Date: Feb 28, 2008 Source: Company Data (
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Stanford University School of Medicine conclu des a randomized trial to evaluate the Chinese Caregiver Assistance DVD Program
As part of its ongoing research and development of di gital photo and video app lications for healthcare, Photozig produced a training DVD for Chinese dementia family caregivers for Stanford University, which contracted Photozig for the complete DVD production. The DVD was filmed entirely in Mandarin Chinese, with a cast of Chinese-American actors, and outlined skill-building techniques for coping with the responsibilities a nd emotions of caring for an olde r adult relative with dementia.
This program was funded by the Alzheimer's Associ ation and the Principal Investigator was Dr. Dolores Gallagher-Thompson, Stanford University School of Medicine. Mr. Kajiyama, Photozig, was the Producer. The DVD was produced in 2006 and its effectiveness was evaluated by a randomized trial in 2006-2007.
The promising results of the randomized trial were reported recently by Dr. Dolores Gallagher- Thompson, which are reproduced in the next pages, suggesting that the Chines e Caregiver Assistance DVD Program may improve the qua lity of life of Chinese Am erican family caregivers.
Summary of Results: Chinese Caregiver Assistance DVD Program Grant # IIRG-04-1109 from the national of fice of the Alzheimer's Association Dolores Gallagher-Thompson, Ph.D ., Principal Investigator Stanford University School of Medicine
This project grew out of our ear lier work with Chinese and Chinese American dementia family caregivers. In the first project, we developed a cultu rally sensitive, bilingual program to teach a variety of coping skills to help caregivers manage the stre ss associated with day-to-day caregiving of a loved one with Alzheimer's disease or another form of de mentia. We taught things such as: how to better manage disruptive behaviors of the care-recipient (wandering, for example) and how to communicate more effectively with family members so that needed help could be received from them. This program was delivered in the caregivers' home over a 16 week period. It was compared to a program that offered telephone support and that mailed informati onal materials. A total of 51 women caregivers enrolled in the research and 46 completed it. When the programs were comp ared statistically, it was clear that caregivers in the skill training (SK) condition impr oved more than those in the education/support condition (ES). Ca regivers in the former were le ss depressed and reported less stress associated with caregiving at the end of the program. They also repor ted high levels of satisfaction and said they would recommend the in-hom e program to other caregivers.
Encouraged by these positive results, the Alzhei mer's Association then funded a new project whose aim was to take the most ef fective skill training techniques fr om the first study and "package" them in such a way that they would be available to a larger number of Chinese and Chinese American caregivers, for a modest cost (in comparison to th e very costly home care program). In this second study, with major input from an Advisory Board of Chinese American professionals and caregivers, our team created a 6-part DVD (and accompanying wor kbook) that illustrated several key skills for handling everyday stressful caregiving situations. It was produced lo cally by Photozig, Inc. (Mountain View, CA) in Mandarin Chinese using volunteer actor s from a San Francisco-based theatre company, with both English and Chinese sub-titles. They portra yed "less effective" vers us "more effective" ways to handle common caregiving situations, such as wandering and suspiciousness. The impact of this new DVD was evaluated with a new group of 70 Chin ese and Chinese American caregivers, including some men and some paid caregivers - although the ma jority were middle-aged women, as is true in most studies. The skill training DVD (SK-DVD) was compared to an education-only DVD (E-DVD) in Chinese provided by another Alzheimer's Assn. ch apter; all participants also received monthly phone calls to see if they had any questions a nd to encourage their us e of the materials.
Overall satisfaction with the pr ogram was significantly higher in the SK-DVD group than in the E-DVD group. These caregivers also reported greate r improvement in knowledge and skills in 6 of 8 content categories (e.g., managing stre ss) and believed that watching this DVD enhanced their ability to care for their afflicted family member -- more than those in the E-DVD group. Although depression did not improve significantly over time, positive affect did increase. Most importantly, caregivers' stressful reactions to the care recipient's memory and behavior problems was decreased significantly over the course of the 4 months. Results support the conclusion that Chinese-American caregivers like and can benefit from the SK-DVD program. At pres ent we are planning wide r distribution of these materials through the national office of the Alzheime r's Assn. For more information please call: 1-800- 272-3900 or consult this website: www.alz.org
CHINESE and CHINESE-AMER ICAN CARGIVER ASSIST ANCE PROJECTS (CCAP) Funded by the national office of the Alzheime r's Association to Dolores Gallagher-Thompson, Ph.D., Stanford University School of Medicine
It is now well-documented that many family careg ivers (CGs) experience high levels of distress, including even depressive and anxiet y disorders, and this effect is readily apparent in many different ethnic and racial groups (Shul z & Martire, 2004; Chou, La Mont agne & Hepworth, 1999; Yates, Tennstedt, & Chang, 1999; Patterson, et al., 19 98; Pinquart & Sorensen, 2005). Evidence-based interventions have been developed specifically to help family CGs minimize the stressful effects of caregiving. Some of these techniques have been shown to help CGs fr om different ethnic and racial groups (Gallagher-Thompson & Coon, 2007), but to our knowledge no studies have evaluated evidence- based interventions for Chinese-American CGs. The research discussed here focused on the development and evaluation of an intervention designed specifically for this ever-increasing segment of the US population.
