JMIR Publications

ABSTRACT

Background:

Elder mistreatment (EM) occurs in many as one-half of dementia care partners. Psychological EM is the most common form of EM by family caregivers. The Knowledge and Interpersonal Skills to Develop Enhanced Relationships (KINDER) intervention was developed to prevent psychological EM, one of the most common EM types. Caregivers found the initial web-based version (KINDER 1.0) to be acceptable, and appreciated the program’s authenticity. However, caregivers also reported difficulty using the intervention’s web-based platform and expressed a desire to engage with other family caregivers. Based on this feedback, KINDER was revised to integrate three facilitated small group discussion sessions conducted by videoconference. Reading materials and exercises featured in the web-based portal were converted into a workbook delivered by PDF or mailed hardcopy.

Objective:

The purpose of this study is to evaluate the acceptability of the revised KINDER intervention.

Methods:

The investigators collected semi-structured qualitative interviews with a purposeful sample of family caregivers following participation in KINDER (N=11), as well as post-intervention survey data (N=71). The qualitative interview codebook and survey questions were informed by the Sekhon’s Theoretical Framework of Acceptability (TFA). Components of acceptability in this framework include affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy at completing activities. Qualitative interviews were coded by two independent coders using a thematic analytic approach, while survey data was analyzed using descriptive analyses (e.g., frequencies and percentages).

Results:

Caregivers reported high levels of overall satisfaction with KINDER; 80.3% (53) of participants reported they were “Very Satisfied” with the intervention and 19.7% (13) indicated they were “Satisfied.” Group discussion sessions and lesson readings were particularly valued, with more than 80% of caregivers reporting these components were “Very valuable.” Qualitative findings supported survey responses and provided additional information about caregivers’ experiences with the revised intervention. Themes addressed 1) the interventions’ alignment with caregiver values (affective attitude, intervention coherence, ethicality), 2) beliefs about the effectiveness of the program (perceived effectiveness), 3) difficultly of participating in the program relative to its perceived overall value (burden, opportunity cost, self-efficacy), and 4) recommendations to further improve the intervention.

Conclusions:

These findings indicate that KINDER was well-received among family caregivers, who reported high levels of satisfaction and positive feedback on its components. The addition of virtual group discussion sessions was particularly valued. The use of multiple data collection methods in this research provided a comprehensive understanding of caregiver experiences, highlighting the intervention's acceptability as well as areas for improvement. This study contributes to current knowledge by demonstrating the acceptability of a novel intervention to prevent EM by family caregivers to persons living with dementia. Future research should focus on testing the efficacy of KINDER and exploring its implementation in health and social service settings. Clinical Trial: NCT05783102