Characterizing mechanisms of a theory-underpinning mHealth multicomponent supportive program for adult children caregivers of community-dwelling frail older adults (Hi-Care): a randomized clinical trial.

BACKGROUND AND

OBJECTIVES

Family caregivers of community-dwelling frail older adults often experience substantial stress and poor mental health. This study aimed to examine whether and how a Stress Process Model (SPM)-based mHealth multicomponent supportive program (Hi-Care) promoted adult children caregivers' mental well-being.

RESEARCH DESIGN AND

METHODS

A 3-month randomized controlled trial (n = 136) was conducted among the Hi-Care intervention group versus usual care. Caregivers' mental outcomes (depressive symptoms and anxiety symptoms), potential mediators (mastery and competence), and moderators (reciprocal filial piety, social support, and coping) were evaluated at baseline (T0), postintervention (T1), and 1-month postintervention (T2).

RESULTS

Caregivers were primarily female (62.5%), with a mean age of 48.4 ± 9.4. The intervention group improved more than the control group in mastery (T1, T2), social support (overall and three types of objective support, subjective support, and support utilization) (T1, T2), negative coping (T2), depressive symptoms (T1, T2), and anxiety symptoms (T2), but not competence, reciprocal filial piety, or positive coping. Mastery mediated the intervention effectiveness on depressive and anxiety symptoms. Overall social support modulated the effects of mastery and intervention on psychological outcomes. Specifically, objective support enhanced mastery's role in reducing depressive or anxiety symptoms, while subjective support impeded intervention impacts but strengthened mastery's effect on anxiety management. Support utilization boosted intervention or mastery in decreasing depressive symptoms. Negative coping weakened the intervention's protective effect against anxiety.

DISCUSSION AND IMPLICATIONS: Mastery, social support, and negative coping served as mechanisms of mental improvement, informing more targeted interventions to promote caregivers' mental well-being.

CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2400089142.