Ecological momentary intervention for stroke caregivers’ psychological support: a randomised controlled trial

Professor Lee, Jung Jae   (Principal Investigator (PI))

Dr Lau Esther Yuet Ying   (Co-Investigator)

Professor Cuijpers Pim   (Co-Investigator)

Professor Chau Pui Hing   (Co-Investigator)

Professor Lou Vivian Weiqun   (Co-Investigator)

Professor Wang Man Ping   (Co-Investigator)

Professor Lau Gary Kui Kai   (Co-Investigator)

Mr Yu Chung-tsang   (Co-Investigator)

42

2021-01-01

734456

Ecological momentary intervention for stroke caregivers’ psychological support: a randomised controlled trial

cognitive behaviour therapy, Mobile intervention, Psychological well-being, RCT, Stroke caregiver

NursingPublic Health

Humanities & Social Sciences (H)

17617620

General Research Fund (GRF)

2020

On-going

1. To develop a highly-accessible, personalised intervention to provide timely psychological support to stroke family caregivers; Despite the availability of both private and government-subsidised support services in Hong Kong (HK), stroke caregivers experience barriers to accessing these services. Existing services are mainly centre-based services, which are less accessible to stroke family caregivers who either continue to work, care for their patients full-time, or live in rural areas. Additionally, caregivers need to pay for access to private services, while government-subsidised services are limited compared to the demand and tend to have long waiting lists. Without timely access to psychological support services, stroke family caregivers can feel increasingly isolated and their psychological distresses will go unmanaged, negatively affecting their ability to provide stroke care. In this research, the proposed intervention will be delivered through instant messaging applications (e.g. WhatsApp) according to their preferences. As mobile device penetrance in HK is high, most caregivers will be able to access psychological support as and when they need it, from any location they might be in. Access barriers to psychological support are thus minimised, increasing its practical implications. Moreover, as there is no need for a separate platform to deliver the intervention as instant messaging applications are used, costs incurred in the development of the proposed intervention will be minimal. This enhances the cost-effectiveness and scalability of the proposed interventions. 2. To carry out a randomised controlled trial (RCT) to determine the effectiveness of the proposed intervention in reducing stroke family caregivers’ psychological distress; The number of stroke caregivers required to provide care in the community is rising due to a growing number of stroke survivors in the context of global ageing populations and improved mortality rates. The WHO has recommended provision of caregiver support in combating the challenges of ageing populations. In HK, where there is a significant ageing population, stroke caregivers are dominantly family members. Stroke family caregivers undergo a lot of psychological distress additional to the physical burdens of caregiving, such as cultural expectations, financial burdens, societal pressures and emotional strain. Recent local studies have shown that a significant number of family caregivers experience depressive symptoms and are at high risk of burnout. This can lead to poorer health outcomes for both stroke patients and caregivers, resulting in increased total hospitalisations and therefore, increased health burden. In this research, stroke family caregivers will receive support and learn how to self-manage their psychological distresses, thereby enhancing the sustainability of the effects of the intervention. Through a RCT research design, the effectiveness of the proposed intervention in reducing psychological distress can be determined by comparing the outcomes between the Intervention group and the Control group. Establishing the effectiveness of the intervention will have implications for practical application in service delivery and facilitate policy development. 3. To generate evidence on an innovative brief psychological support intervention; iCBT as a psychological intervention and EMI as an intervention framework have both individually been proven as effective strategies to support psychological well-being, however they have rarely been used together. The proposed intervention is designed as an innovative approach of brief psychological intervention, an approach recommended by the WHO to ensure intervention scalability. By delivering brief iCBT through EMI, caregivers receive personalised psychological support in the form of informative text messages, and real-time chat-based services. This is the first research that will investigate and evaluate the delivery of iCBT through EMI for family caregivers to stroke patients. We will also conduct cost-effective analysis of the iCBT-based EMI to produce evidence of its practical applicability. This pioneer research will be a valuable opportunity to generate evidence of a novel intervention that can be utilised for further research and practical applications. 4. To inform future research design on EMI through post-trial qualitative interviews; Due to the novelty of the proposed intervention (i.e., iCBT-based EMI), we will qualitatively explore stroke family caregivers’ experiences of intervention including their compliance of the intervention. The findings will be used to further improve the proposed intervention, accordingly maximising its effectiveness. The understanding of how caregivers adjust and use the psychological intervention (i.e., caregivers’ compliance to the intervention) will also inform other mobile intervention projects in HK and globally targeting not only stroke caregivers, but all caregivers to patients with long-term care needs (e.g., dementia and cancer).