Mobile health (mHealth) technologies exhibit promise for offering patients and their Caregivers point-of-need tools for health self-management. The goal of this research was to expand upon the limited body of knowledge that exists regarding mHealth by assessing the impact of a suite of mobile health applications (apps) on Veterans Administration (VA) Family Caregiver burden levels, and to identify factors and characteristics of Veterans and their caregivers that predict use of mHealth apps in this complex population.
The research involved the dissemination of iPads® containing a suite of mHealth apps to Family Caregivers of Veterans who receive care at the VA and have serious physical or mental injuries resulting from the post-09/11 wars. Family Caregivers enrolled in VA's Comprehensive Assistance for Family Caregiver program (N=4501) were invited to participate in the VA's Family Caregiver Mobile Health Pilot program. The program distributed government-furnished iPads to participants (N=881) loaded with seven VA mHealth apps. The suite of apps was designed by the VA to assist the caregiver in managing Veteran PTSD and pain, provide support with healthcare-related tasks, and help Caregivers manage their own stress.
This mobile health pilot program ran for three months and consisted of two studies. The Zarit Burden study was designed as a pretest-posttest non-random control study that involved an assessment of changes in Caregiver Zarit burden (4-question) scores experienced by the treatment group receiving the iPad /mHealth intervention, as compared with a control group who did not have the intervention. The mHealth Use study involved quantifying the use of the mHealth apps and predicting their use based on Veteran and Caregiver characteristics. A subset of the treatment group receiving the iPads completed three surveys assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. App use was modeled as a binary outcome (use vs. nonuse) using a multivariable logistic regression model, and also as a count outcome based on the frequency of use and modeled using a negative binomial model.
In the Zarit Burden study, no statistically significant difference in Caregiver burden change scores could be detected between the treatment and control groups. This is consistent with other studies showing mixed results in demonstrating changes in Caregiver burden with a technological intervention. In the mHealth Use study, the most frequently used apps were those that provided access to VA health information and provided medication support. Initial use of the apps was positively associated with increasing computer skills, being a spouse, living in a rural location, and Veterans having a mental health diagnosis. Use of the apps was negatively associated with Caregiver preparedness and Veteran age. This mobile health Family Caregiver research study effectively established the VA's first patient-facing mobile health applications that are integrated within the VA data system.
|Advisor:||Shaw, Gregory L., Houston, Thomas K.|
|Commitee:||Barbera, Joseph A., Santos, Joost R., Van Dorp, Johan R.|
|School:||The George Washington University|
|Department:||Engineering Mgt and Systems Engineering|
|School Location:||United States -- District of Columbia|
|Source:||DAI-B 76/06(E), Dissertation Abstracts International|
|Subjects:||Health care management, Systems science, Operations research|
|Keywords:||Caregiver burden, Family caregiver, Mhealth, Mobile app, Telemedicine, Veterans health|
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