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ONLINE PROGRAM FOR HOME CARE WORKERS
This is an Accep ed Manusc ip o an a icle published by HOGREFE in Ge oPsych
The Jou nal o Ge on opsychology and Ge ia ic Psychia y, 38(1), 23-36, Published
Feb ua y 19 2025, a ailable a h ps://doi.o g/10.1024/1662-9647/a000344.
This e sion o he a icle may no comple ely eplica e he inal au ho i a i e e sion published.
I is no he e sion o eco d and is he e o e no sui able o ci a ion.
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An online psychoeduca ional pilo p og am wi h home ca e wo ke s o dependen
olde adul s: Lessons lea ned and ini ial indings
Igone E xebe ia1, Fá ima Ma ía Ga cía-Pena1, A an xa Go os iaga1, Chloe Rezola-
Pa do2, Maialen Aies a an2, and Ka l, A. Pilleme 3,4
1Depa men o Clinical and Heal h Psychology and Resea ch Me hods, Facul y o
Psychology, Uni e si y o he Basque Coun y UPV/EHU. Donos ia, Spain.
2Depa men o Physiology, Facul y o Medicine and Nu sing, Uni e si y o he Basque
Coun y UPV/EHU. Leioa, Spain.
3College o Human Ecology, Co nell Uni e si y, I haca, New Yo k, USA.
4Di ision o Ge ia ics and Pallia i e Medicine, Weill Co nell Medicine, New Yo k,
USA.
ORCID
Igone E xebe ia: 0000-0003-2276-8355
Fá ima Ma ia Ga cía-Pena: 0000-0002-2304-0617
A an xa Go os iaga: 0000-0002-3477-3488
Chloe Rezola-Pa do: 0000-0001-9715-4564
Maialen Aies a an: 0000-0002-3289-9001
Ka l A. Pilleme : 0000-0002-7700-3563
Funding: This esea ch was unded by he ini ia i e E o kizuna E aikiz, p omo ed by
Dipu ación Fo al de Gipuzkoa, g an numbe DGE20/02.
Con lic o in e es : The au ho s decla e no con lic o in e es .
Co espondence conce ning his a icle should be add essed o Igone E xebe ia,
Depa men o Clinical and Heal h Psychology and Resea ch Me hods, Facul y o
Psychology, Uni e si y o he Basque Coun y UPV/EHU. A da Tolosa, 70, 20018 San
Sebas ián, Gipuzkoa, Spain. Email: [email p o ec ed]us
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Abs ac
Al hough home ca e wo ke s play an impo an ole in ca ing o dependen olde
adul s, no esou ces a e a ge ed speci ically a his popula ion. This s udy desc ibes he
implemen a ion o an online psychoeduca ional pilo p og am among home ca e
wo ke s o olde adul s ecei ing dependen ca e and p esen s p elimina y esul s in
esea ch se ings. The esea ch design was quasi-expe imen al and consis ed o a single
g oup o 20 home ca e wo ke s comple ing baseline and pos -in e en ion assessmen s.
The in e en ion consis ed o an online 6-week psychoeduca ional p og am conduc ed
by a psychologis ia ideocon e encing. A endance and d opou a es we e eco ded,
along wi h comple ion o homewo k assignmen s, pa icipa ion in in e en ion sessions,
and he collec ion o quali a i e in o ma ion abou he in e en ion’s accep abili y
indexes. Lessons lea ned om he implemen a ion o he pilo s udy a e discussed,
ollowed by he p elimina y esul s ega ding i s e ec s on he well-being o ca e
wo ke s ( end owa ds imp o emen s in bu nou , anxie y, and dep ession). Finally,
clinical implica ions and u u e di ec ions o online p og am de elopmen a e
p oposed.
Keywo ds: home ca e wo ke , psychoeduca ional pilo p og am, online,
dependen olde adul s
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An online psychoeduca ional pilo p og am wi h home ca e wo ke s o dependen
olde adul s: Lessons lea ned and ini ial indings
In oduc ion
In many coun ies a ound he wo ld, amilies o en choose o employ home ca e
wo ke s o ca e o olde adul s (Gallo i, 2016). This end a ises om he inc easing
inco po a ion o women in o he labo ma ke and o he socioeconomic changes
including he inc easing need o mul iple incomes pe household, which esul s in a
lack o in o mal ca egi e s o ca e o he elde ly (Roge o-Ga cía, 2009).
Home ca e wo ke s o e pe sonalized and dedica ed ca e, ensu ing he well-
being o olde adul s wi hin he com o o hei own homes. As socie y con inues o age
he cos o long- e m ca e con inues o ise and he demand o home ca e wo ke s is
likely o inc ease. The e o e, he con inuous imp o emen o suppo sys ems o
amilies and ca e wo ke s is essen ial.
Simila o o he coun ies, paid ca e wo ke s play a i al ole in looking a e
dependen adul s in Spain and elsewhe e in he Medi e anean (Di Rosa e al., 2008).
