Caring for Dementia Caregivers in Ethnic Immigrant Communities

About This Grant

PROJECT SUMMARY Alzheimer’s disease and related dementia (ADRD) caregivers in ethnic immigrant communities, particularly those with limited English proficiency (LEP), have often been excluded from the benefits of evidence-based interventions (EBIs). Focusing on Korean Americans as a target LEP group and the Savvy Caregiver Program (SCP) as a target EBI, our team of cultural and content experts conducted a cultural adaptation of SCP for Korean American caregivers, resulting in K-Savvy. In a pilot test, K-Savvy, a 6-week online psychoeducation program delivered in Korean, demonstrated feasibility, acceptability, and efficacy in reducing depressive symptoms among dementia caregivers. We documented the cultural adaptation process using the Framework for Reporting Adaptations and Modifications–Enhanced (FRAME) and developed the K-Savvy Trainer-the- Trainer (TTT) program. Building upon this preliminary work, we now propose an efficacy study. Grounded in stress process and social cognitive theories, our goal is to examine the efficacy of K-Savvy and the underlying mechanisms of action. Using an explanatory sequential mixed methods design, our Aim 1 is to quantitatively assess the effects of K-Savvy on caregiver outcomes (burden, depressive symptoms, and psychological gain) and the mediating role of caregiver appraisals (perceived stressfulness and self-efficacy). We hypothesize that K-Savvy will yield positive caregiver outcomes, mediated through cognitive appraisals. Aim 2 focuses on qualitatively evaluating the experiences of both caregiver participants and interventionists with K-Savvy. This sequence is to maximize the mixed methods data use (i.e., validation, contextualization, capture of delicate nuances, explanation of success/failure of the approach). We will employ a three-arm design, randomly assigning participants to (1) active treatment with K-Savvy (n = 60), (2) attention control with Healthy Living (n = 60), and (3) usual care (n = 30). Our goal is to enroll 150 participants across 25 classes, each consisting of 6 participants, proportionately representing three areas with varying Korean population densities: CA (n = 72), TX (n = 48), and FL (n = 30). All participants will be assessed at five points: baseline, and at 3, 6, 9, and 12 months. Following the baseline assessment, those assigned to the active treatment group will participate in K- Savvy immediately, while participants in the attention control and usual care conditions will begin K-Savvy after a delay of 6 months, following the 6-month data collection. Guided by the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) model, we will analyze mixed methods data to pursue our aims. Using FRAME, we will also document our implementation process and respond to the culture, context, and characteristics of the target group. This proposed study aims to build evidence for K-Savvy's efficacy and mechanisms of action, refine the K-Savvy protocol, and generate the K-Savvy Online TTT Program, preparing our team for a real-world effectiveness trial. We expect our efforts to bring societal benefits by narrowing the gap in EBI delivery.