Jaime Perales Puchalt, Ph.D., MPH

• Director of the Latino Brain Health Lab, Neurology
• Assistant Professor, Neurology, KU School of Medicine
• Research Project Lead, Implementation Science for Equity Center for Biomedical Research Excellence

Project Summary

Latino caregivers of individuals with dementia experience disproportionate levels of stress, depression and poor access to caregiver community resources. Caregiver support interventions can reduce caregiver stress by providing knowledge and skills regarding dementia, caregiving, available community resources, and coping with stress. Unfortunately, most primary care clinics offer little in terms of caregiver support for their patients with dementia.

Community health workers are being used in many primary care clinics to provide culturally tailored health education and connections with community resources, but to our knowledge have not been specifically engaged in providing support for caregivers of individuals with dementia. There is a unique opportunity to engage community health workers in efforts to implement caregiver support interventions among Latinos in primary care. The overall objective of this project is to inform the development of an implementation strategy in which community health workers deliver ¡Unidos Podemos! among Latinos in primary care. ¡Unidos Podemos! is a culturally tailored evidence-based caregiver support intervention for Latinos. We propose an implementation strategy that leverages community health workers already working in primary care and provides them with the training, resources and ongoing support needed to implement ¡Unidos Podemos!.

We aim to identify barriers and facilitators to the implementation of ¡Unidos Podemos! by community health workers among Latinos in primary care and test the feasibility of a community health worker support strategy for implementing ¡Unidos Podemos! among Latino caregivers in two primary care clinics.

Specific Aims:

1. Identify barriers and facilitators to the implementation of ¡Unidos Podemos! By community health workers among Latinos in primary care. We will conduct semi-structured interviews with community health workers, primary care providers, and administrative staff from two clinics to identify barriers and facilitators to the implementation strategy. The interviews will be informed by the Consolidated Framework for Implementation Research (CFIR). Findings will allow to tailor non-core components of the intervention, and inform an implementation strategy tailored to the local context of each clinic, including manuals, materials, and toolkits.
2. Test the feasibility of a community health worker-support strategy for implementing ¡Unidos Podemos! Among Latino caregivers in two primary care clinics. We will test the feasibility of our strategy for implementing ¡Unidos Podemos! in a one-arm trial design. We will train CHWs from two primary care clinics to deliver ¡Unidos Podemos! to 20 Latino caregivers of individuals with dementia for 6 months. Primary outcomes will focus on the feasibility of design methods (e.g., % recruited, retained, completed assessments, adherence), and acceptability ratings (e.g., 5-point Likert scales on satisfaction with the implementation strategy) among primary care providers and CHWs. Secondary outcomes will include caregiver use of community health worker resources, stress, and depressive symptoms. Findings will facilitate go/no-go decisions, based on prespecified criteria, regarding whether and how to progress to a fully powered RCT.

This project aligns with the parent COBRE project's goal to develop sustainable and generalizable approaches to reducing inequities in care. Given the strong evidence base for caregiver support interventions, there is a strong need to identify strategies to implement these interventions in practice, particularly for Latino caregivers. If successful, this feasibility study will inform a fully powered effectiveness trial (e.g., R01 PAR-21-307; PAR-19-070) within our growing primary care network, MyAlliance. This project has the potential to develop sustainable solutions to connecting Latinos to evidence-based caregiver support interventions, which would impact the lives of the families of more than 3.5 million Latino IWDs by 2060.

References Cited

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