They a e usually mig an s who o en lack he necessa y aining and ha e no p io
expe ience in he ield be o e s a ing hei ca ee (Di Rosa e al., 2008; Ma ínez-Buján,
2014; Schneide , 2017). Some au ho s e e o his phenomenon as he “modi ied amily
social s uc u e,” in which ca e is ou sou ced bu is s ill p o ided wi hin he amily
en i onmen , mainly by women, eplica ing a adi ional amily ca e model (Díaz &
Ma ínez-Buján, 2018). Among hese ca e wo ke s, li e-in and li e-ou ca e wo ke s a e
dis inguished. Li e-ins (mos ly mig an s), a e hose who li e in he household o he
pe son hey ca e o while li e-ou s li e elsewhe e.
The nega i e heal h consequences o ca ing o lo ed ones by amily ca egi e s
ha e been widely s udied in he scien i ic li e a u e, such as ch onic s ess, anxie y,
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dep ession, and a weakened immune sys em (Bom e al., 2019; Ins i u o de Mayo es y
Se icios Sociales, IMSERSO, 2005; Pinqua & Sö ensen, 2003). Howe e , li le is
known abou he s ess expe ienced by home ca e wo ke s, he impac o his s ess on
hei o e all heal h, o e en i such s ess in luences hei abili y o deli e ca e. Some
au ho s ha e d awn a en ion o he p eca ious wo king condi ions o which hese
wo ke s a e exposed o (long hou s, o which ew a e o icially ecognized, low pay,
si ua ions o abuse, and li le pe sonal and leisu e ime) and ha e highligh ed he ac
ha being he p incipal sou ce o ca e o a dependen olde adul has nega i e
consequences o wo ke s’ psychological and physical heal h (Hewko e al., 2015).
Fleming and Taylo (2007) obse ed ha home ca e wo ke s exp ess signi ican
conce ns ega ding hei wo king hou s, suppo and supe ision, and wo kload
p essu es. These ac o s we e pe cei ed as unsocial, un eliable, and dis up i e o hei
own amily li e, po en ially exe ing nega i e e ec s on hei men al heal h. In
pa icula , long wo king hou s, p eca ious wo king condi ions, and he p esence o pain,
in luence hei psychological and emo ional heal h (Ande sen & Wes gaa d, 2014).
Ano he challenge o be conside ed o home ca e wo ke s is how he
in e ac ions wi h ca e ecipien s and hei amilies a e managed. Di icul ies in handling
clien s’ a i udes and demands we e associa ed wi h diminished o e all heal h among
his popula ion (Den on e al., 2002). Fu he mo e, disc epancies and disag eemen s ha
a ise wi h ca e ecipien s o hei amily membe s may ha e ad e se heal h
consequences o he home ca e wo ke s hemsel es (Mu ama su e al., 2019).
In conclusion, i appea s ha ca egi ing has nega i e consequences o home
ca e wo ke s, who p o ide home ca e o olde dependen adul s. Howe e , o da e, ew
in e en ion p og ams ha e been designed o imp o e he heal h and well-being o his
popula ion. Speci ically, ou e iew o he scien i ic li e a u e e ealed only ou such
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in e en ion p og ams: one by Ba be o and E xebe ia (2011), one by Saa ed a e al.
(2020), one by Gum e al. (2022), and one by Vahabi e al. (2022). Saa ed a e al.
(2020) conduc ed a psychoeduca ional cou se ca ied ou wi h 29 ca e wo ke s (mos ly
Spanish, only one mig an ) p o iding home ca e o olde dependen adul s. The esul s
e ealed a educ ion in dys unc ional hough s abou ca egi ing by pa icipa ing ca e
wo ke s, wi h a medium-la ge e ec size.
Simila ly, Ba be o and E xebe ia (2011) implemen ed a psychoeduca ional
p og am wi h 13 mig an ca e wo ke s p o iding home ca e o olde dependen adul s,
obse ing imp o emen s in pa icipan s’ dep ession and subjec i e well-being le els
a e he in e en ion. Finally, Gum e al. (2022) an a pilo s udy in Is ael wi h 6
mig an ca e wo ke s. They ained pa icipan s in beha io al ac i a ion (a cogni i e
beha io al he apy (CBT) skill used o ea dep ession), and esul s e ealed ha
pa icipan s inc eased hei engagemen in alued and meaning ul ac i i ies, bene i ing
bo h hemsel es and he olde adul s. This helped pa icipan s be mo e sa is ied wi h
hei wo k ollowing he in e en ion, ha e a highe quali y o li e, and a highe sense o
achie emen . In e es ingly, pa icipan s in his s udy sugges ed adap ing he in e en ion
o an online o ma o g ea e access.
Al hough hese p og ams ollowed a ace- o- ace o ma , o e ecen yea s,
in o ma ion and communica ion echnologies (ICT) ha e enabled in e en ions wi h
amily ca egi e s o be ca ied ou o e he In e ne , and he ad an ages o his o ma
ha e been ou lined in se e al di e en s udies (E xebe ia e al., 2021; Pa a-Vidales e
al., 2017). Despi e he ad an ages o in e ne -based in e en ions, howe e , only one
online in e en ion p og am ocused on mig an li e-in ca e wo ke s has been ound.
