Effectiveness of web-based intervention for life-change adaptation in family caregivers of community-dwelling individuals with acquired brain injury: A cluster-randomized controlled trial

Abstract

Objective To test the effectiveness of the web-based intervention “Koji-family.net 3-day program” (KF3 PGM) for life-change adaptation in family caregivers of community-dwelling individuals with acquired brain injury (ABI). Design A cluster-randomized trial. Settings All 82 institutions for families of individuals with ABI in Japan. Participants Participants were 240 families at 16 different institutions for families of individuals with ABI. Inclusion criteria for participants were (1) families caring for an individual with ABI, (2) family members aged 20 years and over, and (3) the individual with ABI developed ABI when aged more than 16 years and less than 65 years. Methods Clusters were randomly assigned to the intervention (8 clusters, n = 120) or the control (8 clusters, n = 120) group. For the intervention group, the KF3 PGM was assigned, in addition to routine family group activities to enhance the life-change adaptation. The control group followed their daily routine and received usual services. The primary outcome was the life-change adaptation scale (LCAS); secondary outcomes were the multidimensional scale of perceived social support (MSPSS) and the positive appraisal of care (PAC) scale at the baseline, after 3 days (short-term follow-up), and after 1 month (long-term follow-up). A mixed model for repeated measures (MMRM) was applied. Results A total of 91 participants were enrolled. The mean age (SE) of the participants was 64.0 (9.2) years; 87.8% of them were female. The intervention group showed better improvement in the LCAS than the control group in the whole study period (F = 6.5, p = 0.002). The mean observed change in LCAS from baseline was +8.0 (SE = 2.0) at 3 days and +11.6 (SE = 2.0) at 1 month in the intervention group (F = 18.7, p < 0.001). No significant differences in MSPSS and PAC were observed among the intervention and control groups in the whole study. Conclusions The KF3 PGM can be an effective method of enhancing the adaptation to daily life in family caregivers of community-dwelling individuals with ABI. The results show that a potential web-based intervention in institutions for families of individuals with ABI plays a substantial, longer-term role in their support in Japan. Future studies could address the same research questions in different settings and cultures for family caregivers for even longer time periods.

Exploring the Landscape of Eco-Mapping in Health Services Research: A Comprehensive Review

“…Most studies reported a qualitative study design (n � 58) [17,18,21,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and , followed by mixed methods (n � 9) [95][96][97][98][99][100][101][102][103] and quantitative designs (n � 3) [22,104,105]. Data collection methods consisted of semistructured interviews alone (n � 36) [17, 41-44, 46, 48, 52, 53, 56, 58, 59, 61-65, 67, 69, 70, 72, 76, 78-81, 83-85, 88, 89, 92, 93, 104] or interviews combined with focus groups [77,98], surveys [22,95,96,[99][100][101][102][103], participant observations [49,51,…”

“…Data collection methods consisted of semistructured interviews alone (n � 36) [17, 41-44, 46, 48, 52, 53, 56, 58, 59, 61-65, 67, 69, 70, 72, 76, 78-81, 83-85, 88, 89, 92, 93, 104] or interviews combined with focus groups [77,98], surveys [22,95,96,[99][100][101][102][103], participant observations [49,51,54,55,57,60,66,68,71,73,97], document analysis (i.e., feld notes and medical records) [50,54,66,74,86,96,101], and photographs (i.e., photovoice) [86,90]. Several studies used only focus groups [18,91], analysis of institutional medical records [47], questionnaires [105], and participant observation methods [94]. Te data collection method applied in three studies was not reported [45,82,87].…”

“…Many authors suggested that through eco-mapping and understanding the family dynamics, bonds, and available sources of support [21,45,48,75,78,83,85,88,95,99,100,102], healthcare professionals can tailor their communication approaches and information [21,22]. With consistent updates, the tool was recognized as a helpful reminder of the available social resources for patients and family members [59,76,98,105]. Several authors suggested that eco-maps ofer a systematic way of assessing and organizing resources that could be reviewed with patients and families periodically [59,61].…”

“…Authors of one study stated that eco-maps illuminated and "verifed a shared perception" of the participants' family functioning [46], thus reinforcing the researcher-participant connection. Two studies highlighted the value of refection encouraged by eco-maps [105] over the imposition of research preconceptions on the data collection process [57].…”

“…According to six studies, applying eco-maps to emphasize family strengths and resources can increase opportunities for healthcare providers to achieve positive outcomes [58,79,101,105], promoting closer bonds, autonomy, and acceptance in families [83,86]. For example, in light of fnancial costs associated with illness, one paper suggested that providers could use the eco-map to specifcally identify unpaid support to address expenses by asking, "How can Uncle Charlie be of help?"…”