Applying the RE-AIM framework to evaluate a holistic caregiver-centric hospital-to-home programme: a feasibility study on Carer Matters

Abstract

Background Prolonged caregiving of an older adult can cause family caregivers to be overwhelmed, potentially affecting the well-being of both the caregivers and their care-recipients. Carer Matters is a holistic hospital-to-home programme, centred on caregivers’ needs as their care-recipients transit from hospital to home. The programme was piloted to support caregivers through caregivers needs assessment, tailored resources, tele-support, training courses, and community support network. This study aimed to examine the feasibility of Carer Matters in a tertiary hospital in Singapore. Methods This feasibility study was conducted on the pilot implementation from January to December 2021, during the Covid-19 pandemic. It adopted the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The study highlighted quantitative data collected from key process indicators, such as number of caregivers screened, assessed on their needs and provided with assistance. Additionally, qualitative data was collected from in-depth interviews with 51 stakeholders involved in the implementation to examine their perspectives and experiences. These included family caregivers, clinician caregiver support nurses, hospital leaders and community partners. Results During the pilot, 550 caregivers were enrolled. All caregivers received educational resources when they completed the needs assessment, while 69 of them who reported high burden were given tele-support and 252 attended our caregiver training courses. Despite initial recruitment challenges and obstacles to adoption, stakeholders interviewed found Carer Matters to be effective in providing caregivers with emotional support, knowledge and skills that improved their caregiving abilities, and reduced their sense of isolation and caregiving stress. Among caregivers, the training courses were effective with majority of caregivers agreeing that the courses addressed their needs (99%) and improved their knowledge of the relevant disease conditions (97%). Programme maintenance considered among stakeholders included strategies such as multipronged approach in recruiting caregivers and inviting caregiver advocates to share their experiences. Conclusion This feasibility study highlights that Carer Matters is a valuable component to the ecosystem of support for family caregivers and their care recipients. Carer Matters extends the current patient-centric care model to a more holistic post-discharge continuity of care for both caregivers and their care-recipients, improving and maintaining their overall well-being to better allow transition from hospital-to home. Trial registration Feasibility Study of Project Carer Matters for Family Caregivers of Persons with Dementia (NCT number: NCT05205135).

Developing a theory of change to guide the design and implementation of a Caregiver- Centric Support Service

“…The nal theory of change could also be potentially used as a conceptual tool Family caregivers are the main bene ciaries of Project Carer Matters, wherein they would be trained to possess skills and knowledge to care for their loved ones and ensure self-care in the process. They would also learn problem-solving techniques to overcome unforeseen or future caregiving obstacles and enhance their capacity to acknowledge and address their own caregiving needs and manage their caregiving burden and the associated negative emotions [5]. Ultimately, when caregivers cope well with their caregiving tasks with decreased distress, they will enjoy optimal health as they continue to provide sustained and effective care to their loved ones [28].…”

“…It is an evidence-based caregiver training that was originally conceptualised and developed in Canada [37]. The team subsequently prototyped a virtual version of the CARERS programme to allow learners to attend off-site -especially during the COVID-19 outbreak, and better equip family caregivers in their caregiving responsibilities for their older care-recipients [5]. This programme was valued by the implementation team as it allowed them to address local caregiver needs, founded on principles of problem-solving techniques, adult-learning and experiential learning, which equipped caregivers to better manage their caregiving needs.…”

“…This responsibility is often borne by spouses, siblings or adult children [3], with the spectre of caregiving looming widely in many societies with ageing populations. One example is Singapore, a developed city-state with one in four Singaporeans expected to be 65 years or older in 2030, leading to a heavy reliance on family caregivers to care for and help the older persons age-in-place [4][5].…”

‘24/7’ Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest in Caregiving

“…A secondary analysis was conducted on data collected from caregivers of PwD who were involved in a holistic caregiver support program during the COVID-19 pandemic [ 16 , 17 ]. Data were collected in a tertiary hospital in Singapore between December 2020 and November 2021.…”