Jaime Perales Puchalt, Ph.D., MPH

• Assistant Professor, Neurology, KU School of Medicine
• Director, KU Alzheimer's Disease Research Center Outreach, Engagement, and Recruitment Core
• Previous Research Project Leader, Kansas Center for Implementation Science COBRE

Project Summary

Latino caregivers of individuals with dementia (IWDs) experience elevated levels of stress, depression, and limited access to caregiver community resources.[8-14] Caregiver support interventions can reduce caregiver stress by providing knowledge and skills regarding dementia, caregiving, available community resources, and coping with stress. [15] Unfortunately, most primary care clinicsoffer little in terms of caregiver support for their patients with dementia. [16,17]

Community health workers (CHWs) are being used in many primary care clinics to provide community-tailored health education and connections with community resources, but to our knowledge have not been specifically engaged in providing support for caregivers of IWDs. [18,19] There is a unique opportunity to engage CHWs 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 CHWs deliver ¡Unidos Podemos! among Latinos in primary care. ¡Unidos Podemos! is a contextually aware and community-tailored evidence-based caregiver support intervention for Latinos. [20,21] We propose an implementation strategy that leverages CHWs already working in primary care and provides them with the training, resources and ongoing support needed to implement ¡Unidos Podemos!.

We aim to identify impediments and facilitators to the implementation of ¡Unidos Podemos! by CHWs among Latinos in primary care.

Specific Aims

Identify impediments and facilitators to the implementation of ¡Unidos Podemos! by CHWs among Latinos in primary care. We will conduct semi-structured interviews with CHWs, primary care providers, and administrative staff from two clinics to identify impediments and facilitators to the implementation strategy. The interviews will be informed by the Consolidated Framework for Implementation Research (CFIR). [22] Findings will allow us 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.

This project aligns with the parent COBRE project’s goal to develop sustainable and generalizable approaches to improving health outcomes. Given the strong evidence base for caregiver support interventions, [15] there is a strong need to identify strategies to implement these interventions in practice, particularly for Latino caregivers.

References Cited

8. Pinquart M, Sörensen S. Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist. 2005;45(1):90-106.

9. Cox C, Monk A. Minority caregivers of dementia victims: A comparison of Black and Hispanic families. Journal of Applied Gerontology. 1990;9(3):340-354.

10. Harwood DG, Barker WW, Cantillon M, Loewenstein DA, Ownby R, Duara R. Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: a cross-ethnic comparison. Alzheimer Disease and Associated Disorders. 1998;

11. Rote SM, Angel JL, Moon H, Markides K. Caregiving across diverse populations: new evidence from the National Study of Caregiving and Hispanic EPESE. Innovation in aging. 2019;3(2):igz033.

12. Hinton L, Chambers D, Velásquez A, Gonzalez H, Haan M. Dementia neuropsychiatric symptom severity, help-seeking patterns, and family caregiver unmet needs in the Sacramento Area Latino Study on Aging (SALSA). Clinical gerontologist. 2006;29(4):1-15.

13. Hinton L, Haan M, Geller S, Mungas D. Neuropsychiatric symptoms in Latino elders with dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression. The Gerontologist. 2003;43(5):669-677.

14. Adams B, Aranda MP, Kemp B, Takagi K. Ethnic and gender differences in distress among Anglo American, African American, Japanese American, and Mexican American spousal caregivers of persons with dementia. Journal of Clinical Geropsychology. 2002;8(4):279-301.

15. Walter E, Pinquart M. How effective are dementia caregiver interventions? An updated comprehensive meta-analysis. The Gerontologist. 2020;60(8):e609-e619.

16. Perales-Puchalt J. Access to dementia services among Latinos. Alzheimer's Association diversity and Disparities PIA; 2021:

17. Hinton L, Franz CE, Reddy G, Flores Y, Kravitz RL, Barker JC. Practice constraints, behavioral problems, and dementia care: primary care physicians’ perspectives. Journal of general internal medicine. 2007;22(11):1487-1492.

18. Pérez LM, Martinez J. Community health workers: social justice and policy advocates for community health and well-being. American journal of public health. 2008;98(1):11-14.

19. Hartzler AL, Tuzzio L, Hsu C, Wagner EH. Roles and functions of community health workers in primary care. The Annals of Family Medicine. 2018;16(3):240-245.

20. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health education quarterly. 1988;15(2):175-183.

21. Gallagher-Thompson D, Tzuang M, Hinton L, et al. Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers. Alzheimer disease and associated disorders. 2015;29(2):146.

22. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation science. 2009;4(1):1-15.