A Culturally Sensitive Transition Assistance Program for Stroke Caregivers: Examining Caregiver Mental Health and Stroke Rehabilitation

Article excerpt

INTRODUCTION

Stroke is the leading cause of serious long-term disability in the United States, with more than 4 million people living with the effects of stroke [1-2]. Findings from the 1999 National Long-Term Survey and the Informal Caregiver Survey support initiatives to reduce caregiver stress as a strategy to prevent or defer nursing home entry [3]. Currently, approximately 80,000 veterans receiving healthcare in the Veterans Health Administration (VHA) are living with stroke [4]. It is estimated that approximately 9,000 to 11,000 additional veterans are hospitalized annually with a new stroke [4-5]. Roughly 80 percent of individuals with stroke are discharged home and live for at least 5 years poststroke, shifting a large amount of continuing care to informal caregivers [6]. Informal caregivers play a key role in assisting people with stroke who need long-term care to sustain independent living in their own homes and communities. A top VHA priority is to improve the quality of life of veterans who are receiving long-term care, which includes informal home care from caregivers. The current pilot study contributes to this priority by evaluating an evidence-based caregiver intervention.

Stroke is a triggering event in which family members focus initially on survival during the acute phase of treatment. When family members see that the loved one will survive, they anticipate changes needed after discharge, and the individuals with stroke begin coping with changes in functional abilities and body image [7-8]. Research has found that the experiences of individuals with stroke during the first month postdischarge involve adapting to changes in their sense of self, connections with others, and community participation [8-9]. Managing multiple psychosocial changes in the first month postdischarge is often very difficult [10], and research supports the need for interventions during the immediate postdischarge period [11].

Interventions addressing education, support, and problem solving are effective in improving the mental health of individuals with stroke and stroke caregivers [11-16]. Informal caregivers need information about the experiences of people with stroke and about how to manage stroke recovery effectively, thereby promoting better quality of life for people with stroke [8]. A number of studies have examined the effects of interventions for stroke caregivers. For example, research has demonstrated the effectiveness of social problem solving therapy by telephone in improving stroke caregivers' mental health, social functioning, preparedness, vitality, and problem solving skills [17]. Other research has highlighted the importance of routine and real-time telephone interventions in which healthcare providers supply information about stroke [18]. Similarly, stroke caregiver support, education, and training programs are effective in reducing stoke caregiver stress levels [19]. And large-scale reviews and meta-analyses have generally suggested that caregiver education, counseling, and support interventions by telephone and in person are effective in reducing caregiver stress; improving family functioning, caregiver mental health, psychosocial functioning, and knowledge; and reducing the anxiety and depression of people with stroke [11,20-22].

The fundamental premise for the intervention in the current study is that the stronger a caregiver's ability to provide quality informal care, the better the rehabilitation of the individual with stroke will be [23-24]. The research question that drove this study is "Do videophone educational and supportive problem solving interventions for stroke caregivers improve caregiver mental health and functioning of individuals with stroke following discharge home?" This study specifically builds on previous research by attempting to create a culturally sensitive educational and supportive problem solving videophone intervention for stroke caregivers in Puerto Rico and the U. …