The s udy was conduc ed in Canada and i assessed he e icacy o a 6-week online
psychological in e en ion based on accep ance and commi men he apy (ACT) among
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17 mig an li e-in ca e wo ke s. Resul s showed imp o emen s in educing
psychological dis ess and p omo ing mind ulness and esilience o pa icipan s in he
expe imen al g oup, al hough di e ences we e no signi ican , p obably due o he small
sample size (Vahabi e al., 2022). Same au ho s epo ed a p e e ence o online heal h
esou ces among his popula ion since i allows o g ea e each and lexibili y (Vahabi
& Wong, 2017; Vahabi e al., 2018). Howe e , he e a e added di icul ies in ol ing
such a o ma wi h his pa icula popula ion, including an immense digi al di ide,
di icul ies su ing he In e ne , and limi ed In e ne access.
Wi h he aim o p oducing highly po en and implemen able beha io al
in e en ions ha imp o e well-being among his wo k o ce, we ollowed he NIH
S age Model o Beha io al In e en ion De elopmen (Onken e al., 2014). P ecisely,
s ages 0 basic esea ch, I in e en ion gene a ion and e inemen , and II es ing in
esea ch se ing we e conduc ed. In s age 0, we explo ed how ou in e en ion could
posi i ely impac he well-being o home ca e wo ke s. In s age I we de eloped an
inno a i e online psychoeduca ional p og am u ilizing a combina ion o cogni i e-
beha io al and pe son-cen e ed app oaches. Due o he limi ed exis ing in o ma ion on
p og ams ailo ed o his speci ic popula ion, we elied on a ailable e idence
conce ning online in e en ions (E xebe ia e al., 2021; She i ali e al., 2018). By
combining hese e idence-based app oaches in an online o ma , we aimed o add ess
he gap o accessible suppo o home ca e wo ke s and p omo e posi i e men al heal h
ou comes in his i al wo k o ce. Finally, in s age II, we es ed he beha io al
in e en ion in a esea ch se ing wi h he aim o examining in e en ion componen s
mechanisms o beha io al change and easibili y. The aim o his pape is o desc ibe
s age II, namely he implemen a ion o an online psychoeduca ional pilo p og am o
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home ca e wo ke s o dependen olde adul s and o sha e p elimina y esul s in
esea ch se ings.
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Ma e ials and Me hods
Pa icipan s
Pa icipan s we e ec ui ed using an inciden al sampling me hod due o he
absence o p e iously iden i ied po en ial pa icipan s. The e o e, a andomiza ion o he
sample was no easible.
A o al o 63 po en ial pa icipan s we e con ac ed, bu only 35 home ca e
wo ke s we e ec ui ed, all o whom p o ided home ca e o dependen olde adul s and
me he inclusion c i e ia o pa icipa ing in he s udy. These c i e ia we e as ollows:
being o e 18 yea s o age, ha ing a leas one yea ’s expe ience ca ing o dependen
olde adul s, and ca ing o a dependen olde adul o a leas 5 hou s a week a he
ime o ec ui men . Exclusion c i e ia included being on sick lea e o an ex ended
pe iod o ime a he ime o ec ui men . The es ablishmen o inclusion and exclusion
c i e ia helped o ensu e uni o mi y among pa icipan s, all adul s wi h some expe ience
ca ing o dependen olde adul s. Fu he mo e, hese c i e ia enabled all pa icipan s o
in eg a e and apply he acqui ed echniques and skills in o hei daily p o essional
ac i i ies since hey we e wo king du ing he psychoeduca ional pilo p og am.
Thi y- i e pa icipan s we e e alua ed in he baseline assessmen . A e his
e alua ion, howe e , 15 people wi hd ew due o: ime able clashes (n = 8), lack o
in e es (n = 5) and lack o esponse (n = 2). In he end, 20 home ca e wo ke s s a ed
he online psychoeduca ional p og am (see Figu e 1).
(Figu e 1 abou he e)
The majo i y o pa icipan s we e women (90%), om La in Ame ica (78.5%),
wi h a mean age o 41 yea s (SD = 11.11) (Table 1). Mos we e single (70%) and hei
mean numbe o child en was 2.18. As ega ds hei educa ion le el, 35% comple ed
seconda y educa ion, 25% had a uni e si y deg ee, 25% a p o essional ce i ica e and
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low le el o digi al li e acy obse ed among pa icipan s, we decided o change he
e alua ion s a egy o a pencil and pape o ma . Expe ienced psychologis s we e
p esen while he ques ionnai es we e sel -adminis e ed by pa icipan s. In ligh o hei
di icul ies wi h new echnologies, and gi en he ac ha he psychoeduca ional pilo
p og am was o be ca ied ou online, we decided o un a b ie 2-hou aining cou se
ocusing on in o ma ion and communica ion echnologies (ICT) and o compile a use ’s
guide o enable ca e wo ke s o pa icipa e in he p og am o e he Black Boa d
Collabo a e (BBC) pla o m. A “ es session” was also held o ensu e ha all
pa icipan s we e able o co ec ly manage he pla o m p io o he s a o he p og am.
