Chronic diseases such as diabetes mellitus, hypertension, stroke, heart disease, and arthritis reduce physical functioning and increase the risk of physical disability from uncontrolled disease in older adults.1 As a result, older adults living with these health conditions may not be capable of independently performing their basic activities of daily living (ADLs), such as toileting, dressing, bathing, grooming, or their instrumental activities of daily living (IADLs), such as taking public transport or counting change.2 In addition, physical disabilities significantly increase social isolation among older adults with chronic diseases when compared with those without these conditions.3 Consequently, these older adults require more ADL, IADL, and social relation assistance from caregivers.4 Furthermore, older people need assistance from long-term care centers in their community to facilitate care support that ensures their security and alleviates their caregivers’ burden.5

In Asian countries, dependent older adults are more likely to be cared for by family members living in the home rather than receive care at a nursing home.6 Even in western countries with extensive formal care support, most older people are still cared for by cohabitant caregivers in the home.7 In fact, informal Thai caregivers of dependent older adults are daughters (40.4%), spouses (31.9%), and daughters-in-law, respectively.8 Informal caregivers often face the burden of care partners' care needs related to ADL decline, with total scores of the Barthel Index9 lower than 12.10 Moreover, this burden is also related to disease seriousness,11 the behavioral and mental health of their care partners such as depression or agitation, and the duration of caregiving.12,6

Caregiver burden is defined as physical and emotional distress, feelings of social isolation, and negative feelings experienced by those providing care for a family member with medical conditions.13 Informal caregivers perceive a high burden when performing their caregiver duties, which include hygiene tasks, transfers and mobility, medication and feeding through a tube, and tracheal aspiration.14 These caregiving duties are linked to a loss of self-efficacy in managing or caring for dependent older adults at home.14 Furthermore, a high level of caregiver burden could lead to family conflicts and financial burdens. This burden adds to the negative effects on a caregiver's physical and emotional health.15

Several single-component educational interventions have been developed to alleviate the burden on caregivers of dependent older adults with stroke and memory loss.16,17 However, multi-component interventions delivered by caregivers are recommended and are more effective in decreasing caregiver burden than single interventions.18,19 Recently, Karagiozi et al. (2022)20 discovered an online psychoeducational intervention. This intervention delivers educational content (i.e., the challenges in caring for older adults with disability and disease) and trains caregivers in the adoption of coping skills to significantly reduce caregiver burden when compared with an in-person group intervention after 4 months (p < .0001). However, the online psychoeducational program may not be accessible to vulnerable informal caregivers who are older, have a lower level of education, or have a lower income.20 Aung et al. (2021)10 suggest that the interventions should deliver essential educational content through face-to-face and online modes to reduce the burden on Thai caregivers responsible for caring for dependent older adults.21

Previous interventions guided by the Stress Process Model (SPM)22 have been shown to significantly reduce the Thai caregiver burden of those caring for individuals with dementia.23 The principal investigator (PI) developed the Strengthening Caregiving Activities Program based on the SPM, integrated with literature reviews, to enhance care skills and capability among informal Thai caregivers of older adults with disabilities. The Strengthening Caregiving Activities Program is a psychoeducational intervention designed to decrease negative emotions (i.e., worry and anxiety) among informal caregivers by strengthening both their caring skills and social relationships with their care partners. The Strengthening Caregiving Activities Program facilitated a home visit as support to follow up on their skills or ensure that they applied the contents they learned to cope with stress or burden. In addition, this intervention provided caregivers with care skills, geriatric assessments, urgent management, and stress management. Importantly, caregivers learned to assess their care partners' health by using a smartphone application in which they can decide to refer their care partners to the community care center to receive urgent care or receive suggestions from clinic nurses.

Thus, this study sought to pilot test and examine the efficacy of the Strengthening Caregiving Activities Program on caregiver burden and care partners' ADLs. We hypothesized that the Strengthening Caregiving Activities Program would significantly decrease caregiver burden and improve ADL for dependent older adults at the end of the program (week 6) and follow-up (week 10).