Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention

Abstract

Background Families living with Alzheimer disease and related dementias have more access to support thanks to the development of effective telehealth-based programs. However, as technological science grows, so does the risk that these technology-based interventions will diverge from foundational protocols, diluting their efficacy. Strategies that ensure programs are delivered as intended, with fidelity to guiding protocols, are needed across the intervention spectrum—from development to wide-scale implementation. Few papers address fidelity in their technology-based work. Here, we present our translated telehealth intervention, Tele-STAR, with our fidelity findings. Objective This study aimed to assess the preliminary efficacy of Tele-STAR on reducing family caregiver burden and depression. Across the implementation phases, we assessed the fidelity of a caregiver education intervention, STAR-C, as it was translated into a telehealth option (Tele-STAR). Methods A total of 13 family caregivers consented to participate in an 8-week, videoconference-based intervention (Tele-STAR). Tele-STAR efficacy in reducing the affective burden of caregiving was assessed using pre- and postintervention paired t tests. Content experts assessed program fidelity by reviewing and rating Tele-STAR materials for adherence to the original STAR-C protocol. These experts assessed treatment fidelity by viewing videos of the intervention and rating adherence on a checklist. Results Tele-STAR reduced caregiver burden and retained good program and treatment fidelity to STAR-C. Conclusions We found Tele-STAR reduced caregiver burden and had good fidelity to the original protocol. Assessing fidelity is a complex process that requires incorporation of these procedures early in the research process. The technology used in this study facilitated the accrual of informative data about the fidelity of our translated intervention, Tele-STAR.

The Tele‐STELLA protocol: Telehealth‐based support for families living with later‐stage Alzheimer's disease

“…We will assess treatment fidelity for adherence to the study protocol, as well as Care Partner receipt of the Tele-STELLA intervention, using procedures tested in our second pilot (Lindauer et al, 2019;Onken et al, 2014). We will record Tele-STELLA sessions, and All of the above procedures will be implemented with the first cohort (up to 36 Care Partners).…”

“…In the last decade, nurse scientists have met this challenge by incorporating internet‐based videoconferencing technology into caregiver interventions, making them more accessible for families living with ADRD (Hepburn et al, 2021; Hopwood et al, 2018; Lindauer et al, 2018, 2019). These interventions combine nursing expertise with person‐centred foci, resulting in interventions that improve caregiver well‐being.…”

Telemedicine in neurology: current evidence

“…Telephone interventions for family caregivers of people with dementia have been studied and are associated with increased mental and physical health and reduced caregiver burden 87,88,89 .…”

The Potential for the Internet and Telehealth in Caregiver Support. Comment on “Using Technology to Facilitate Fidelity Assessments: The Tele-STAR Caregiver Intervention”

“…Lindauer and colleagues [1] reported a slight reduction in caregiver burden, attributed to an improvement in caregivers' responses to patients with dementia, facilitated by the Tele-STAR intervention. Caregiver burden is an important consideration in the field of dementia care.…”

“…The support that can be offered to caregivers using internet-driven technologies should continue to be explored, and the study conducted by Lindauer and colleagues [1] provides useful data in this regard. We agree that internet-based interventions will be beneficial to caregivers of persons with dementia in the future.…”