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MCaP6eY6HKhPmzADztKeDTixFhxjGVkBEhdwFPNSWiG9DCNvxKYaIpMBqBFEnKxFE3Ivg88rmNmgvuqjWNPwqg7df2YxY5m

Online Eligibility Learning Skills Together

Returning?

We will need to contact you in order to confirm whether or not you are eligible to participate in this research study. Please provide your name, email, and phone number so we may contact you once you complete this screening.

Yes

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Yes

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Yes

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NOTE: In order to participate in this study, you must enroll at least 2 weeks prior to the first session of the Learning Skills Together program. You may delay your participation in the Learning Skills Together program if you choose, in order to participate in the study. You are also welcome to not participate in the study and keep your scheduled time.

Learning Skill Together Study Online Eligibility Survey

Information about this study:
Thank you for your interest in the Learning Skills Together Study! Your participation in this study will allow researchers to better understand how feasible it is to deliver an online program meant to improve caregivers’ confidence when providing complex care tasks for a family member living with mid-stage Alzheimer’s Disease. We also hope to observe how likely it is that participation in this program will improve caregiver’s confidence when providing complex care tasks.

By “complex care tasks,” we mean tasks that caregivers take on to care for a person with a progressive condition, like Alzheimer’s Disease, or functional disability, such as managing medications, preparing special diets, and providing assistance with mobility.

Who is conducting the study?
Carole White, PhD, RN
Professor and Nancy Smith Hurd Chair in Geriatric Nursing and Aging Studies
School of Nursing, UT Health San Antonio

Do you have to be in this study?
No, participation in this study is voluntary. You may still participate in the Learning Skills Together program even if you do not choose to participate in the research study.

What will I be asked to do if I choose to participate?
If you choose to participate, you will be asked to complete three 20 to 30-minute online surveys that will ask about you and your care situation, in addition to participating in the Learning Skills Together Program. You will each receive payment as a thank you for completing these questionnaires.

What are the risks involved with participating?
During the research study, your data will be kept in a secure location and we will limit who has access to it. Despite the precautions we plan to take, there is a small risk that others outside the study team could connect your identifying information, such as your name, with sensitive information you may provide. Some participants may experience discomfort, such as embarrassment or guilt, when answering questions complex care tasks.

How will I benefit from participating?
You may not receive any personal benefits from being in this study. We hope the information learned from this study will benefit other family caregivers in the future.

By completing the questions below, you are indicating that you have reviewed and understood the information about the study provided above.

Completion of as many questions as possible using this online form will expedite the telephone follow up call, where we will confirm whether or not you are eligible to participate in this study.

Yes

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Yes

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Yes

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Do you help the person with dementia with bathing? Such as helping with getting in/out of the shower or bathing parts of the body?

Do you help the person with getting dressed? Such as getting clothes out of the closet, putting on the clothes, or assistance with buttons and zippers?

Do you help the person use the toilet? Such as getting on/off the toilet, getting pants on/off, or cleaning up afterward?

Do you help the person get in/out of the bed or chairs?

Do you help manage incontinence? Do you help clean up for a person who does not have control over their bowel or bladder?

Do you help the person feed themselves? Such as getting the food from the plate to their mouth with a fork?

Shopping - accompanies during shopping trips or do all the shopping

Food preparation - help with heating, serving, or preparing adequate meals

Housekeeping - help with tasks around the home and yard

Laundry - help with laundry

Transportation - provide assistance with driving or arranging transportation

Responsibility of medication - help prepare medications and keep track of correct dosage

Finances - managing financial matters (budgets, writes checks, pays rent and bills, goes to the bank; collects and maintains income)

White or Caucasian

African American or Black

Asian

Native American or Other Pacific Islander

American Indian or Alaska Native

Latino/Hispanic

Other [write in]

Yes

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As a part of this research study, we will soon be contacting you to complete research surveys before you participate in the Learning Skills Together Program, 5 weeks later, and another 4 weeks after that.

Please provide the name and phone number of an alternative contact who will be able to reach you, if we are not able to.

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Thank you for providing this information! We will reach out shortly to let you know if you may be eligible and to complete telephone eligibility screening.

Your eligibility will not affect your ability to attend the Learning Skills Together Program.

Please let us know if you have any questions by contacting us at:

Telephone: 210-450-8862
Email: utcaregivers@uthealthsa.org

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.