Translating Caregiver Wellness to Telehealth: A Mixed-Methods Feasibility Study

PURPOSE: This study addressed four research questions. First, is telehealth a feasible delivery method for an educational program to support caregiver wellness? Second, what is the participant experience of an education-based wellness program delivered via telehealth? Third, what factors are associated with a successful telehealth educational program experience? Fourth, are the Depression Anxiety Stress Scale 21 (DASS–21) and the Bakas Caregiving Outcomes Scale (BCOS) effective outcome measures?

BACKGROUND: Unpaid family caregivers are a valuable part of the health care system, yet are themselves at increased risk for health problems, stress, and depression. Wellness programs may mitigate some of these health concerns; however, caregivers report numerous barriers to attending such programs. Telehealth may help overcome some of these barriers. However, we do not know what services are suitable for telehealth, and traditionally face-to-face caregiver wellness programs have not been translated to an online environment.

METHOD: This study used a convergent parallel mixed-methods design to examine the feasibility of a telehealth delivery method for a traditionally face-to-face evidence-based wellness program, Powerful Tools for Caregivers (PTC). The Aging and Disability Resource Center of Ozaukee County, Wisconsin, assisted with recruiting four family caregivers for an older adult who reported barriers to attending a face-to-face program, spoke English, were able to use a computer and VSee software (Sunnyvale, CA), were motivated to participate, and lived in southeastern Wisconsin. The four participants (three female; age range = 61–83 yr) engaged in a 6-wk PTC program delivered for the first time via telehealth in a synchronous videoconferencing format. Participants underwent pre- and postprogram measures of the Technology Profile Inventory (TPI), the BCOS, and the DASS–21. Class attendance was recorded. Participants also completed the Telehealth Usability Questionnaire (TUQ) and participated in a focus group the week after PTC participation.

RESULTS: Median attendance was six of six classes. Participants indicated the telehealth method was feasible, with a high total median TUQ score of 5.7 (range = 5.0–6.4). Spearman’s rho tests found no significant associations between PTC classes attended and other measures. Wilcoxon signed-rank tests found no significant findings pre- to postparticipation on the TPI, BCOS, and DASS–21 total scores. However, visual trend graphs demonstrated a small upward trend for TPI and BCOS scores. Three researchers coded the qualitative data using open coding and thematic analysis. Two major themes emerged relating to (1) the PTC program experience and lessons learned and (2) the telehealth experience. Qualitative Theme 1 triangulated with the upward trend in BCOS post scores. Qualitative Theme 2 triangulated with un upward trend in TPI scores, high TUQ scores, and high class attendance.

DISCUSSION: The telehealth delivery format of synchronous videoconferencing for PTC facilitated learning, shared experience, and enabled participation. In this small sample of four caregivers, no limiting factors were found. Attitude toward technology and demographic factors such as age, gender, or caregiving situation did not influence participation or participants’ telehealth experience. This study demonstrated the telehealth delivery method was feasible.

IMPACT STATEMENT: This information is valuable to clinicians and researchers examining telehealth as a potential delivery method. The study explored the participant experience, which provides information relevant to program delivery decision making. Furthermore, this study demonstrated telehealth to be a feasible method to increase access to wellness programming for a population at risk for decreased health and wellness.