distressed as they experience the fluctuating moods, intensity, and unpredictability associated with bipolar disorder. Bipolar symptom exacerbation, relapse, inability to manage daily activities, and need for ongoing treatment for the person with bipolar disorder, put family caregivers at great risk for compromised mental and physical health. These caregivers have been found to experience greater distress than caregivers of persons with diabetes, hypertension, asthma or dementia and have significantly more mental and physical health problems than the general population, leading to greater use of mental health and primary care services. When their health declines, symptom exacerbation, affective episodes, and re-hospitalization of the diagnosed family member increase. Existing family therapy and education interventions for these caregivers have had little effect on their own health. Health self-management interventions, particularly those tailored to address caregivers' needs and preferences for education, stress management, or resourcefulness skills, have not been examined in this population. This randomized controlled trial will evaluate how varying levels of participation by family caregivers in selecting self-management interventions (ranging from no input into the selection to selection based on caregiver need or preference) affect their health risks and physical and mental health over time. Caregivers will be randomized to: 1) a control group (no intervention); 2) education (usual care); 3) self-management intervention based on need (SM-need); or 4) self-management intervention of their preference (SM-preference). The study aims to: 1) examine differences across the four groups on caregiver health over time; 2) explore relationships between caregiver needs and preferences and relevant contextual factors (care recipient symptoms, caregiver reactions, and caregiving involvement); and 3) build caregiver profiles that are associated with their needs and preferences for intervention. Caregivers in the SM-need and SM-preference groups will receive one of three interventions tailored to match their need or preference: 1) education; 2) biofeedback; or 3) resourcefulness training. Family caregivers will be assessed at baseline (T1), 6 months (T2) and one year (T3). Repeated measures multivariate analyses will address the study aims. The findings from this study will generate new scientific knowledge about the effectiveness of novel, easy to use, independently performed interventions that can be self-tailored to promote caregiver health through education, biofeedback, or resourcefulness. Once established, these health self-management interventions can be tailored to match the needs and preferences of other comparably distressed family caregivers of persons with other chronic mental or physical conditions.

为高度痛苦的家庭照顾者量身定制健康自我管理干预措施 在美国，家庭成员为超过 1000 万患有此病的成年人提供无偿的非正式护理人员 躁郁症。这些家庭照顾者因情绪波动而感到非常痛苦， 与双相情感障碍相关的强度和不可预测性。双相情感障碍症状加重、复发、无力 为了管理双相情感障碍患者的日常活动以及需要持续治疗，请让家人 护理人员面临着身心健康受损的巨大风险。这些护理人员被发现 比糖尿病、高血压、哮喘或痴呆症患者的护理人员经历更大的痛苦，并且 比一般人群有更多的精神和身体健康问题，导致更多 使用心理健康和初级保健服务。当他们的健康状况恶化、症状恶化、情感 发病率和确诊家庭成员的再住院率增加。现有的家庭治疗和 对这些照顾者的教育干预对他们自身的健康影响甚微。健康自我管理 干预措施，特别是那些专门针对照顾者的教育需求和偏好、压力 管理或足智多谋的技能尚未在这一人群中得到检验。这个随机对照 试验将评估家庭照顾者在选择自我管理时的不同参与程度 干预措施（从不参与选择到根据护理人员的需要或偏好进行选择） 随着时间的推移，会影响他们的健康风险以及身心健康。护理人员将被随机分配到：1) 对照组 小组（无干预）； 2）教育（日常护理）； 3）基于需要的自我管理干预（SM-need）； 或4）他们偏好的自我管理干预（SM-偏好）。该研究的目的是：1）检查 随着时间的推移，四组护理人员健康状况存在差异； 2）探索照顾者之间的关系 需求和偏好以及相关背景因素（护理接受者症状、护理者反应和 护理参与）； 3) 建立与其需求和偏好相关的护理人员档案 进行干预。 SM 需求组和 SM 偏好组的护理人员将接受三种干预措施之一 根据他们的需要或偏好量身定制：1）教育； 2）生物反馈；或3）机智训练。家庭 护理人员将在基线 (T1)、6 个月 (T2) 和一年 (T3) 时接受评估。重复措施 多变量分析将解决研究目标。这项研究的结果将产生新的科学 关于新颖、易于使用、独立执行的干预措施的有效性的知识，这些干预措施可以 自我定制，通过教育、生物反馈或机智来促进护理人员的健康。一次 建立后，这些健康自我管理干预措施可以根据需要和偏好进行定制 患有其他慢性精神或身体疾病的人的其他相对困难的家庭照顾者。