CONFIDENCE Financial Education for Caregivers

Study Overview
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Brief Summary
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The purpose of this study is to determine how feasible it is to deliver an online course to reduce out-of-pocket costs of caregiving and reduce financial stress among Latino family caregivers to a family member living with dementia. The investigators hope that that the results of this study will help to reduce high these out-of-pocket costs and improve financial wellbeing for Latino family caregivers. Caregivers will be asked to to participate in 3 online surveys, in addition to participating in 5, 1.5 hour group-based Zoom learning sessions.

Official Title
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Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving

Conditions
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Caregiver Burden, Financial Stress, Dementia, Alzheimer Disease

Intervention / Treatment
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* Behavioral: Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Caregiver to someone diagnosed by a physician with probably Alzheimer's disease or a related dementia at least 6 months ago Latino or Hispanic ethnicity At least 50 years of age of older Able to attend 5, 1.5 hour to 2 hour group-based lessons over 5 weeks No plans to place family member in a facility within the next 3 months Exclusion Criteria: Unreliable access to email, a computer and internet access Does note speak and read English Previously participated in CONFIDENCE program

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: CONFIDENCE Education Intervention<br>Participants will attend the 5-week CONFIDENCEProgram. This program will include attending 5 group-based sessions delivered by videoconference. Each session will last approximately 1.5 hours each and will cover topics such as how to budget, accessing community resources to displace the out-of-pocket costs of caregiving, asking for help, balancing employment and caregiving, and more. | Behavioral: Confidently Navigating Financial Decisions and Enhancing Financial Wellbeing in Dementia Caregiving<br>* Multicomponent psychoeducational intervention focused on financial wellbeing<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Monthly out-of-pocket caregiving costs | Monthly out-of-pocket costs of caregiving is based on the tool used by the AARP Public Policy Institute in their 2016 report on the out-of-pocket costs of caregiving (Rainville et al., 2016). This measure combines caregiver recall of care costs in the previous month, collected at baseline, with 5 days of daily spending diaries. Daily surveys will be sent using an email with a survey link, and a text message reminder. Monthly costs include less-frequent, high-cost expenditures (e.g., mortgage payment), while daily costs include lower-cost items caregivers may pay for more frequently (e.g., groceries). Daily self-reports of spending will be averaged and multiplied by 6 to approximate the number of days in a month, and added to estimated monthly costs. | Change from baseline to 8 weeks post-intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Psychological financial strain | The measure for psychological financial strain is from multiple scales. Items 1 to 11 ask about financial anxiety and is based on the 10-item scale from Shapiro & Burchell (2012). The investigators added an item based on another related to caregiving (i.e., I find planning for my caregiving expenses to be unpleasant). Items 12 to 14 are based on those used by Novilitis et al., (2003), and address additional components of financial anxiety than those items introduced by Shapiro (e.g., arguments with others; alpha=0.74). Lastly, the investigators included the 1-item question from Shim et al. (2010) that asks about financial worry (I worry constantly about money; CFA factor loading was 0.79 for this item). Participants are asked to indicate the extent to which each statement is true (Very true [3], Somewhat true[2], Somewhat untrue[1], and Complete untrue[0]). Scores are summed such that scores range from 0 to 45, where higher scores indicate higher levels of financial strain. | Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention | 
| Caregiver self-efficacy | Self-efficacy is measured using the Caregiver Self-Efficacy Scale (Ritter et al., In Press). This 8-item scale asks about multiples domains of self-efficacy (e.g., managing behavioral symptoms, accessing respite, and controlling upsetting thoughts). It demonstrates high reliability (alpha=0.89) and good test-retest reliability (0.73). Participants rate the extent to which they are Not confident at all (1) to Totally confident (10). Scores range from 8 (lowest level of self-efficacy) to 80 (highest level of self-efficacy). The outcome measure will use the average change score from baseline scores. | Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention | 
| Caregiver resourcefulness | Resourcefulness is measured using the 28-item Caregiver Resourcefulness Scale (alpha=0.85; Zauszniewski, 2006). This scale has two factors: one focused on help-seeking and another on self-help. Caregivers are asked the frequency at which they use different strategies to manage challenges, and may respond: Not at all like me (0), Pretty much not like me (1), A little bit not like me (2), A little bit like me (3), Pretty much like much like me (4), or Very much like me (5). Items are added together to create a total score. Scores range from 0 to 140, where higher scores indicate higher levels of resourcefulness. The outcome measure will use the average change score from baseline scores | Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Out-of-pocket costs, Behavioral intervention, Hispanic, Latino, Self-Efficacy