Developing a Culturally-sensitive Volunteering Program to Reduce Stress of Dementia Caregivers in Chinese American Communities
Phase: NA
Conditions: Caregiver Burnout
Sponsor: Columbia University

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Study Protocol and Statistical Analysis Plan 
 
 
 
Research Title: Developing a Culturally-sensitive Volunteering Intervention to Reduce 
Stress among Dementia Caregivers in Chinese American Communities 
 
NCT: 04346745 
 
Date: April 29th, 2019 
 

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Procedure and setting 
 
Following the approach of community-based participatory research, we worked with a 
community agency, [blind for review], the largest organization serving dementia caregivers in 
New York City (NYC). Before designing the intervention, we conducted in-depth interviews 
with 30 caregivers and a survey with 168 caregivers to understand caregivers’ needs, 
challenges, strengths and resources [Blind for review]. We also studied the utilization, 
effectiveness and limitations of existing services for these caregivers from a focus group with 
social work professionals [Blind for review]. Based on the empirical evidence, we concluded 
that a peer mentoring intervention may help reduce Chinese American caregiver reduce 
stress. We established a community advisory committee, including one social work 
professional, one administrator and three caregivers, and gathered their insights on the 
development of the intervention. We sent the first and second drafts of the intervention 
manual to committee members, collected their feedback from committee meetings, and 
revised the manual based on their feedback. After a pilot test, we presented the results in 
community events to dementia caregivers, professionals and administrators for their 
comments to improve the intervention for a larger-scale test. 
We developed the intervention and conducted the pilot test in NYC, the metropolitan area 
with the largest Chinese American population in the United States. Based on 2017 census 
estimates, 893,697 Chinese live in NYC, and most Chinese older adults live in ethnic 
enclaves such as Chinatown (U.S. Census Bureau, 2017). In the past three decades, bilingual 
professionals in [blind for review] had provided various services, such as group training, 

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public lectures, mental health counseling, to support local Chinese older adults and their 
family caregivers. However, many Chinese caregivers in NYC have challenges accessing 
individually tailored support due to the shortage of bilingual and bicultural professionals. 
Intervention 
The PMP was a 3-month intervention that provides one-on-one mentoring support via 
phone calls to reduce the stress of Chinese dementia caregivers. Guided by the conceptual 
framework shown in Figure 1, the peer mentoring support covered the themes of cultural 
beliefs about dementia, culturally effective coping strategies, and culturally appropriate social 
support. The program recruited and trained Chinese American experienced caregivers to be 
volunteering mentors for dementia caregivers in the same ethnic community. Prior to 
mentoring caregivers, the mentors received training on knowledge about dementia, 
caregiving skills, social support, and problem-solving strategies. A social worker led the 
training workshop via lectures, discussions, and role-play practice, in which mentors could 
learn how to deliver knowledge and skills in a culturally competent way to their mentees. 
Due to the COVID-19 pandemic, the mentor training workshop was delivered in five 
synchronous online sessions and each session lasted for 4 hours with two 10-minute breaks. 
With technology support provided by the research assistants, mentors did not have any 
technology issues and appreciated the convenience of having the training via the internet. 
Each mentor was paired with one to three caregivers based on their language 
preference and similar caregiving experiences (e.g., relationship with care recipient). During 
the 3-month intervention, each pair of mentor–mentee was expected to have one weekly 
phone call, which lasted for 30 to 60 minutes. After each call, the mentor was required to 

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document major issues and strategies covered in the call by filling the mentoring record form. 
A social worker supervised mentor’s work by reviewing mentoring records and facilitated bi- 
weekly meetings with mentors to address questions or issues related to the intervention. 
Sample 
 
We recruited caregivers and mentors through referrals by [blind for review] and 
distributing flyers in community events as well as the agency’s monthly letters to clients, 
senior centers, hospitals, geriatric clinics, and community agencies serving Chinese older 
adults in NYC. Trained research assistants conducted screening interviews with caregivers 
and mentors who expressed interest to the study. The eligibilities for being a participating 
caregiver were: (a) self-identify as Chinese; (b) 21 years old or older; (c) providing care to a 
family member with dementia for 10 hours or more a week; (d) interested in receiving 
supportive interventions; (e) having moderate to severe caregiver burden; and (f) able to 
access a telephone and communicate via phone call. The eligibility of being considered as a 
mentor were: (a) 50 years old or older; (b) self-identify as Chinese; (c) able to speak 
Mandarin or Cantonese Chinese; (d) having experience of providing care to a family member 
with dementia; (e) able to access a telephone and communicate via phone call; (f) able to 
attend mentor training via zoom; and (g) committed to volunteering with minimal financial 
compensation. Caregivers and volunteer mentors were excluded if they had cognitive 
impairment. We aimed to develop the intervention as a senior volunteer program, so mentors 
were limited to those aged 50 or older. We recruited 45 caregivers and 10 volunteers who 
expressed interests and participated in the screening interviews. Our final sample for this pilot 
study included 38 Chinese caregivers and 8 mentors who met the above criteria. The enrolled 

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caregivers were randomly assigned to the intervention group (n=19) and the control group 
(n=19). The intervention group received 3-month mentoring support and the control group 
received a package of educational materials on knowledge of dementia, caregiving skills, 
self-care and community resources. A caregiver participant received a $30 gift card after each 
assessment at baseline (T1), 3-month follow up (T2), 6-month follow up (T3). A volunteer 
mentor received a $100 gift card after completing the training and another $100 gift card after 
the 3-month mentoring service and assessments at T1 and T2. 
Analysis 
 
For the feasibility test, we calculated relevant percentages and means across the 
intervention study measurements. We also transcribed and coded the qualitative data from the 
open-ended questions to identify strengths and weakness of the intervention design and 
implementation. For the efficacy test, we conducted t-test to compare outcome variables 
across T1 to T3, and changes between time points (T2-T1, T3-T2, T3-T1) between the two 
groups. We also conducted difference in difference (DID) analysis using the mixed command 
in Stata. In multilevel (observations nested in caregivers) linear regression models, we first 
entered group, time and the interaction term of group and time and then entered covariates, 
such as sociodemographic, health, acculturation and caregiving variables, one by one due to 
the small sample size. None of the covariates changed the main findings, so we did not report 
those parameters in this paper. We missed three caregivers’ data at T2 and T3. Two 
caregivers (one in the intervention group and the other in the control group) lost their care 
recipients during the intervention time and most measures (e.g., caregiving burden, 
caregiving competency) were not applicable to them. One caregiver in the control group 

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dropped off the study due to tight personal schedule. Given the purpose and sample size of 
this pilot study, we did not perform imputations or replications for missing data.