The Existential Cognitive Intervention to Enhance Positive Aspect of Caregiving (EXCITE-PAC) in a Dementia Context

Research evidence is emerging on the co-existence of a positive caregiving experience in the physically and psychosocially taxing dementia care context, but little attention has been paid to promoting the positive aspects of caregiving (PAC) among family carers.

We adopt the paradigm of existential positive psychology, integrating cognitive behavioural theory, construal level theory, and Antonovsky's theory of salutogenesis to develop an existential-cognitive intervention to enhance positive aspects of caregiving (EXCITE-PAC), and thereby improve the health outcomes of family carers of people living with dementia (PLwD).

Objectives:

i) To evaluate the effects of the existential-cognitive intervention to enhance the positive aspects of caregiving (EXCITE-PAC) on PAC and the health outcomes of family carers of persons living with dementia (PLwD).

ii) To evaluate whether the positive health effects of EXCITE-PAC, if any, are mediated through a change in PAC.

iii) To explore the experience of family carers in engaging with EXCITE-PAC, as well as the perceived intervention effects.

Hypotheses: Family carers who receive the 12-week EXCITE-PAC programme will report more positive changes in i) PAC, ii) HRQoL, iii) depression, iv) self-efficacy in caregiving, and v) meaning-making upon programme completion (12 weeks), and at 24 weeks and 36 weeks, than those who receive a 12-week education programme on dementia caregiving.

The changes in HRQoL and depression among family carers from baseline to the three post-test endpoints will be mediated by an improvement in PAC.

Research method

This sequential mixed-method study will include a double-blind randomised controlled trial and a post-trial qualitative study.

The inclusion criteria are: i) family carers of Chinese PLwD diagnosed at least six months previously; ii) caregiving for ≥ 4 hours/day; iii) Chinese-speaking; iv) having a mobile device to access virtual meetings via GoToMeeting or Zoom; and v) providing consent to participate. Power analysis guides the sample size estimation. Permuted block randomisation (block size: 8, 12, 16) with computer-generated random codes will be performed to allocate participants in a 1:1 ratio to the EXCITE-PAC or education programme.

For the qualitative interviews, a purposive subsample of 30 family carers who have completed the EXCITE-PAC programme will be recruited.

The 12-week EXCITE-PAC programme is underpinned by existential positive psychology, and meaning-making with respect to the purpose and significance of dementia caregiving. A strength-based approach that includes narrative and empowerment strategies will be integrated.

The 12-week EXCITE-PAC programme adopts a hybrid mode, including a face-to-face home visit, group-based virtual meetings, and telephone follow-ups.

Inclusion criteria

• family carers of Chinese PLwDs diagnosed at least six months previously
• caregiving for ≥ 4 hours/day
• Chinese-speaking
• have a mobile device to access virtual meeting via Go-To-Meeting or Zoom
• consent to participate

Exclusion criteria

• NA