Wi h he goal o ensu ing a endance, pa icipan s we e sen a elephone message
e e y week eminding hem o he da e and ime o he in e en ion session. The
message also con ained he link o accessing he BBC ideocon e encing pla o m.
Finally, he pos -in e en ion e alua ion was also a sel -applied o ma and was
comple ed by pa icipan s a home, wi h help and suppo p o ided by he psychologis
who had un he in e en ion o e he BBC pla o m.
Da a analysis
To analyze he impac o he p og am on home ca e wo ke s well-being, he
sco es ob ained be o e and a e he in e en ion we e compa ed. To his end, and due o
he small size o he sample and he ac ha i did no mee he assump ion o
no mali y, we used non-pa ame ic s a is ical g oup compa ison es s o ela ed samples
(Wilcoxon signed- ank es ), and calcula ed e ec size using . When in e p e ing his
index, = .30 was conside ed indica i e o a medium e ec size and = .50 indica i e
o a la ge e ec size (Rosen hal, 1991). Pa icipan s who did no comple e he pos -
in e en ion e alua ion we e elimina ed om he analyses. All analyses we e ca ied ou
using e sion 25 o he SPSS so wa e package (IBM Co p., 2017).
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We used open coding o analyze he quali a i e da a induc i ely, s a ing wi h
desc ip i e coding o summa ize he main opics. Two esea che s independen ly
assigned codes and hen wo ked oge he o consolida e simila codes in o ca ego ies
and, ul ima ely, hemes. Any disc epancies we e esol ed h ough eam discussions.
Gi en he small da a se , quali a i e analyses we e ca ied ou by hand, wi hou using
any so wa e package.
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Resul s
Desc ip i e analyses o heal h- ela ed a iables
In ela ion o bu nou le els, 30% o pa icipan s epo ed high emo ional
exhaus ion, 20% high le els o depe sonaliza ion and 5% low pe sonal accomplishmen .
Mo eo e , 55% and 35% o pa icipan s sco ed low in he physical and men al
dimensions o HRQOL ( espec i ely). In e ms o men al heal h, 25% and 5% o sco es
co esponded o p obable clinical cases o anxie y and dep ession ( espec i ely), and
20% and 10% o sco es co esponded o clinical cases o anxie y and dep ession
( espec i ely). Table 3 p esen s a mo e de ailed o e iew o he sco es ob ained by
pa icipan s in all heal h- ela ed a iables p io o he in e en ion.
(Table 3 abou he e)
Implemen a ion o he p og am
A endance and d opou a es
Al hough 20 people s a ed he in e en ion, only 35% (7/20) o he sample
comple ed i . O hese, o e hal (57.1%; 4/7) a ended all six sessions ha made up he
p og am, 28.6% (2/7) a ended i e sessions and 14.3% (1/7) a ended ou sessions.
The easons gi en o no a ending we e ca e wo ke illness o pe sonal issues.
On he sample, 40% (8/20) did no e en s a he in e en ion, and he d opou
a e among hose who did was 25% (5/20). The easons o d opping ou o he
in e en ion we e: changes in wo king hou s (61.5%; 8/13), ca e wo ke illness (15.4%;
2/13), change o job (7.7%; 1/13), unknown (7.7%; 1/13) and pe sonal issues (7.7%;
1/13).
Due o he high d opou a e among pa icipan s, we analyzed he di e ences in
sociodemog aphic and ca e- ela ed a iables be ween hose who comple ed he
in e en ion p og am and hose who did no . To his end, we used chi-squa ed es o
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ca ego ical a iables and Mann-Whi ney U es o con inuous a iables. The esul s
indica ed ha he e we e no s a is ically di e ences, excep o sex a iable (chi-squa e
= 4.127. p = .042). Speci ically, he e we e mo e men in he g oup ha comple ed i
han in he d opou s g oup.
Comple ion o homewo k assignmen s and pa icipa ion du ing online sessions
O hose who comple ed he in e en ion, 42.9% (3/7) pa icipa ed in all sessions
and comple ed all homewo k assignmen s. A u he 42.9% (3/7) pa icipa ed in i e
sessions and comple ed 80-90% (8-9/10) o homewo k assignmen s. Lack o
pa icipa ion and/o ailu e o comple e homewo k assignmen s we e due o ailu e o
a end some o he in e en ion sessions.