The first phase of this program was completed in collaboration with Chinese-American CGs and local Chinese professionals who work with CGs in Chinese communities. Using their recommendations, we developed an intervention based on principles underlying Cognitive Behavioral Therapy (CBT) that could be administered to individuals in their home within the framework of a psychoeducational model. The decision to work with caregivers in the home resulted from focus-group feedback that Chinese caregivers would be reluctant to seek services requ iring them to come to public meetings and discuss their problems with strangers. This intervention is referred to as th e In-Home Behavioral Management Program (IHBMP).
In the second phase, IHBMP was compared to a telephone support c ondition (TSC) in a randomized clinical trial over a 4- month period. Results indicated that the IHBMP was superior to the TSC in reducing depressive symptoms (p =.017), as well as severe stress due to problems encountered in caring for a family member (p =.022). CGs with a high sense of self-efficacy benefited from both conditions, but more so in the IHBMP than the TSC. CGs with a low sense of self efficacy did not benefit at all from the TSC, but did show improve ment in the IHBMP. Outcome results have been published in the pee r-reviewed American Journal of Geriatric Psychiatry (Gallagher-Thompson, et al., 2007) and other manuscripts are "in press" at this time.
Although the IHBMP was effective, it required more staff time than what is typically required for administering similar small group programs in c onvenient public locations. Since the home seems to be the preferred site for interven tion, the question was raised whether a program could be developed for home use that would require less professional staff time.
Thus, in the third phase we expl ored the feasibility of using th is CBT-based psycho-educational approach to develop a Skill-Train ing Program similar to the IHBMP that could be recorded on a DVD (SK-DVD). A workbook was also deve loped to accompany the DVD that amplifies the material and contains practice exercises, to rein force learning. The content of this DVD paralleled the content of the IHBMP. For each component or topic, stressful situ ations that frequently occur in caregiving were scripted, showing a typical interact ion that often leads to a negative outcome, contrasted with a more positive strategy based on CB principles. Chinese professional actors performed the scripts, which were then discussed by a moderator. A pilot DVD of th is approach was evaluated by professionals who approved of the concept and made suggestions fo r modifications. Technical production of the DVD, including editing, and adding in both English and Chinese sub-title s, was done by Photozig, Inc., in Mountain View, CA.
In the fourth phase this final DVD skill trai ning package was compar ed to a DVD containing substantive information about dementia, how to recogni ze it in family members and what to do to help them (E-DVD) in a randomized c linical trial. Mandarin was the la nguage spoken in both conditions, with a choice of Chinese or English subtitles. Workbooks were in Chinese and English for the SK-DVD caregivers only. Participants were asked to use the DVDs and the other materials for four months. They were called monthly to see if th ey had any questions or problems with the materials; they were encouraged to continue to review what they had b een sent. Overall satisfac tion with the program was significantly higher in the SK-DVD group than in the E-DVD gr oup (p<.0001). Those caregivers also reported significantly higher knowledge and skills in 6 of 8 content categories (p<.005 in 5 and p<.05 in 1), and believed that this experi ence enhanced their ability to care for their afflicted family member more than the E-DVD group (p<.05). Further, positive aff ect was significantly improved (p <. 001) and the stressful reaction to th e care recipient's memory and behavior problems was decreased significantly (p< .001). Results support the conclusion that Chines e-American caregivers like and can benefit from the SK- DVD- program. These results were presen ted at the annual meeting of the Gerontological Society of America in Nov. 2007 in San Francisco, and are being prepared for publication in an international peer-reviewed journal.
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