Asynchronous web-based modules with tailoring and videos
Caregivers only Caregivers of family members with dementia who maintained outside employment
(i) CES-D (ii) State-Trait Anxiety Inventory (iii) Caregiver Strain Scale (iv) Positive Aspects of Caregiving
Length: 4 weeks. Intervention: () access to asynchronous web-based modules and videos (caregiver’s friend: dealing with dementia) and educational materials tailored to care recipient and care giver characteristics. The coping strategies presented throughout focused on problem-focused techniques and social support skills. Wait list control: () usual treatment, then given access to the intervention.
Those in the intervention group reported significant improvements in depression, anxiety, level and frequency of stress, caregiver strain, self-efficacy, intention to seek help, and positive aspects of caregiving.
Asynchronous web-based educational modules with email
Caregivers only Family caregivers of persons with dementia
(i) CESD (ii) HADS (iii) Informal Care Scale (self-perceived pressure subscale) (iv) RMBPC (v) Short Sense of Competence Questionnaire (vi) Pearlin Mastery Scale
Length: self-paced; 5-6 months from baseline with midpoint assessment at 3 months. Intervention: () eight self-paced interactive web-based modules (Mastery over Dementia) which included problem-solving, relaxation, arranging help from others, cognitive restructuring, and assertiveness training, plus a booster summary session were delivered. After each session, participants completed and submitted homework to a coach who returned electronic feedback. Comparison: () E-bulletins (digital newsletters) with practical information on providing care for someone with dementia were sent by email every 3 weeks over nearly 6 months. There was no contact with a coach.
Depression and anxiety improved significantly in the intervention group. Noteworthy, even older caregivers (>65 years) can benefit from a web-based intervention to reduce psychological symptoms.
Asynchronous web-based educational materials, interactive electronic patient reported outcomes, medical online platform which generated emails to clinicians in certain situations
Caregiver-care recipient dyads Family caregivers of persons with advanced stage lung, breast, and prostate cancer in outpatient clinics
(i) Family Care Inventory (caregiver preparedness subscale) (ii) Caregiver Burden Inventory (caregiver physical burden subscale) (iii) Shortened Version of the Profile of Mood States (negative mood items)
Length: 52 weeks, with 6- and 12-month follow-up. Intervention: ( dyads) asynchronous access to an interactive medical online platform with a wide variety of practical, cancer-specific educational and self-help coaching resources. Also given rating scales to report physical and psychological symptoms of caregiver and patient. Clinical reports of those symptoms were generated and made available to their medical providers, including an email alert when reported symptom intensity crossed a threshold. Comparison: ( dyads) access to the interactive website, but this did not generate a clinical report to their clinical team.
Caregiver burden and subjective preparedness did not differ between groups at 6- and 12-month postintervention, but caregiver reports of negative mood were lower for those in the intervention group.
Web-based training modules plus online peer and expert communities for support and information exchange
Caregivers only Informal caregivers of persons with dementia; volunteers in dementia care; professional caregivers
(i) Alzheimer’s Disease Knowledge Scale (ii) Alzheimer’s Disease Survey (iii) Approaches to Dementia Questionnaire (iv) Interpersonal Reactivity Index (v) 3 Researcher-Developed Items (vi) Short Sense of Competence Questionnaire
Length: 2 to 4 months. Intervention: () participants were given access to web-based interactive training modules plus online peer support and expert communities for information exchange. Wait list control: () participants were given access to the training modules, online support, and expert communities after 4 months.
Lay people in both the intervention and control conditions showed positive change over time in reporting a person-centered approach to dementia care. No other measures of knowledge about and attitudes toward dementia were statistically significant across groups among laypeople or professionals. In pre-postcomparisons, participants in the intervention group reported less distress in tense situations, more empathy and concern for the well-being of other people and feeling better able to understand situations and the actions of other people versus the waitlist/control. However, participants in the intervention group reported feeling less competent in caregiving after the intervention.
Asynchronous (educational modules with videos available online and on DVD). Workbooks also available and encouraged
Caregivers only Family caregivers of older adults with dementia
(i) PSS (ii) RMBPC (iii) CES-D (vi) Perceived Quality of Life
Length: 12 weeks. Intervention: () asynchronous access to an online or DVD intervention program which included 6 skill building modules with video illustrations, as well as modules focused on reducing stress and negative thoughts designed to be completed in set order. They also received a workbook and were encouraged to fill it out. Comparison: () received access to a website containing similar navigational features, with information about dementia as well as links to video-taped information plus booklet materials from various health agencies.
Perceived stress decreased significantly over time in the intervention group, whereas there was no significant change in perceived stress in the comparison group. The groups did not differ in the amount of change over time in feeling “bothered” by care recipients’ memory deficits and behavior problems, nor did they differ in amount of change in depression or perceived quality of life.
