Evaluating the Effectiveness and Implementation of Caregiver Support Initiatives for Caregivers of Older Patients in Singapore

This is a mixed method study that seeks to evaluate the bundle of caregiver support initiatives being provided to caregivers at TTSH, based on their needs. The evaluation will focus on 1) evaluating the process / delivery / implementation of these initiatives to caregivers and 2) the outcomes of caregivers and their care recipients after receiving these caregiver support services at TTSH. Research questions are as follows:

Process evaluation:

• How are the bundle(s) of caregiver support initiatives at TTSH delivered to caregivers?
• What and how was impact achieved for these initiatives?

Outcome evaluation:

• Did caregivers (and patients) benefit from these support initiatives and how?
• Which aspects of the caregiver support initiatives are most beneficial to caregivers (and patients)?

Quantitative methods:

Eligible caregivers will be invited to take part in the study and to complete 3 surveys and an optional interview over the period of their care recipients' hospital stay at TTSH, and 2 months after discharge. During their care recipients' stay, they may be introduced to any of the caregiver support initiatives, based on their needs. Caregivers enrolled in this study will take part in 3 surveys - 1 conducted at the beginning of care recipients' hospital stay, 1 conducted around the discharge period and 1 conducted one month after discharge. The aim of the surveys is to find out if caregivers have attended or used any of these services and whether they benefited from them.

We hypothesise that caregivers outcomes, for e.g. caregivers' knowledge, preparedness to provide care and well-being will be increased for those who have used or attended the initiatives recommended for them by the hospital and caregivers' stress, anxiety, depression, will decrease after receiving these caregiver support initiatives. We also hypothesise that the time spent on caregiving will decrease for those who have used or attended the hospital's caregiver support services and initiatives.

As some of the caregiver initiatives may be progressively implemented at TTSH over the study period, the study will capture data from caregivers who did not receive these initiatives with those who have received them when these initiatives were made available at the hospital.

We will also seek patients' consent to use their data in EPIC for research purposes. We hypothesise that patients' re-admission and visits to the ED post-discharge will be reduced.

Qualitative Methods:

Through the optional interviews with caregivers, either before or after discharge of the care recipients, we aim to ask the following research questions:

• How were the caregiver support initiatives introduced and carried out at TTSH?
• How did caregivers respond to these initiatives and what were their perceptions towards these interventions? Which aspects of these initiatives benefit them the most and why?
• What are the barriers and facilitators faced by the healthcare professionals who implemented these initiatives to caregivers?

Inclusion criteria

• 21 years of age and above
• Main or secondary caregiver of an older person receiving home-based care
• Able to read and converse in English
• Has a mobile smartphone and is able to navigate basic functionalities on mobile apps

Exclusion criteria

• Participants who are cognitively impaired
• Unwilling to download and utilise app
• Unable to read or converse in English comfortably