Effectiveness of a psychoeducational skill training DVD program to reduce stress in Chinese American dementia caregivers: Results of a preliminary study

Abstract

Prior research (Gallagher-Thompson, D., Gray, H., Tang, P., Pu, C.-Y., Tse, C., Hsu, S., et al. (2007). Impact of in-home intervention versus telephone support in reducing depression and stress of Chinese caregivers: Results of a pilot study. American Journal of Geriatric Psychiatry, 15, 425–434.) found that an in-home behavioral management program, derived conceptually from cognitive behavioral theories (CBT), was effective in reducing caregiver related stress and depressive symptoms in Chinese American dementia caregivers (CGs). Results were promising, but a more cost-effective intervention is needed to serve this growing population. Past work also found that a psychoeducational videotaped training program based on CBT was effective in reducing stress due to caregiving in Caucasian and African American dementia family CGs (Steffen, 2000, Anger management for dementia caregivers: A preliminary study using video and telephone interventions. Behavior Therapy, 31, 281–299.). To date no research has been conducted using a technological medium to deliver a similar kind of intervention to Chinese American caregivers. The present study evaluated the effectiveness of a similar but culturally “tailored” program in which 70 CGs were randomly assigned to a 12-week CBT skill training program delivered on a DVD, or to a general educational DVD program on dementia. Both were available in Mandarin Chinese or English as preferred. Pre post change analyses indicated that CGs did not differ on change in level of negative depressive symptoms, but positive affect was higher, and patient behaviors were appraised as less stressful and bothersome, for CGs in the CBT skill training program. They were also more satisfied with the program overall and reported that they believed they were able to give care more effectively. Results encourage further development of theoretically based interventions, delivered using modern technology, for this ever increasing group of CGs.

Keywords:

• dementia
• caregiving
• technology
• cognitive/behavioral therapy
• psychoeducational program
• Chinese American

Acknowledgements

Substantial support for this project was provided by funding from the national office of the Alzheimer's Association (grant # IIRG-04-1109) to Dolores Gallagher-Thompson, Principal Investigator. The authors first wish to thank the Alzheimer's Association chapter of Eastern North Carolina, located in Raleigh, NC - specifically, Mrs. Alice Watkins, Executive Director, who graciously provided the English language DVD that was planned for use in the comparison condition, and Dr. Frank Longo, MD, of Stanford's Neurology Department, who facilitated this exchange. That DVD is entitled: ‘Accepting the Challenge: Providing the Best Care for People with Dementia’. It is a four-module DVD containing segments describing what dementia is, improving communication skills with persons with dementia, managing problem behaviors, and scheduling meaningful activities. However, the DVD that was used virtually by all caregivers in the control condition was one produced in Mandarin Chinese, which was provided to the project by Taiwanese professionals through the efforts of Dr. Peng-Chih Wang, PhD, of our staff.

The authors express grateful appreciation to the members of the Hua Yi Performing Troupe of San Francisco, who volunteered their time to enact the role plays in this DVD. Specifically, Joanna Zhang, DVD director, spent countless hours working with the script and the actors to achieve excellent results. These are the actors from that group: Luona Wang, Angel Tu, Frank Huang, Amy Dung, Jason Tu, Jessica Chang and Jason Chang. Additional actors were Tenny Tsai-Eng, Weiling Liu, Hank Wang, Hui-Qi Tong, M.D., and Peng-Chih Wang, PhD, who served as the DVD narrator.

Many thanks are also extended to Shao Chun, Sunny Liao, Yung Hui, and Vivien Lin for their tireless efforts in creating and translating the DVD workbook. Thanks are also due to Chunyu Pu, PhD, Laurie Leung, PhD, Florence Kwo, Susan Long, Catherine Sunderland, and most importantly, Mr. John Di Mario, for technical support, and finally, to Ms. Danielle China for her skillful database management.

The authors also wish to acknowledge the contribution of individuals from the following agencies who volunteered their time and input throughout the process of creating, and evaluating, this new DVD: Edie Yau, Diversity Program Manager, and Herching Ku, Helpline Volunteer, from the Northern CA/ Northern NV chapter of the Alzheimer's Assn; Traci Wei of the Asian Network Pacific Home Care, Oakland, CA; May Au, LCSW and Diane Diep Ngo of Self-Help for the Elderly, San Francisco, CA; Lina Chen Pan and Virginia Chan from Self-Help for the Elderly in Santa Clara, CA; Emily Poon, Executive Director of Aegis Gardens Assisted Living and Memory Care (specializing in serving the Chinese community) in Fremont, CA; Marsha Fong from the Office of Aging and Adult Services of San Mateo County; Regina Kwo from On-Lok, Inc., in San Francisco, CA; Teresa Mo, Cupertino Senior Center, Cupertino, CA; and last but not least, Tenny Tsai-Eng, Area and National Alzheimer's Association Board Member.

Finally, this entire project would never have been completed without the extraordinary talent and skills of Mr. Bruno Kajiyama, Executive Director of Photozig, Inc., of Mountain View, CA, which is the company that produced and edited this DVD and formatted it suitably for wider distribution by the national office of the Alzheimer's Association. Copies of the DVD and workbook can be ordered for a nominal fee through the website of the Stanford Geriatric Education Center (http://sgec.stanford.edu) and from the Diversity Resources section of the national Alzheimer's Association website (www.alz.org).