Development of a Behavioral Activation Mobile Application for Dementia Patients’ Family Caregivers with Depression (Preprint)
Authors: Liu lin , Song jie , Wang junna , Liu chunyan , Liu xiaohan 
Published: October 2023

BACKGROUND

Dementia is a progressive, neurological condition that may affect an individual’s memory, language, perception, executive functioning, and functional abilities 1. It is estimated that 75 million global citizens will be living with dementia in 2030 2 and this number will continue increasing 3. Unfortunately, effective treatment for dementia has not been found so far. Therefore, the majority of elderly people with dementia are looked after by family members4. These family caregivers usually handle time-consuming and labor-intensive care duties, resulting in less leisure time. In addition, they may be ashamed and embarrassed of their family members’ dementia. This distancing them from friends and family members and leaving them with little time for enjoyable activities5. There is strong evidence that the level of engagement in pleasant activities is associated with depression among dementia patients’ family caregivers 6.7. It is reported that approximately 30% to 40% of family caregivers who take care of dementia patients claimed having depression8. Moreover, a meta-analysis suggested that family caregivers of dementia patients experienced higher levels of stress than non-dementia family caregivers did, suffered from more severe depressive symptoms and physical health problems9.

OBJECTIVE

Therefore, the development and application of a self-help app based on BA theory is urgently needed for family caregivers to implement BA and self-management at home. Within this context, the present study aimed to develop a mobile app based on the BA theory for family caregivers of dementia patients, to reduce their negative mood and improve their life quality. The project will be conducted in three phases:1) the preparation phase;2) the design phase; and 3) the evaluation phase.

METHODS

During the BATD therapy session, the participant is provided with a week’s worth of daily monitoring forms to complete and is instructed to complete one monitoring form per day 13. This reliance on paper forms may make it difficult for family caregivers to complete exercises and may similarly make it difficult for some therapists to draw associations between the completed activities and the mood of participant 13. A recent meta-analysis found that participants who utilized mobile app as either a supplement to treatment or as a substitute for direct therapist contact experienced superior psychotherapy outcomes as compared with participants who did not obtain mobile technology 14. Two reasons may explain this result. One is that therapists have access to real-time data on participants' adherence and function over the network, resulting in treatment efficiency improved and the care burden of participants reduced by eliminating the use of paper monitoring forms13. Another is that the mobile app allows participants to have access to treatment materials at all times. Therefore, as a superior treatment delivery platform, it is crucially important to develop a BA application for family caregivers of dementia people to decrease their depression.

RESULTS

The final sample consisted of 10 family caregivers (4 men, 6 women; mean age, 51.8 years, SD = 7.4 years). The intervention steps were as follows Before the study, the aims of BA and the treatment rationale were introduced and explained to the family caregivers by researchers. ②At Week 1, caregivers recorded their daily activities in detail in the "activity" sub-module, and rated the pleasure and importance of the activities, so that caregivers had a detailed understanding of their own activity level. ③ At Week 2, caregivers were encouraged to determine values on the "values" and "activity" sub-module, and complete the activities corresponding to the values, or caregivers could arrange activities that make them pleasurable. If the goal was difficult for caregivers, they were instructed to decompose the goal and monitor mood changes daily. ④At Week 3, the last week's activities were reviewed by researchers. If all the goals were completed, caregivers were directed to increase the difficulty of the next week's activities; If the targets were unaccomplished, the researcher could help caregivers analyze the reasons. If the activity is reasonably arranged and not completed due to some external factors, the targets will be continued in the next week. If the activity doesn't fit, the researcher will direct caregivers to adjust their activities. ⑤At last week, the methods of other interventions were as same as in the third week. After 4 weeks, compared with baseline data, the mean score for PHQ-9 ranged 9.80±5.49 to 5.00±3.34, SAS ranged 49.50±16.74	to 44.00±7.56, STAXI-2 ranged 122.60±6.18to 119.60±5.12, ZBI ranged44.60±8.96 to43.00±8.37, PSQI ranged 9.20±1.94 to 6.40±1.50. Results indicated that BA app not only had an effect on reducing depression but also had the potential to improve other areas of psychological, the burden, and sleep quality among family caregivers.

CONCLUSIONS

The present study developed a mobile app based on BA for family caregivers with depression, reducing their negative mood and improving their life quality. To address the issue of learnability before using the mobile app, the therapist could assist the caregivers by providing guidance and technical support for the mobile app installation. In the website background management system, the therapist can also monitor the completion of caregiver activities and focus on the caregiver’s problems anytime, anywhere. At the same time, the results of the pre-experiment showed that the app could effectively alleviate depressive symptoms and improve other forms of psychological distress of caregivers. In the future, the effect of this app will be verified in our further studies.

CLINICALTRIAL

Registered with the China Clinical Trial Registration Center