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. What is your first and last name?* must provide value
Phone number:* must provide value
Email:* must provide value
Do you provide unpaid care to a family member, friend, or neighbor?* must provide value
Yes
No
Do you provide care to someone living with Alzheimer's Disease or a related dementia?* must provide value
Yes
No
Have you previously participated in the Caring for the Caregiver Skills Workshop/Learning Skills Together? Yes
No
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.
Participation in this study will require that you have reliable access to email, a computer or tablet, and internet access to complete study activities. Do you have access to these resources? Yes
No
To participate in this study, we ask that you be able to attend 4 group-based sessions lasting approximately 1.5 hours each using a videoconferencing platform (Zoom) over 2 weeks. Sessions will occur twice per week. Are you able to commit to participation in 4 sessions? Yes
No
Do you currently provide unpaid assistance to someone diagnosed by a physician with probable Alzheimer's Disease? Yes
No
How are you related to the person living with Alzheimer's Disease? They are my: Spouse or domestic partner Child (including step and in-law) Parent (including step and in-law) Grandparent (including step and in-law) Other family member Friend or acquaintance
What year were you born in?
Below is a list of tasks that caregivers often help care recipients complete. Please indicate which of the following activities you provide any kind of assistance with by checking the box. 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?
Below is a list of tasks that caregivers often help care recipients complete. Please indicate which of the following activities you provide any kind of assistance with by checking the box. 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)
We would like to make sure our study sample represents our community. To help us do this, please tell us your race/ethnicity? White or Caucasian
African American or Black
Asian
Native American or Other Pacific Islander
American Indian or Alaska Native
Latino/Hispanic
Other [write in]
Other race/ethnicity
Do you have any plans to place the person you provide care to in a skilled nursing facility within the next 3 months? Yes
No
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. Name of alternative contact
Alternative contact phone number
What are you most interested in learning about during the Learning Skills Together Program?
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.
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