Caregivers only Mostly employed (part- or full-time) adults (≥40) caregivers of persons with a chronic disease, with 9 retired or full-time caregivers as well
(i) CES-D (ii) Modified CSI (iii) CQoL-I
Length: 12 weeks. Professionally facilitated intervention group: () a psychiatric nurse provided psychoeducation through weekly posts on topics related to caregiving and responded to questions as requested. Moderated intervention: () primarily peer-directed, this group was moderated by the primary investigator and utilized an unstructured format once initial guidelines and purpose had been posted. Usual care: () standard care. No access to website and received no treatment.
The two intervention groups showed significant improvements in depressive symptoms and quality life as compared to the control group; the two intervention groups did not differ significantly on depressive symptoms or quality of life. There were no significant differences between groups for caregiver strain. Results suggest providing support to caregivers, regardless of format, can help improve quality of life and decrease depressive symptoms.
Caregivers only Family caregivers of older adults with neurodegenerative diseases
(i) Composite of the HSQ-12 and the MOS-36 (ii) CES-D (iii) Caregiver Report: Activities of Daily Living and Instrumental Activities of Daily Living Performed for Care Recipient, Plus Stress Rating for Each (vi) RMBPC (v) Multidimensional Scale of Perceived Social Support
Length: 10 weeks. Intervention: () asynchronous access to a website with information, email, and threaded discussion; a point-to-point video-conferencing link supported caregivers’ participation in a manual-guided psychosocial support group for 10 weekly sessions, followed by an additional two sessions led by a group member. Usual care: () standard care. No-intervention condition.
The intervention group showed reliable adherence to the manual-guided support group and similar themes were noted as compared to face-to-face support groups. The intervention group also reported significantly less stress postintervention, while the control group reported an increase in stress.
Synchronous web-based, in-person (initial visit for intervention group only)
Caregivers only Primary family caregivers of adolescents (12-17 years old) with mild to severe TBI within prior 1-7 months
(i) SCL-90-R (ii) CES-D (iii) CSES
Length: 6 months; follow-up at 6-, 12-, and 18-month postbaseline. Intervention: () an initial 2-day intervention training program was provided to participating therapists. Family caregiver participants received an initial 1-day in-home training session to introduce the family intervention which focused on problem-solving training, communication skills, self-regulation, and anger management and to identify family goals to be addressed in the intervention. Participants received a detailed manual and completed a series of online modules and Skype sessions with a licensed therapist. Up to 4 supplemental modules were available for use as determined by the therapist. Comparison: () a self-guided, web-based program which provided information about TBI and online resources. Participants were asked to access this 1 hour per week.
The intervention was effective in reducing parent distress but had minimal effect on depression and self-efficacy. The intervention was more effective in reducing distress in low-income families at 12- and 18-month follow-up than the control group. While depression was greater for caregivers of adolescents with severe TBI versus adolescents with moderate TBI, these differences did not continue through the 12- and 18-month follow-up.
Caregivers only Family caregivers of adult first-time stroke survivors discharged from rehabilitation center; novice Internet users
(i) CES-D (ii) SWLS (iii) Functional Independence Measure (iv) Healthcare Usage-Researcher Developed
Length: 52 weeks. Intervention: () asynchronous access to web-based educational materials, customized “tip sheets”, email forum to ask questions of a multidisciplinary team (e.g., nurses, therapists, social worker, physician), and a nonstructured, nurse-facilitated email forum among all participants. Control: () received usual medical care and were asked not to use the Internet for the year of the study.
No differences were found in reported depression and life satisfaction between the intervention and usual care groups. Significant differences were found between the groups on survivors’ visits to hospital emergency departments (33% fewer visits for the intervention group) and number of hospital readmissions (66% fewer readmissions for the intervention group). No differences were found in number of visits to their healthcare providers.
Caregivers only Parents/legal guardians of children with TBI
(i) Symptom Checklist-90-Revised (Global Severity Index) (ii) CES-D (iii) Parenting Stress Index (3rd) (iv) CSES
Length: 4-6 months, no follow-up. Intervention: () participants received an initial in-home visit to introduce the intervention designed to increase positive parenting skills and improve caregiver stress management. Participants also received 10 core web-based sessions and up to 4 supplemental sessions. Each session included self-guided web content, followed by a videoconference call with a therapist to discuss content and practice parenting skills with live feedback. Comparison: () participants received links to TBI web resources.
Parent income moderated treatment effects on parent psychological distress. Specifically, lower-income parents in the parenting skills group reported significant reductions in psychological distress compared with lower-income parents in the control group. No differences for caregiver depression, parenting stress and caregiver efficacy between the two groups over time.
