Testing the effects of a text message caregiver support intervention for Latinos

ABSTRACT Family caregiving for individuals with Alzheimer’s disease and related dementias (ADRD) has a serious emotional, physical, and financial toll. Latino family caregivers of individuals with ADRD experience a disproportionately poorer mental health than non-Latino Whites and are less likely to access caregiver support.

Text messaging can dramatically enhance the access of effective culturally and linguistically tailored caregiver support interventions among Latinos. However, to our knowledge, no text message interventions exist to provide caregiver support among caregivers of individuals with ADRD. To address this need, we developed

CuidaTEXT (Spanish for self-care and texting; cuídate + text) using a set of user-centered principles. CuidaTEXT is a bilingual (English and Spanish) 6-month text message intervention that includes daily automatic messages tailored to Latino caregivers. All caregivers receive one core daily automatic message on

five domains: ADRD education, social support, self-care, ADRD care management, and behavioral symptoms. Caregivers can access on-demand automatic messages to expand on the five domains by sending keywords and interact with a coach via a live chat for more personalized help. Preliminary findings from our one-arm

feasibility study (n=24) showed CuidaTEXT was highly usable with high levels of satisfaction and engagement, increased preparedness for caregiving and approach-coping, and decreased caregiver behavioral symptom distress and depressive symptoms at 6 months. The next logical step is to assess the efficacy of CuidaTEXT.

Therefore, we will conduct a randomized clinical trial (RCT) to test the efficacy of CuidaTEXT among Latinos. This research corresponds with Stage 2 of the NIH Stage Model for Behavioral Intervention Development (efficacy testing) and will also assess CuidaTEXT’s mechanisms of change informed by the Science of

Behavior Change, the Stress Process Framework, and our quantitative feasibility data. We will randomize caregivers (n=144/arm) to 6 months of CuidaTEXT +1-month post-treatment or a 7-month waitlist control group. In Aim 1, we will determine the effects of CuidaTEXT on Latino caregiver stressors and their negative

consequences (outcomes). Outcomes include change in caregiver depressive symptoms and behavioral symptom distress from baseline to 6 months. In Aim 2, we will explore CuidaTEXT’s effects on ameliorating factors of stress (targets). Targets include changes in caregiver approach-coping and preparedness for

caregiving from baseline to 6 months. In Aim 3, we will examine the mediation of ameliorating factors on CuidaTEXT’s outcomes. We will test whether CuidaTEXT affects outcomes from Month 3 to 6 by engaging targets from baseline to Month 3.