Alzheimer's disease and related disorders caregiver's acceptance of a web-based structured written emotional expression intervention

Ji Woon Ko

doi:10.17077/etd.2fqi1los

Alzheimer's Disease and Related Disorders (ADRD) are a major public health problems. Major sources of care provision are family members in the community and these ADRD caregivers encounter a variety of stressor. Currently there continues to be a need to develop and test Internet based interventions designed to reduce stress for caregivers for persons with ADRD. The web-based Structured Written Emotional Expressions (SWEE) was developed to manage ADRD caregivers stress related to caregiving experiences through writing about their thoughts and feelings. However, differences between provided services by researchers (the web-based SWEE) and the desired services of ADRD caregivers could be a barrier to ADRD caregivers' acceptance and use of the web-based SWEE. The purpose of this study was to assess the acceptability of implementing a web-based nursing intervention for ADRD caregivers and to describe participants' experiences in using the website to understand ADRD caregivers' website usage. An experimental design was used to determine whether the web-based SWEE helped to manage ADRD caregivers' stress through writing interventions. In addition, the UTAUT model was employed for a theoretical framework to explain and predict the web-based SWEE usage behavior by ADRD caregivers. The Finding Meaning Through Caregiving Scale (FMTCS) was used to evaluate finding-meaning related to caregiving experiences as a mediator between performance expectancy and behavioral intention to use in the UTAUT model. Furthermore, the web-based research methods were assessed throughout the web-based SWEE implementing process. Both web-based and paper-based methods were used for recruiting potential participants. Most people who contacted the researcher were recruited by the web-based method. Structural Equation Modeling (SEM) was used for test ADRD caregivers' acceptability of the web-based SWEE and direct content analysis was used for describing participants' experiences in using the web-based SWEE. Fifty people completed the study out of the 90 people who enrolled. Of these 50 participants, 31 completed the study as intended and on schedule. The research showed a good model fit with a Chi-square value (df=43) of 57.191 (p>0.05). The findings showed that performance expectancy had a significant effect on participants' behavioral intention to use (β=0.620, p<0.01) and that effort expectancy also affected the behavioral intention to use the web-based SWEE (β=0.293, p<0.01). Performance expectancy showed stronger effects than effort expectancy. This model explained 52% of variance in behavioral intention to use. However, the effects of facilitating conditions on actual usage and effects of behavioral intention to use on actual usage were not supported by this research. The finding-meaning measure did not show a significant mediating effect on the relationship between performance expectancy and behavioral intention to use. Findings suggested that recruitment methods which use the Internet were an effective way to find potential study participants. Regardless of the topic, the writing intervention helped ADRD caregivers to express stress related to caregiving experiences. In addition, the perceived usefulness of this nursing intervention (performance expectancy) and the perceived ease of use (effort expectancy) were two important constructs which predicted and explained the acceptance of the web-based SWEE by ADRD caregivers. Finally, even though the UATAUT model was only partially supported by a good model fit, this study's findings showed the potential of the UTAUT model for providing health consumer information systems in nursing.

Alzheimer's disease and related disorders caregiver's acceptance of a web-based structured written emotional expression intervention

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