Quali a i e in o ma ion
In gene al, pa icipan s epo ed a high le el o sa is ac ion wi h bo h he
in e en ion i sel and he echniques lea ned [“ his is my i s expe ience and i ’s been
g ea ” (pa icipan 7), “ he con en is e y impo an , and i is e y use ul” (pa icipan
6), “ he e’s always some hing mo e o lea n abou his opic” (pa icipan 5)]. In ela ion
o he echniques co e ed h oughou he cou se o he p og am, pa icipan s pa icula ly
app ecia ed hough -s opping echniques and diaph agma ic b ea hing [“I ha e lea ned
o elax in o de o be able o do ce ain hings” (pa icipan 2), “lea ning o elax has
been e y help ul, because i ’s some hing you can do in he momen when you ealize
wha ’s happening” (pa icipan 1), “I lo ed he echniques and hey’ e eally helped
me” (pa icipan 4)].
Some pa icipan s epo ed beha io al changes, bo h in hemsel es and in hei
ca e ecipien [“when I signed up I didn’ ha e much hope, bu i eally helped me
imp o e he ca e I p o ide” (pa icipan 1), “ he e was a e y posi i e change in hei
a i ude” (pa icipan 4), “I’ e lea ned o help hem in he way I’m supposed o; now,
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when hey can’ do some hing, hey call me” (pa icipan 2), “ hey didn’ wan o look
a e hei plan s and I didn’ know why; now I unde s and i ’s because o (physical)
space limi a ions” (pa icipan 2)].
The ac ha he online psychoeduca ional pilo p og am ollowed a g oup
o ma was also iewed by pa icipan s as a posi i e ea u e ha enabled hem o lea n
no jus om hei own expe iences, bu om o he people’s expe iences as well [“being
in g oup helped us lea n mo e; we lea ned om each o he ” (pa icipan 3), “o he
people’s expe iences and s o ies help oo” (pa icipan 1), “i helped me le o s eam,
and sha ing my expe iences wi h o he s has enabled me o lea n” (pa icipan 7)]. Some
pa icipan s also claimed o eel com o able in he space gene a ed o he in e en ion
“as immig an s, we a ely eel we can alk abou hese hings; I eally app ecia ed he
con iden ial na u e o he sessions” (pa icipan 1)], and s a ed ha hey now el able o
help o he s who we e unable o pa icipa e “i ’s enabled us o help o he colleagues who
a e in a simila si ua ion” (pa icipan 2)].
Commen s abou he less use ul aspec s o he cou se ocused on ime issues [“I
el i was oo sho ” (pa icipan 5)] and new con en ha should be included. This
con en include g ie managemen [“when someone we a e ca ing o passes away, we
su e oo” (pa icipan 1), “ he i s lady I ca ed o died in my a ms; ha is a ha d hing
o ge o e ” (pa icipan 7)] and con lic s ha may a ise wi h ela i es o he ca e
ecipien [“ he issue o he amily is e y impo an ” (pa icipan 6)].
Impac o he in e en ion on home ca e wo ke s well-being
Table 4 p esen s he baseline and pos -in e en ion sco e compa isons o all he
a iables s udied. Al hough none o he di e ences eached s a is ical signi icance, he
la ge e ec size e ealed ha sco es we e lowe a e he in e en ion in a sub-
dimension o bu nou (emo ional exhaus ion), as well as in anxie y and dep ession. In
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he depe sonaliza ion sub-dimension o bu nou , he sco es we e lowe a e he
in e en ion wi h a medium e ec size. In he es o a iables s udied (pe sonal
accomplishmen and he physical and men al dimensions o HRQOL), he e ec size
was small.
In ela ion o sa is ac ion wi h ea men , 100% o he sample a ed he se ice
ecei ed as “excellen ”. All pa icipan s s a ed ha he in e en ion p og am had
sa is ied hei needs, ha hey would ecommend i and hey would pa icipa e in i once
again, ema king ha he se ices ecei ed had enabled hem o cope wi h p oblems
mo e e ec i ely ( e y much: 85.7% and qui e a lo : 14.3%).
(Table 4 abou he e)
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Discussion
The aims o his s udy we e o desc ibe he implemen a ion o an online
psychoeduca ional pilo p og am o home ca e wo ke s o olde adul s ecei ing
dependen ca e and o sha e p elimina y esul s in esea ch se ings. Despi e ce ain
ba ie s and challenges, he p og am’s implemen a ion was ound o be easible, and he
accep ance le el was good among hose who comple ed he in e en ion. P omising
ou comes we e also obse ed ega ding pa icipan s’ psychological heal h.
Lessons lea ned
The i s challenge when implemen ing his in e en ion was he high digi al
di ide among home ca e wo ke s. Howe e , wi h p ope aining, ca e wo ke s we e
able o ca y ou he in e en ion online. Despi e he ac ha o he s udies (Gum e al.,
2022) ha e sugges ed he need o online in e en ions o g ea e access, he digi al
di ide mus be aken in o accoun be o e ca ying ou in e en ions in his o ma .
Despi e a ce ain deg ee o ini ial e icence among pa icipan s abou ha ing o use a
mobile de ice ( able o sma phone) o a end sessions, he in e en ion was in ac
ca ied ou online. This leads us o conclude ha , wi h adequa e aining, his popula ion
g oup is capable o using mobile de ices o he apeu ic pu poses.
