Boots Lizzy Mm, de Vugt Marjolein E, Smeets Claudia Mj, Kempen Gertrudis Ijm, Verhey Frans Rj
Department of Psychiatry and Neuropsychology, Alzheimer Center Limburg, School for Mental Health and Neurosciences, Maastricht University Medical Center+, Maastricht, Netherlands.
Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands.
J Med Internet Res. 2017 Dec 19;19(12):e423. doi: 10.2196/jmir.7666.
Caring for a family member with dementia puts caregivers at risk of overburdening. Electronic health (eHealth) support for caregivers offers an opportunity for accessible tailored interventions. The blended care self-management program "Partner in Balance" (PiB) for early-stage dementia caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored Web-based modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability and interpretation of results.
The aim of this study was to describe the process evaluation from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to determine internal and external validity before the effect analysis and aid future implementation.
Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from logistical research data, coach questionnaires (n=13), and interviews with coaches (n=10) and participants (n=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis.
The participation rate of eligible caregivers was 51.9% (80/154). Recruitment barriers were lack of computer and lack of need for support. Young age and employment were considered recruitment facilitators. All coaches attended training and supervision in blended care self-management. Deviations from the structured protocol were reported on intervention time, structure, and feedback. Coaches described an intensified relationship with the caregiver post intervention. Caregivers appreciated the tailored content and positive feedback. The blended structure increased their openness. The discussion forum was appreciated less. Overall, personal goals were attained after the program (T>50). Implementation barriers included lack of financing, time, and deviating target population.
Participants and coaches were satisfied with the intervention, but adapting the content to specific subgroups, for example, younger caregivers, was recommended. Implementation of the program requires more awareness of the benefits of blended care self-management programs and training in tailored self-management skills.
Dutch Trial Register (NTR): NTR4748; http://www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg).
照顾患有痴呆症的家庭成员会使照顾者面临负担过重的风险。为照顾者提供的电子健康（eHealth）支持为提供可及的个性化干预措施提供了契机。针对早期痴呆症照顾者的混合式护理自我管理项目“平衡伙伴”（PiB）在荷兰的痴呆症护理机构中实施。该项目将面对面指导与个性化的网络模块相结合。除了评估项目效果外，对抽样和干预质量进行评估对于结果的普遍性和解读至关重要。
本研究的目的是从家庭照顾者（参与者）和提供干预措施的专业人员（指导者）的角度描述过程评估，以便在效果分析之前确定内部和外部效度，并为未来的实施提供帮助。
利用后勤研究数据、指导者问卷（n = 13）以及对指导者（n = 10）和参与者（n = 49）的访谈中的定量和定性数据，对实施情况、抽样和干预质量进行评估。采用目标达成量表来衡量治疗引起的变化。分析采用描述性统计和演绎性内容分析。
符合条件的照顾者的参与率为51.9%（80/154）。招募障碍包括缺乏电脑和不需要支持。年轻和就业被认为是招募促进因素。所有指导者都参加了混合式护理自我管理方面的培训和督导。报告了在干预时间、结构和反馈方面与结构化方案的偏差。指导者描述了干预后与照顾者关系的强化。照顾者赞赏个性化的内容和积极的反馈。混合式结构增加了他们的开放性。对讨论论坛的评价较低。总体而言，项目结束后个人目标得以实现（T>50）。实施障碍包括缺乏资金、时间以及目标人群偏差。
参与者和指导者对干预措施感到满意，但建议针对特定亚组，如年轻照顾者，调整内容。该项目的实施需要更多地认识混合式护理自我管理项目的益处，并开展个性化自我管理技能方面的培训。
荷兰试验注册库（NTR）：NTR4748；http://www.trialregister.nl（由WebCite存档于http://www.webcitation.org/6vSb2t9Mg）。
