Distance Savvy: Testing Tele-Savvy, a Distance Dementia Family Caregiver Education Program

Study Overview
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Brief Summary
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The purpose of this study is to refine and test the web-based delivery of a well-established in-person group program that provides information and education to informal caregivers (family and friends) of persons with Alzheimer's disease (or related illnesses).

Detailed Description
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The pilot project proposed will allow the investigators to use telehealth methods to deliver the Savvy Caregiver, an evidence-based dementia caregiver psychoeducation program, to family caregivers of community-dwelling persons with dementing illnesses (PWD) for whom attending in-person meetings poses difficulties. The program - named Tele-Savvy - uses iPad and PC technology and on-line conferencing capacity to deliver the program through daily asynchronous self-learning modules and weekly, hour-long synchronous group meetings with program facilitators. Tele-Savvy addresses all of the learning objectives of the current in-person Savvy program (Savvy entails in-person participation in six weekly two-hour group sessions).

Official Title
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Distance Savvy: Testing Tele-Savvy, a Distance Dementia Family Caregiver Education Program

Conditions
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Dementia, Alzheimer's Disease, Depression

Intervention / Treatment
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* Behavioral: Tele-Savvy
* Behavioral: Tele-Savvy
* Other: iPad


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: an informal caregiver for a person with a dementing disorder, such as Alzheimer's disease able to speak, read, and understand English has access to a computer with internet connection lives in the US Exclusion Criteria: unwilling to participate in data gathering

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Non-Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Prototype Program<br>The Savvy Caregiver (Savvy) - program delivered on an iPad (a tablet computer with an internet connection) extends over a six week period. Caregivers are asked to view brief daily videos (8-12 minutes) on the iPad. Once each week, a group of caregivers joins in a videoconference (an hour) with one or two trained leaders to review material from the week and to learn new material. | Behavioral: Tele-Savvy<br>* as a program delivered on an iPad with daily instructional video segments (8-12 minutes each)<br>Other: iPad<br>* a tablet computer with an internet connection<br>|
| Experimental: Field Program<br>The Savvy Caregiver (Savvy) - program delivered on an iPad (a tablet computer with an internet connection) extends over a six week period. Caregivers are asked to view brief daily videos (8-12 minutes) on the iPad. Based on the feedback from the prototype program, the videos may vary. Once each week, a group of caregivers joins in a videoconference (an hour) with one or two trained leaders to review material from the week and to learn new material. | Behavioral: Tele-Savvy<br>* as a program delivered on an iPad with daily instructional video segments (8-12 minutes each). Videos may be modified after feedback from Prototype arm.<br>Other: iPad<br>* a tablet computer with an internet connection<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The number of participants who use at least half of the opportunities (half of the conferences and half of the daily lessons) |  | 6 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Zarit Burden Interview Score | A 22-item questionnaire in which subjects rate how often they experience negative feelings associated with caregiving. Each item rated on a 5 point scale anchored at 0 for never and 4 for nearly always. Scores range from 0-88 with higher scores indicating increased burden of care. | Baseline, 6 weeks | 
| Change in Center for Epidemiological Studies-Depression Scale Score | A 20-item scale measuring general depression. Scores range from 0-60, with higher scores indicating greater general depression. | Baseline, 6 weeks | 
| Change in State Trait Anxiety Index (STAI) Score | State Trait Anxiety Index questionnaire consists of 40 questions with 20 items allocated to each of the State Anxiety and Trait Anxiety subscales. The scores for each subtest range from 20 to 80, with higher scores indicating higher levels of anxiety. | Baseline, 6 weeks | 
| Change in Connor Davidson Resilience Scale (CD-RISC) | The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale. A score of 0 is suggestive of no resilience, a score of 100 is suggestive of high level of resilience. | Baseline, 6 weeks | 
| Change in Perceived Stress Scale | The Perceived Stress Scale is a 10-item questionnaire, on a 4-point scale (0 = Never, 4 = Very Often). Scores range from 0-40, with higher scores reflecting greater perceived stress. | Baseline, 6 weeks | 
| Change in Caregiver Self-Efficacy Score | Caregiver self-efficacy was measured by the Revised Checklist for Caregiving Self-Efficacy; the scale consists of 17 items which are rated from 0 - 100% confidence. The total score is summed from these percentages and ranges from 0 - 1700 where higher scores indicate a higher level of confidence. | Baseline, 6 weeks | 
| Change in Personal Mastery scale | Personal Mastery scale is a seven item, five-point Likert scale. Scoring is done by summing item scores for a total score (possible range 7-35) with higher scores indicating higher levels of mastery. | Baseline, 6 weeks | 
| Change in Revised Memory and Behavior Problem Checklist | This scale measures the type/number of dementia patients disturbing behaviors, and how much they bother caregivers with 24 items describing possible troublesome behaviors that the patient might evidence in the past month. Caregivers are first asked whether the dementia patient had displayed any of these in the time period, and secondly to rate on a 5-point scale (0=not at all; 4= extremely) how much this bothered or upset them. A conditional bother score is calculated which is the upset or bother ratings for only the problematic behavior that occurred. The scale refers to the caregiver. Minimum score (best value)=0. Maximum score (worst value)=4. Higher values represent a worse outcome. | Baseline, 6 weeks | 
| Change in Lawton Activities of Daily Living (ADL) / Instrumental Activities of Daily Living (IADL) Scale | Lawton ADL/IADL is caregiver reported performance of personal and instrumental activities of daily living (ADLs). There are 6 personal ADLs (i.e. dressing, grooming, eating, etc) and 8 instrumental ADLs (i.e. managing finances, transportation, food preparation) which are assessed. Each item is awarded 2 points for fully independent, 1 point for minimal or moderate support required, and 0 points for full support. Maximum score for independence with all personal and instrumental ADL's is 28. | Baseline, 6 weeks |