Indeed, one o he aspec s o he p og am ha was a ed highes by pa icipan s
was i s online o ma . Ca e wo ke s s a ed ha , once hey had lea ned how o use he
applica ion, ha ing online sessions was help ul in ensu ing egula a endance despi e
he cons ain s imposed by wo king hou s, since some a ended sessions om hei
wo kplace.
Ne e heless, ano he lesson lea ned om his s udy is ha he in ol emen o
hese ca e wo ke s in his ype o in e en ion is made challenging by he in ense and
changing wo k schedules hey ha e. O he 35 people who exp essed an ini ial in e es ,
23
ONLINE PROGRAM FOR HOME CARE WORKERS
only 20 s a ed he in e en ion and only 7 comple ed he en i e p og am. The mos
common eason gi en o no pa icipa ing was scheduling clashes, wi h some po en ial
pa icipan s being employed o ca e o mo e han one dependen adul o p o iding
li e-in ca e, which le hem li le o no ime o pa icipa e in he online
psychoeduca ional pilo p og am. Noguei a and Zalakain (2015) a gue ha mig an ca e
wo ke s a e o en exposed o (among o he hings) a high deg ee o job ins abili y and
in ense wo king hou s, a ci cums ance which o en leads o exhaus ion, social isola ion,
and ew oppo uni ies o engage in aining o educa ion.
This pa e n is also e lec ed in he easons gi en by pa icipan s o d opping
ou o he in e en ion (e.g., a change o job o changes in wo king hou s). Ano he
inding wo h highligh ing is ha some ca e wo ke s said hey did no wan o
pa icipa e due o ea o possible ep isals linked o hei lack o legal immig an s a us
in he coun y, and o he s said hey had o “ask hei employe amily o pe mission”,
which hey claimed may p o e an obs acle o hei pa icipa ion. This is consis en wi h
he ac ha ca ing o dependen olde adul s is he p incipal labo ma ke niche o
mig an s in Spain (Díaz & Ma ínez-Buján, 2018).
Posi i ely alued aspec s o he psychoeduca ional pilo p og am
So a we ha e ocused on he nega i e aspec s o he lessons lea ned; howe e ,
he p og am also had se e al posi i e aspec s ha will be discussed below. Ou s udy
shows ha an online psychoeduca ional pilo p og am based on Cogni i e-Beha io al
The apy (CBT) and he Pe son-Cen e ed Ca e app oach is accep ed by hose ca e
wo ke s who comple ed he in e en ion. The answe s in he Clien Sa is ac ion
Ques ionnai e (CSQ) and pa icipan sa is ac ion su ey e ealed ha mos aspec s o
he in e en ion p og am, bo h hose linked o i s o ma and i s con en , we e a ed as
sa is ac o y and use ul in p ac ice, and we e deemed o mee pa icipan s’ needs.
24
ONLINE PROGRAM FOR HOME CARE WORKERS
The ac ha he p og am ea u ed a g oup in e en ion enabled pa icipan s o
lea n om hei colleagues and o eel ha hei p o essional expe ience was ecognized
and alued by o he s. This is undamen al since, as Schneide (2017) poin ed ou in he
e iew, he social s a us o hese wo ke s is low, which may esul in diminished sel -
es eem; howe e , he e is e idence o sugges ha coming oge he may help home ca e
wo ke s o e come hese nega i e conno a ions. This is e iden in he ac ha
pa icipan s in ou p og am iewed he in e en ion as a “mu ual suppo g oup”, a place
whe e hey could le o s eam and alk abou he di icul ies hey encoun e ed du ing
hei wo k, bo h wi h hei ellow ca e wo ke s pa icipa ing in he sessions and wi h
o he colleagues who we e no .
The use o he Pe son-Cen e ed Ca e app oach is pa icula ly wo h men ioning,
along wi h he unc ional beha io analysis ha was designed o encou age pa icipan s
o use elemen s such as non- e bal language, con ex , and hei own beha io o educe
any p oblem beha io s hey may encoun e du ing hei ca egi ing ac i i ies.
Pa icipan s iewed hese echniques in a posi i e ligh , which is consis en wi h ha
epo ed by Mu ama su e al. (2019), who ound ha home ca e wo ke s we e highly
mo i a ed o make an e o o p omo e he heal h o he dependen olde adul s in hei
ca e, al hough hey o en lacked he aining necessa y o do so. In his sense, he home
ca e wo ke s who pa icipa ed in ou p og am s a ed ha he echniques hey lea ned
had helped hem cope be e wi h p oblems.
