Evaluating a Community Based Family Caregiver Training ... - IUPUI

Developing and
Evaluating a Training
Program Responsive to
Family Caregiver Needs
Janet Witucki Brown, PhD, RN, CNE;
Shu-li Chen, PhD, RN; Pratsani
Srikan, MSN;
The University of Tennessee,
Knoxville, College of Nursing

Funding
• Funding for this study provided by the
University of Tennessee Health Science
Center

Background
• Care of a family member with multiple
needs at home can be very challenging.
Multiple skills are needed. Many family
caregivers provide some type of
"nursing care" for their loved ones
often with no training

Purpose
• The purpose of this mixed methods
study with data triangulation was to
evaluate a Family Caregiver Training
Program: Helping Others Provide
Exceptional Care (HOPE ).
• Both the actual training program itself
and the impact of the training program
on family caregivers were evaluated.

Theoretical Framework
• The goal of this outcomes research is
the evaluation of outcomes as defined
by Donabedian (1987).

Study Design
• This pilot study used a mixed methods
timed series outcomes study with data
triangulation of both quantitative and
qualitative data.
• Data was collected prior to beginning
the classes (Time 1), immediately after
(Time 2) and one month after (Time 3).

Instruments
• Time 1- Prior to beginning the FCTP class:
Caregiver demographic questionnaire, Care
recipient demographic questionnaire, & Adapted
Revised Caregiving Appraisal Scale
• Time 2- Immediately following the completion
of the FCTP: Post Program Evaluation Survey
& Adapted Revised Caregiving Appraisal Scale
• Time 3- Approximately one month after
completion of the FCTP: Adapted Revised
Caregiving Appraisal Scale, Follow-up Post
Program Survey

Data Analysis
• Descriptive statistics for demographic
data
• Friedman’s Two-way analysis of
variance for quantitative data
• Krippendorff’s (2004)content analysis
for qualitative data.

HOPE Training Program
• Based upon the Minnesota Family Workshop
(Ostwald, Hepburn & Burns, 2003)
• Main aims:
– increase caregivers’ knowledge
– Increase family’s insight
– Help caregivers develop new skills
– Increase sense of self-efficacy
– Help with understanding of caregiving situation
– Increase awareness of community resources

Findings: Demographics
• The majority of caregivers (n=58) were:
– female (81%)
– married (76%)
– Caucasian (91%)
– Ages ranged from 42-90 years old.
• Thirteen caregivers were caring for
more than one care recipient and one
caregiver provided care for three family
members.

• Care recipients (n=70) were:
– mostly female (63%)
– 50% married
– 96% Caucasian
– Ages ranged from 46 to 105 years of
age
– 51.7% had a diagnosis of dementia
– 49.1% had moderate to severe
impairment

Quantitative Survey Findings
• Time 1, n=58; Time 2, n=30; Time 3, n=
19.
• Adapted Revised Caregving Appraisal
Scale (entire scale)
– No difference between Times 1 and 2
– No difference between Times 2 and 3
– No difference between Times 1 and 3
– Significant difference among the three
survey points (x 2 = 10.21; p< 0.01)

• Revised Caregving Appraisal Scale
(subscales)
– Statistically significant differences at all
three points on subscale of caregiving
satisfaction (x 2 = 8.05; p< 0.05)
– Significant increase in caregiving
satisfaction between Time 1 and Time 3
and Time 2 and Time 3
– No significant differences on subscales of
burden, mastery, demand, or impact

Post Program Evaluation Survey
Quantitative Results
• Over 96% of caregivers reported
– positive increases in knowledge,
confidence, and skills acquisition
– Clarity and importance and time
presentation of materials
– Timing of program, valuing of questions
and opinions, usefulness of information
*100% would recommend the program to
others

Post Program Evaluation Survey
Qualitative Results
• Participants made suggestions regarding:
– Timing of classes
“The lawyer needed more time”
– Content of classes
• “Council on Aging representative gave
too much information for me to absorb it
all”
• “When should they be put in the nursing
home-more about cost and nursing
home in our area”

– Presentation of content
• “Could all speakers have an outline
to give us so we could write on
them, and they could stop on topic
and on time”

• This feedback was used to modify
subsequent classes to make them more
responsive to caregivers’ needs
– The program was reduced to four weeks
from six weeks after first two classes
– Content was modified or added ( more
handouts used, timing of material)

Qualitative Findings: Themes
• Applicability/Usefulness
– Information
• “Finding out about services available at county
and state levels that I was unaware of”
• “Information presented by the nurse regarding
nutrition, recovery from broken hip and drug
interactions”
– Skills
• “I am more cognizant in the importance of
keeping mom stretched, flexed & exercised”
• “Have used some of the techniques to divert
conversations or responding to the emotion”

• Socialization
– “Makes one feel they are not alone as well
as making one feel that where a problem
might be difficult it can be taken care of”
– “Also seeing other folks and realizing my
problems are universal and there is help
there”

• Satisfaction
– I think this training is invaluable for
everyone caring for ailing loved ones”
– “You gave me a boost to keep going”
– “I felt that the program was a very much
needed program- that so many people are
in my shoes and these shoes are very
uncomfortable”

• Barriers/Facilitators
– Barriers
• “Most people are not aware of this program. I
saw the article in the newspaper or I might
never know”
• “Timing….If I were working, I would not have
been able to attend”
– Facilitators
• “Our evenings are mostly free which made our
evening class perfect.”
• “The location was close to my home. The time
during the day was convenient.”

• Confidence
– “I have a little more confidence in certain areas
after talking the training in regards to caring for
mom.”
– “We have so much more confidence in our ability
to find the help we need”
• Planning Ahead
– “We are changing and updating wills, living wills,
and POAs to meet Tennessee requirements”
– “I found the information very helpful in case I find
myself caring for a relative and have saved the
information for my sons if they have to care for
me”

Limitations
• Majority of sample was Caucasian-
There may be differences in content
needed by other ethnic groups
• Loss of participants from Time 1 to
Time 2
• Small sample size at Time 2 and 3 did
not meet power analysis requirements

Discussion
• Caregivers were satisfied with the
HOPE training and were using what
they learned.
• Caregivers may be caring for more than
one care recipient- unexplored area for
research
• Adaptation of the Revised Caregiving
Appraisal Scale from a verbal to paper
& pencil instrument showed good
psychometric properties