Caregiver-care recipient dyads Wives caring for husbands surviving stroke
(i) CES-D (ii) Mastery Scale (9 items) (iii) Self-Esteem Scale (iv) MOS Social Support Survey-11 items
Length: 11 weeks, with 1-month follow-up. Intervention: ( dyads) asynchronous access to educational videos and an online library of educational materials related to stroke, caregiving, and coping. Participants took part in guided online synchronous audio-only chat sessions with other wives in the study twice weekly for a total of 17 sessions, and an email message board enabling messages exchanged with the nurse facilitator and with each other. Comparison: ( dyads) asynchronous access to an online educational resource library and completed measures at baseline and at two follow-up intervals.
Controlling for baseline depression, caregivers in the intervention group reported significantly lower depression one-month postintervention as compared to the control group. No significant treatment effects were noted for other outcomes.
Caregiver-care recipient dyads Caregivers of a child with ADH
(i) Parenting Strain Index (role restriction, isolation, and spouse subscales) (ii) PHQ-9 (iii) Caregiver Strain Questionnaire
Length: 25 weeks; parenting stress was measured at baseline & 25 weeks; all other domains were measured at baseline, 4, 10, 19, & 25 weeks. Intervention: () children’s ADHD Telemental Health Treatment Study-hybrid telehealth service-delivery model with combined pharmacotherapy and caregiver behavior training for reducing children’s ADHD-related symptoms and caregivers’ distress. Participants received 6 videoconferencing sessions led by a psychiatrist on pharmacotherapy, immediately followed by 6 in-person sessions of caregiver behavior training from master’s level therapists spaced 3 to 4 weeks apart. Comparison: () received primary care with a single teleconsultation session.
Overtime, caregivers in both service models reported significantly decreased levels of distress and depression symptoms and increased levels of family empowerment. Effects were significantly greater for caregivers in the intervention group. Further, combined child symptom improvements mediated reductions in parenting stress and caregiver strain, and improvements in caregiver strain were significantly mediated by treatment-induced decreases in child ODD symptoms.
Synchronous web-based videoconferencing and asynchronous educational modules with tailoring and videos
Caregiver-care recipient dyads Families of children (ages 5-16) with moderate to severe TBI between 1 and 24 months previously.
(i) Social Problem-Solving Index-Short (ii) CES-D (iii) Anxiety Inventory (iv) Symptom Checklist-90 (v) Global Severity Index
Length: 16-24 weeks. Intervention: () manualized problem-solving therapy and cognitive behavioral skills training through synchronous online videoconferencing sessions, plus one in-person in-home initial interview. During the initial meeting, the therapist conducted a structured interview and elicited goals identified by caregivers. Subsequent meetings were conducted via synchronous online videoconferencing, and in-between times, the family completed web-based self-guided materials. There were 8 core sessions, with 4 additional supplemental sessions. Participants also received Internet access to a home page linking them to brain injury web sites and resources. Comparison: () usual psychosocial care, plus access to the home page and links.
The intervention group reported significantly less depression, anxiety, and global distress at follow-up than did the control group, after controlling for baseline symptom levels. No significant findings were noted for problem-solving.
Caregiver-care recipient dyads Family caregivers of adolescents (ages 11-18) with moderate to severe TBI between 3 and 19 months previously
(i) Social Problem-Solving Index (ii) CES-D (iii) Symptom Checklist-90 Global Severity Index
Length: 6 months. Intervention: () web-based interactive teaching modules for 10 core topics, with up to six supplemental modules. Each module was followed by a point-to-point videoconference session to practice the module skills together. Structured materials included problem-solving strategies and TBI information, as well as individualized materials for needs such as pain management. Comparison: () the same technology resources and online TBI-specific educational modules but no problem-solving modules or interactive video sessions; they were encouraged to spend one hour/week reviewing the informational websites.
Both groups improved significantly over time in problem-solving, depression, and destress.
Study reported significant improvement in at least one target outcome in the intervention group as compared to the control/comparison group. CESD: Center for Epidemiological Studies-Depression Scale; HADS: Hospital Anxiety and Depression Scale; CSI: Caregiver Strain Index; CQoL-I: Caregiver Quality of Life Index; CSES: Caregiver Self-Efficacy Scale; TBI: traumatic brain injury; ADHD: attention deficit hyperactivity disorder; ODD: oppositional defiant disorder; SWLS: Satisfaction with Life Scale; PSS: Perceived Stress Scale; MOS: Medical Outcomes Study; HSQ: Health Status Questionnaire; PHQ: Patient Health Questionnaire; RMBPC: Revised Memory and Behavioral Problem Checklist.