In ela ion o he con en o he in e en ion sessions, pa icipan s we e e y
app ecia i e o he s a egies lea ned, highligh ing in pa icula he use ulness o
hough -s opping echniques and diaph agma ic b ea hing, bu also p oposing new
con en s o imp o e he p og am (g ie managemen and p oblem-sol ing s a egies
wi h amilies). Pa icipan s s a ed ha hey used hese echniques no only o educe he
25
ONLINE PROGRAM FOR HOME CARE WORKERS
anxie y- ela ed symp oms associa ed wi h ca e si ua ions, bu also o cope wi h di e en
daily li e si ua ions. This is impo an since, as Mu ama su e al. (2019) poin ou , s ess
p ocesses among home ca e wo ke s a e no only in luenced by hei wo k p o iding
home ca e, bu also by hei pe sonal li e. The ac ha he s a egies lea ned du ing he
in e en ion we e hen applied in o he a eas o hei li es ou side he wo kplace is a
posi i e esul ha e lec s he possibili y o educing anxie y- ela ed symp oms.
Impac o he in e en ion on home ca e wo ke s well-being
Finally, and ela ed o he p elimina y da a abou he impac o he in e en ion
on home ca e wo ke s well-being, none o he esul s eached s a is ical signi icance in
any o he a iables analyzed, bu he e ec sizes we e medium o e en la ge in ce ain
a iables. The absence o s a is ical signi icance in hese a iables may po en ially be
a ibu ed o he small sample size (n = 7) and i s limi ed s a is ical powe , especially
conside ing he e y high a i ion a e.
Fo example, a dec ease was obse ed in he sco es ob ained o di e en
a iables, such as emo ional exhaus ion and depe sonaliza ion, which is consis en wi h
he esul s epo ed by Saa ed a e al. (2020). Al hough in ha s udy, he e ec sizes
we e e y limi ed, whe eas in ou one, hey we e high and medium, espec i ely. A
dec ease was also obse ed in he sco es ob ained o dep ession, wi h a la ge e ec
size. This is consis en wi h ha epo ed by Ba be o and E xebe ia (2011). Sco es o
anxie y we e also obse ed o d op, wi h a la ge e ec size. I is possible ha he change
may be due o he impo ance a ached h oughou he p og am o elaxa ion echniques
(diaph agma ic b ea hing and isualiza ion). Vahabi e al. (2022) ound simila esul s
in anxie y al hough he di e ences we e no signi ican .
O he esul s wo h highligh ing a e: he dec ease in pe sonal accomplishmen
and physical HRQOL sco es, and he inc ease in men al HRQOL sco es (albei wi h a
32
ONLINE PROGRAM FOR HOME CARE WORKERS
Hewko, S. J., Coope , S. L., Huynh, H., Spiwek, T. L., Ca le on, H. L., Reid, S., &
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0090-x
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0447.1983. b09716.x
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ONLINE PROGRAM FOR HOME CARE WORKERS
Table 1
Sociodemog aphic and Ca e- ela ed Cha ac e is ics o he Pa icipan s
Sociodemog aphic
a iables
Full sample
(N = 20)
D opou s
(N = 13)
Comple e s
(N = 7)
M
SD
n
%
M
SD
n
%
M
SD
n
%
Sex
20
13
7
Women
18
90.0
13
100.0
5
71.4
Men
2
10.0
2
28.6
Age
41.00
11.11
19
41.08
11.28
12
40.86
11.69
7
Educa ion le el
20
13
7
Uni e si y deg ee
5
25.0
5
38.5
P o essional Ce i ica e
5
25.0
1
7.7
4
57.1
Seconda y quali ica ions
7
35.0
5
38.5
2
28.6
P ima y quali ica ions
3
15.0
2
15.4
1
14.3
Ma i al s a us
20
13
7
Ma ied
2
10.0
1
7.7
1
14.3
Single
14
70.0
10
76.9
4
57.1
Di o ced
4
20.0
2
15.4
2
28.6
Child en
20
13
7
Yes
17
85.0
11
84.6
6
85.7
No
3
15.0
2
15.4
1
14.3
Numbe o child en
2.18
1.07
17
1.91
1.13
11
2.67
0.81
6
Age o younges child
15.59
8.98
17
15.55
8.85
11
15.67
10.07
6
Age o eldes child
20.29
9.47
17
20.09
10.48
11
20.67
8.18
6
Non-Spanish na ional
19
13
6
Yes
16
84.2
11
84.6
5
83.3
No
3
15.8
2
15.4
1
16.7
Coun y o bi h
14
9
5
Nica agua
9
64.4
6
66.7
3
60.0
El Sal ado
1
7.1
1
20.0
Hondu as
1
7.1
1
11.1
Spain
3
21.4
2
22.2
1
20.0
Ca e- ela ed a iables
M
SD
n
%
M
SD
n
%
M
SD
n
%
Li e-in ca e wo ke
20
13
7
Yes
4
20.0
4
30.8
No
16
80.0
9
69.2
7
100.0
Weekly wo king hou s
among li e-in ca e
wo ke s
141.50
21.51
4
141.50
21.51
4
Weekly wo king hou s
among li e-ou ca e
wo ke s
29.69
21.54
16
29.78
17.92
9
29.57
27.05
7
Time (yea s) in cu en
job
1.99
1.39
20
2.23
1.54
13
1.55
1.02
7
Time (yea s) in cu en
p o ession
7.44
4.73
19
7.08
4.62
13
8.22
5.33
6
37
ONLINE PROGRAM FOR HOME CARE WORKERS
Ca e o dependen adul s
ou side wo k
20
13
7
Yes
4
20.0
3
23.1
1
14.3
No
16
80.0
10
76.9
6
85.7
Weekly hou s spen
p o iding ca e ou side
wo k
10.50
14.45
4
12.00
17.32
3
1
Diagnosis o he ca e
ecipien
15
9
6
Mobili y p oblems
3
20.0
2
22.3
1
16.7
Demen ia
4
26.7
3
33.3
1
16.7
S oke
3
20.0
3
33.3
Unknown
5
33.3
1
11.1
4
66.6
Type o disabili y o he
ca e ecipien
14
8
6
Physical disabili y
4
28.6
2
25.0
2
33.3
Physical and men al
disabili y
10
71.4
6
75.0
4
66.7
No e: The esponse o all pa icipan s is no a ailable o some a iables (non-Spanish na ional, coun y o bi h, ime (yea s) in
cu en p o ession, diagnosis and ype o disabili y o he ca e ecipien ).
