The RESCUE Problem Solving Intervention for Stroke Caregivers: A Mixed-Methods Pilot Study

Purpose/Objective: Stroke caregivers face many challenges after a family member experiences stroke. Because caregivers play such a crucial role in health care, there is a need for more interventions in web-based formats that focus on caregiver psycho-education and skills building. A pilot study was devised to determine the feasibility, acceptability, and value of an active, 4-week telephone and web-based intervention for stroke caregivers. Method/Design: A one-group, pretest-posttest design with a mixed-methods approach was used. Qualitative data supplemented the quantitative findings. Community-dwelling caregivers of stroke patients were recruited from the Veterans Health Administration. Quantitative data were collected pre and postintervention. Semistructured interviews were completed with a subsample of caregivers to capture more detail about the acceptability and value of the intervention. Results: Ninety-three caregivers were recruited; 72 caregivers completed the intervention and 21 withdrew (77% completion rate). From pre- to posttest, caregiver depression (p = .008) and caregiver burden (p = .013) decreased. Problem-solving abilities and health-related quality of life showed no change. Seventy-eight percent of caregivers rated the intervention sessions with the nurses as very helpful or extremely helpful, and 76% reported using the problem-solving strategies a moderate amount to extremely often. Interviews suggest that the intervention was valuable and led to new strategies to relieve stress and prioritize health. Conclusions/Implications: The intervention was feasible to implement and acceptable to caregivers. This intervention shows promise for fulfilling a need for more web-based interventions that focus on skills building and psycho-education, but more rigorous testing is needed to determine effectiveness. Impact and Implications There is a shortage of active, tailored interventions for family stroke caregivers that focus on skills building and psychoeducation that can also be delivered in telehealth formats and accommodate caregivers' busy lives. An intervention was developed to meet these needs, with the goal of reducing caregiver depressive symptoms and caregiver burden. Theoretically grounded in stress and coping theory and using a systematic approach to problem-solving, we offer a brief yet comprehensive intervention to reduce stroke caregiver burden and depression. This was a pilot study. Qualitative and quantitative data were compared side-by-side to reveal the intervention process and outcomes. Pre/post outcomes on depression, burden, quality of life, and problem-solving skills were collected to assess the feasibility of the intervention. The lessons learned from this effort are relevant to other brief web-based interventions that involve active participation between nurses and caregivers. Although more rigorous testing is needed to confirm outcomes, the intervention has the potential to empower stroke caregivers, help them identify and solve common caregiving problems, and address the mental health strain of caregiving. The intervention could be a model for clinician-caregiver partnerships. Nurses and caregivers discussed, developed, and strategized in-home care support for stroke survivors, without the need to visit a hospital or clinic.