Spanish Intervention for Caregivers of Veterans With Stroke

This research study will test a problem-solving intervention for Spanish-speaking stroke
caregivers that will be delivered over the telephone and online via the previously developed
and nationally available Spanish version of the RESCUE website. The investigators will adapt
their previously pilot-tested problem-solving intervention and make it culturally-relevant
for Hispanic caregivers. The investigators' main goal is to test the efficacy of a brief,
telephone and online problem-solving intervention. The objectives are: 1) reduce caregiver
burden and depression, 2) improve caregivers' problem-solving abilities, self-efficacy, and
quality of life, 3) improve Veterans' functional abilities and determine the intervention's
impact on Veterans' healthcare utilization, 4) determine budgetary impact, and 5) determine
caregivers' perceptions of the intervention.

The investigators will conduct a two-arm (8-session intervention vs. standard care), ,
randomized controlled trial to test a problem-solving intervention for Spanish-speaking
stroke caregivers that will be delivered over the telephone and online via the previously
developed and nationally available Spanish version of the RESCUE website. A sample of 290
stroke caregivers will be randomly assigned to either an intervention or a standard care
group. Eligibility criteria: Hispanic caregivers of Veterans with a primary diagnosis of
stroke are eligible for participation if they meet the following criteria: 1) are the primary
caregiver and provide the majority of care for a Veteran who has a diagnosis of stroke (ICD9
codes for stroke: 430-438 or ICD 10 codes 160.0 through 169.998) within the last year and who
has at least two activity of daily living (ADL) deficits or a new or worsening neurological
problem, 2) have Internet access and ability, (either themselves or via a relative or friend)
3) are reachable by cell or home phone, 4) Spanish is their preferred language, 5) have
moderate to severe stress, and 6) ) identify self as Hispanic, and 7) agree to random
assignment to the intervention or standard care group. We will determine caregiver status.

Baseline measurements will be conducted with the caregivers prior to the intervention.
Post-test assessments will be collected at 1 and 12 weeks post-intervention. In addition, the
investigators will obtain pre- and post-test measures of Veteran-related variables via CPRS
electronic health records. Qualitative interviews will be conducted to assess caregivers'
perceptions of the intervention. A general linear mixed model for repeated measures will be
used to examine the relationship between treatment assignment and each outcome over time. The
investigators will measure the budgetary impact of providing intervention by comparing the
costs of the intervention group to the costs of the control group.

Inclusion Criteria:

Hispanic caregivers of Veterans with a primary diagnosis of stroke are eligible for
participation if they meet the following criteria: 1) are the primary caregiver and provide
the majority of care for a Veteran who has a diagnosis of stroke (ICD9 codes for stroke:
430-438 or ICD 10 codes 160.0 through 169.998) within the last year and who has at least
two activity of daily living (ADL) deficits or a new or worsening neurological problem, 2)
have Internet access and ability, (either themselves or via a relative or friend) 3) are
reachable by cell or home phone, 4) Spanish is their preferred language, 5) have moderate
to severe stress, and 6) ) identify self as Hispanic, and 7) agree to random assignment to
the intervention or standard care group.

andom assignment to the intervention or standard care group. The investigators will
determine caregiver status.

Exclusion Criteria:

The investigators will exclude caregivers who fail to meet one or more of the inclusion
criteria or are managing end-of-life issues (stroke survivors are likely to die within five
months following discharge).