An App-Based Just-in-Time-Adaptive Self-Management Intervention for Care Partners: The CareQOL Feasibility Pilot Study

Rehabil Psychol, 2022 · DOI: 10.1037/rep0000472 · Published: November 1, 2022

Patient Experience Mental Health Telehealth & Digital Health

Simple Explanation

This study explores the use of a mobile app (CareQOL) to provide personalized self-management support to caregivers, using real-time data from a Fitbit and daily reports of their health-related quality of life (HRQOL). The app delivers personalized tips and feedback to improve their physical and mental health. The intervention delivers personalized "pushes" in the form of "life insights" or "tips" messages, based on Behavioral Activation (BA) theory, which aims to break the cycle of negative events leading to negative emotions and behaviors. The study aims to determine if this approach is feasible and acceptable for caregivers of individuals with spinal cord injury (SCI), Huntington disease (HD), or hematopoietic cell transplantation (HCT), and whether different caregiver groups respond differently to this type of intervention.

Study Duration

3 Months

Participants

70 care partners (n= 19 SCI; n = 21 HD, n= 30 HCT)

Evidence Level

Not specified

Key Findings

1
The study found high completion rates and acceptability of the data collection protocol, with over 98% of care partners completing the study and high compliance rates for daily and monthly surveys.
2
The JITAI group showed statistically significant improvements in caregiver strain, depression, and sleep-related impairment compared to the control group after controlling for baseline HRQOL.
3
There was some evidence of reactivity of measurement for anxiety over the three-month period, suggesting that the act of monitoring anxiety may have led to improvements in both the JITAI and control groups.

Research Summary

This study investigated the feasibility and acceptability of an app-based just-in-time adaptive intervention (JITAI) called CareQOL for care partners of individuals with spinal cord injury (SCI), Huntington disease (HD), or hematopoietic cell transplantation (HCT). The intervention involved continuous monitoring of physical activity and sleep using a Fitbit, daily reports of health-related quality of life (HRQOL), and personalized push notifications delivered via the CareQOL app. The results showed high completion rates and acceptability of the intensive data collection protocol, with the vast majority of care partners indicating positive responses across the different elements of the study. Compliance rates tended to be lowest for care partners of people with SCI relative to the other two cohorts. The study also found preliminary evidence of the intervention's efficacy, with individuals in the JITAI group demonstrating significant improvements in caregiver strain, depression, and sleep-related impairment compared to the control group. These findings support the potential of this low-cost, low-burden self-management JITAI to improve HRQOL for care partners.

Practical Implications

Feasibility of App-Based Interventions

The study demonstrates that intensive, app-based interventions are feasible for care partners, even with their demanding schedules.

Potential for Improved Quality of Life

Tailored self-management messaging through mobile apps shows promise for improving the mental, physical, and social health of care partners.

Targeted Interventions

The differing responses of caregiver groups (SCI, HD, HCT) suggest the need for group-specific personalization in future interventions.

Study Limitations

1
The study was not powered to examine efficacy and future work is needed to determine if there are differential effects by care partner group and if/how type of care provided influences outcomes.
2
The sample was predominantly Caucasian, and thus generalizability to minority participants warrants future examination.
3
The sample was predominantly female, and although consistent with the caregiver literature more generally, additional work in male caregivers is also warranted.

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