Use of motivational techniques to enhance unpaid caregiver engagement in a tailored skills training intervention

Abstract

Objectives

The Helping Invested Families Improve Veterans’ Experiences Study (HI-FIVES) evaluated a skills training program to support family caregivers of cognitively or functionally impaired persons. HI-FIVES demonstrated sustained improvements in caregivers’ and patients’ experiences of VA care. The aim of this distinct, secondary qualitative study was to explore the potential processes related to the individual tailored skills-based telephone training underpinning HI-FIVES intervention effects. We explored topics caregivers selected, characteristics of action items created, patterns of action or inaction, and barriers to action item completion across topics.

Methods

Qualitative data was analysed from 118 dyads randomized into the HI-FIVES intervention which included three weekly facilitated training calls covering five education topics and action items developed by caregivers for each topic. Qualitative analysis of text responses to questions from the training calls was used.

Results

Three of the top four most selected topics were caregiver-oriented and caregivers created an action item most often for self-care topics. Caregiver-oriented topics also had the highest action item completion rates. The majority of action items created met SMART guidelines for goal setting and simple structure. With regard to barriers to action item completion, caregivers commonly reported still contemplating/pending.

Conclusion

Our findings identify motivational interviewing as an effective technique to identify critical intervention content and address barriers to achieving caregiving goals. We suggest that caregivers felt more empowered to create and complete an action item when they had more control over completing the action item, such as in topics related to their own self-care.

Keywords:

• Motivational interviewing
• family caregivers
• caregiver burden
• training intervention

Acknowledgements

We thank the other authors on the main HI-FIVES study paper: Valerie A. Smith, Jennifer H. Lindquist, Cristina Hendrix, Susan N. Hastings, Eugene Oddone, and Morris Weinberger. We also thank the members of the study’s advisory board: Peggy Becker, Dayna Cooper, Darlene Davis, Thomas Edes, Margaret Kabat, Christy Knight, Jennifer Martindale-Adams, Linda Nichols, Kenneth Shay, Scott Trudeau, and Laura Wray. We thank our interventionist, Shirley Barnhart, and Josh D'Adolf who taught class 4 from the VA Caregiver Support Program. We thank Laurie Marbrey our research assistant who provided high quality data collection and was a valuable team member. We sincerely thank the caregivers and Veteran patients who participated in the study. We also wish to acknowledge Karen Staman, Senior Science Writer at CHB Wordsmith and for the Duke University School of Medicine Department of Population Health, for her editorial support on this particular manuscript.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs, U.S. government, or Duke University.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development Service (IIR 11-345) and by the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) (CIN 13-410) at the Durham VA Health Care System. Megan Shepherd- Banigan was supported by a VA OAA HSR&D PhD Fellowship TPP 21-027.