Department of Nursing, Universitat Rovira i Virgili, Tarragona, Spain.
Department of Nursing, Universitat Rovira i Virgili, Tortosa, Spain.
JMIR Mhealth Uhealth. 2021 Jan 22;9(1):e21708. doi: 10.2196/21708.
While nonprofessional caregivers often experience a sense of fulfillment when they provide care, there is also a significant risk of emotional and physical burnout. Consequently, this can negatively affect both the caregiver and the person being cared for. Intervention programs can help empower nonprofessional caregivers of people with chronic diseases and develop solutions to decrease the physical and psychological consequences resulting from caregiving. However, most clinically tested intervention programs for nonprofessional caregivers require face-to-face training, and many caregivers encounter obstacles that hinder their participation in such programs. Consequently, it is necessary to design internet-based intervention programs for nonprofessional caregivers that address their needs and test the efficacy of the programs.
The aim of this study was to evaluate the effectiveness of a smartphone app-based intervention program to increase positive mental health for nonprofessional caregivers.
This study was a randomized controlled trial of 3 months' duration. A total of 152 caregivers over 18 years of age with a minimum of 4 months' experience as nonprofessional caregivers were recruited from primary health care institutions. Nonprofessional caregivers were randomized into two groups. In the intervention group, each caregiver installed a smartphone app and used it for 28 days. This app offered them daily activities that were based on 10 recommendations to promote positive mental health. The level of positive mental health, measured using the Positive Mental Health Questionnaire (PMHQ), and caregiver burden, measured using the 7-item short-form version of the Zarit Caregiver Burden Interview (ZBI-7), were the primary outcomes. Users' satisfaction was also measured.
In all, 113 caregivers completed the study. After the first month of the intervention, only one factor of the PMHQ, F1-Personal satisfaction, showed a significant difference between the groups, but it was not clinically relevant (0.96; P=.03). However, the intervention group obtained a higher mean change for the overall PMHQ score (mean change between groups: 1.40; P=.24). The results after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; P<.001; d=0.82). Significant changes were reported in 5 of the 6 factors, especially F5-Problem solving and self-actualization (5.69; P<.001; d=0.71), F2-Prosocial attitude (2.47; P<.001; d=1.18), and F3-Self-control (0.76; P=.03; d=0.50). The results of the ZBI-7 showed a decrease in caregiver burden in the intervention group, although the results were inconclusive. Approximately 93.9% (46/49) of the app users indicated that they would recommend the app to other caregivers and 56.3% (27/49) agreed that an extension of the program's duration would be beneficial.
The app-based intervention program analyzed in this study was effective in promoting positive mental health and decreasing the burden of caregivers and achieved a high range of user satisfaction. This study provides evidence that mobile phone app-based intervention programs may be useful tools for increasing nonprofessional caregivers' well-being. The assessment of the effectiveness of intervention programs through clinical trials should be a focus to promote internet-based programs in health policies.
ISRCTN Registry ISRCTN14818443; http://www.isrctn.com/ISRCTN14818443.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-019-7264-5.
虽然非专业护理人员在提供护理时常常感到满足，但他们也面临着情绪和身体疲惫的巨大风险。因此，这会对护理人员和被护理人员都产生负面影响。干预计划可以帮助授权慢性病患者的非专业护理人员，并制定解决方案，以减少护理带来的身体和心理后果。然而，大多数经过临床测试的非专业护理人员干预计划都需要面对面培训，而且许多护理人员遇到了阻碍他们参与此类计划的障碍。因此，有必要为非专业护理人员设计基于互联网的干预计划，以满足他们的需求并测试计划的效果。
本研究旨在评估基于智能手机应用程序的干预计划对增加非专业护理人员积极心理健康的效果。
这是一项为期 3 个月的随机对照试验。总共招募了 152 名年龄在 18 岁以上且至少有 4 个月非专业护理经验的护理人员，他们来自初级保健机构。非专业护理人员被随机分为两组。在干预组中，每位护理人员安装了一个智能手机应用程序并使用了 28 天。该应用程序为他们提供了基于 10 项促进积极心理健康建议的日常活动。主要结果是积极心理健康水平，使用积极心理健康问卷（PMHQ）进行测量，以及护理人员负担，使用 7 项简短版的 Zarit 护理人员负担访谈量表（ZBI-7）进行测量。还测量了用户的满意度。
共有 113 名护理人员完成了研究。在干预的第一个月后，只有 PMHQ 的一个因子 F1-个人满意度在组间显示出显著差异，但没有临床意义（0.96；P=.03）。然而，干预组在总体 PMHQ 评分方面获得了更高的平均变化（组间平均变化：1.40；P=.24）。在干预的第三个月后，PMHQ 评分的增量显示出了结果。PMHQ 评分变化的平均差异在组间显示出显著差异（11.43；P<.001；d=0.82）。在 6 个因子中，有 5 个因子的变化报告显著，特别是 F5-解决问题和自我实现（5.69；P<.001；d=0.71）、F2-亲社会态度（2.47；P<.001；d=1.18）和 F3-自我控制（0.76；P=.03；d=0.50）。ZBI-7 的结果显示，干预组的护理人员负担有所减轻，尽管结果不确定。大约 93.9%（46/49）的应用程序用户表示他们会向其他护理人员推荐该应用程序，而 56.3%（27/49）同意延长该计划的持续时间会有所帮助。
本研究分析的基于应用程序的干预计划在促进非专业护理人员的积极心理健康和减轻护理人员负担方面是有效的，并且获得了很高的用户满意度。本研究提供了证据，表明基于移动电话应用程序的干预计划可能是增加非专业护理人员福祉的有用工具。通过临床试验评估干预计划的有效性应成为推动健康政策中基于互联网计划的重点。
ISRCTN Registry ISRCTN14818443；http://www.isrctn.com/ISRCTN14818443。
国际注册报告标识符（IRRID）：RR2-10.1186/s12889-019-7264-5。
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