Coaching Dementia Caregivers to Master Care-Resistant Behavior (CuRB-IT)

266 family caregivers will be randomly assigned to either immediate intervention or delayed intervention groups. All caregivers will complete baseline surveys and 3 weeks of daily diaries. The immediate intervention group will receive 12 weeks of CuRB-IT. They will complete 3 rounds of 3-week daily diaries followed by an intermittent survey at 12 week intervals for the next 33 weeks. The delayed intervention group will receive 12 weeks of attention, complete 1 round of 3-week daily diaries followed by an intermittent survey, then complete 12 weeks of CuRB-IT, and complete 2 rounds of 3--week daily diaries followed by an intermittent survey at 12-week intervals for the next 18 weeks.

The purposes of the delayed-intervention randomized clinical trial (N=266) are to: Care-Resistant Behavior Internet Training (CuRB-IT). examine the efficacy of CuRB-IT in increasing the self-efficacy of family caregivers of persons living with dementia to handle care-resistant behaviors (CRB); further test the efficacy of CuRB-IT in improving caregivers coping strategies (a) among the experimental (immediate-intervention group) as compared to the control (delayed-intervention group) (between groups) and (b) within-person from pre- to post- intervention; examine intervention decay at 3- and 6-months post intervention to determine performance of intervention and inform scheduling of booster sessions; assess the efficacy of the CuRB-IT intervention in preventing onset of poor coping strategies by family caregivers; test the hypothesized mechanism of action that increased CRB self-efficacy and use of CuRB-IT problem-focused coping strategies mediate the relationship between CRB stress appraisal and caregiving activities.

Complete baseline survey, complete 3 weeks of daily diaries and intermittent survey, receive 12 weeks of CurB-IT, then complete 3 rounds of 21-day daily diaries and intermittent surveys while receiving attention during the 12-week intervals between daily diaries.

Complete baseline survey, complete 3 weeks of daily diaries, receive 12 weeks of attention, complete 3 weeks of daily diaries and 1 intermittent survey, receive 12 weeks of CurB-IT, then complete 2 rounds of 21-day daily diaries and intermittent surveys while receiving attention during the 12-week intervals between daily diaries.

9 1-hour coaching sessions delivered over a videoconferencing platform (Zoom); 6 delivered weekly, 3 delivered biweekly

Change in frequency of care-resistant behaviors and other dementia-related behaviors measured by a 19-item self-report scale (yes/no) for dementia family caregivers

Change in frequency of care-resistant behaviors and other dementia-related behaviors measured by a 19-item self-report scale (yes/no) for dementia family caregivers

Change in frequency of care-resistant behaviors and other dementia-related behaviors measured by a 19-item self-report scale (yes/no) for dementia family caregivers

Change in frequency of care-resistant behaviors and other dementia-related behaviors measured by a 19-item self-report scale (yes/no) for dementia family caregivers

Experimental (immediate) and control (delayed intervention). Measured using yes/no responses to 8 items (2 from the Conflicts Tactics Scale Revised, 2 from the Conflicts Tactics Scale modified for Older Adults, and 4 from the Conflict Tactics Scale for Child Mistreatment).

Experimental (immediate) and control (delayed intervention). Measured using yes/no responses to 8 items (2 from the Conflicts Tactics Scale Revised, 2 from the Conflicts Tactics Scale modified for Older Adults, and 4 from the Conflict Tactics Scale for Child Mistreatment).

Experimental (immediate) and control (delayed intervention). Measured using yes/no responses to 8 items (2 from the Conflicts Tactics Scale Revised, 2 from the Conflicts Tactics Scale modified for Older Adults, and 4 from the Conflict Tactics Scale for Child Mistreatment).

Experimental (immediate) and control (delayed intervention). Measured using yes/no responses to 8 items (2 from the Conflicts Tactics Scale Revised, 2 from the Conflicts Tactics Scale modified for Older Adults, and 4 from the Conflict Tactics Scale for Child Mistreatment).

Experimental (immediate) and control (delayed intervention). Measured using 14 items from the Brief Coping Scale.

Experimental (immediate) and control (delayed intervention). Measured using 14 items from the Brief Coping Scale.

Experimental (immediate) and control (delayed intervention). Measured using 14 items from the Brief Coping Scale.

Experimental (immediate) and control (delayed intervention). Measured using 14 items from the Brief Coping Scale.

Change in caregiver self-efficacy measured by selection of items from 10-item CurB-CuRB-IT Strategy checklist

Change in caregiver self-efficacy measured by selection of items from 10-item CurB-CuRB-IT Strategy checklist

Change in caregiver self-efficacy measured by selection of items from 10-item CurB-CuRB-IT Strategy checklist

Change in caregiver self-efficacy measured by selection of items from 10-item CurB-CuRB-IT Strategy checklist

Change in caregiver self-efficacy measured by selection of items from 10-item CurB-CuRB-IT Strategy checklist

Inclusion Criteria: 1)Caregiver of any race or gender who is aged >18 years 2) provides unpaid care, 3) cares for a spouse/common-law, parent or grandparent (or in-law, aged 60+ years), 4) lives with or shares cooking facilities with the care recipient, 5) Care recipient has mild cognitive impairment or dementia as identified using the Quick Dementia Rating System instrument, 6) the care provided consists of help with at least 2 Instrumental Activities of Daily Living or one Activity of Daily Living, 7) the care recipient is resistant to receiving assistance with, or refuses to do, at least one instrumental or activity of daily living Exclusion Criteria: 1) persons who cannot speak/read English 2) who do not have reliable access to a smart phone or internet

All research data produced by this project will be self-archived at the University of Michigan's NIA-funded National Archive of Computerized Data on Aging. The storage of our research product here will permit many researchers free access to our data in perpetuity. Our archived study will principally include our original (but anonymized) databases as well as any "cleaned," computed, and recoded measures that we produce for or is produced by our analysis. Our project deliverables will include the quantitative databases, a well-documented statistical packaging (SPSS) system file with variable and values labels, a data user guide that includes all SPSS and related computational and analysis syntax code, summary statistics (frequency distributions, means, etc.) for all quantitative variables, a copy of applicable subject consent form, human subject application and the institutional review board (IRB) approval letter, and a blank copy of the survey instrument and interviewer guide.

1) a commitment only to use the data for research purposes and not to identify any individual participant; 2) a commitment to securing the data using appropriate computer technology; and 3) a commitment to destroy or return the data after analyses are completed.