38
ONLINE PROGRAM FOR HOME CARE WORKERS
Table 2
Aims and Con en s o he Online P og am
Session
In e en ion aims
Con en and echniques used
1: Welcome and
why a e we
doing his?
1.- P esen a ion o he in e en ion p og am,
he psychologis , and he in-home ca e
wo ke s.
2.- Concep ualiza ion o bu nou and i s
consequences.
3.- Iden i ica ion o he possible physical
consequences o long- e m ca e (s ess
and anxie y).
4.- Coping wi h s ess / anxie y h ough
diaph agma ic b ea hing.
Du ing he session:
Bu nou , s ess and anxie y.
Diaph agma ic b ea hing.
Homewo k:
Diaph agma ic b ea hing
and eco ding.
2: Wha causes
BPSDs and
o he
beha io al
p oblems?
1.- Focus on he impo ance o sel -ca e o
educe he consequences o bu nou .
2.- Concep ualiza ion o he Beha io al and
Psychological Symp oms o Demen ia
(BPSD) associa ed wi h dependency and
o he beha io al p oblems ha ca e s may
encoun e when looking a e olde adul s.
3.- Analysis o he eme gence o BPSD and
o he beha io al p oblems using
Func ional Beha io al Analysis (FBA).
4.- In o ma ion abou posi i e ein o cemen
and pu ing i in o p ac ice.
5.- Coping wi h s ess / anxie y by p ac icing
isualiza ion.
Du ing he session:
Sel -ca e, BPSD and o he
beha io al p oblems.
FBA and posi i e
ein o cemen .
Visualiza ion.
Homewo k:
Relaxa ion and eco ding.
FBA, posi i e
ein o cemen and
eco ding.
3: How does
ca ing o a
dependen
olde adul
a ec my
emo ions?
1.- Iden i ica ion o how ca e asks in luence
in-home ca e wo ke s a an emo ional
le el (unpleasan emo ions).
2.- Fos e ing unde s anding o how unpleasan
emo ions a ise, using Ellis’ ABC model.
3.- Iden i ica ion o hough s using he hough -
s opping echnique.
4.- Coping wi h unpleasan emo ions h ough
sel -ins uc ions.
5.- Engaging in pleasan ac i i ies ha imp o e
psychological well-being.
Du ing he session:
ABC model, hough -
s opping and sel -
ins uc ions.
Pleasan ac i i ies.
Visualiza ion.
Homewo k:
Relaxa ion and eco ding.
ABC model, hough -
s opping, sel -ins uc ions
and eco ding.
39
ONLINE PROGRAM FOR HOME CARE WORKERS
6.- Coping wi h s ess / anxie y by p ac icing
isualiza ion.
Pleasan ac i i ies and
eco ding.
4: How can I
manage BPSDs
and o he
di icul ies
associa ed wi h
ca e?
1.- Concep ualiza ion o he Pe son-Cen e ed
Ca e (PCC) app oach.
2.- Planning and implemen a ion o ca e asks,
bea ing in mind he di e en domains o
he Pe son-Cen e ed Ca e app oach:
ge ing o know he pe son, pe sonal
ea men , and espec and
acknowledgmen .
3.- Coping wi h s ess / anxie y by p ac icing
isualiza ion.
Du ing he session:
PCC domains: ge ing o
know he pe son, pe sonal
ea men , and espec and
acknowledgmen .
Visualiza ion.
Homewo k:
Relaxa ion and eco ding.
P ac icing he PCC
app oach and eco ding.
5: How can I
manage BPSDs
and o he
di icul ies
associa ed wi h
ca e? II
1.- Planning and implemen a ion o ca e asks,
bea ing in mind he di e en domains o
he Pe son-Cen e ed Ca e app oach:
p omo ing independence and au onomy,
space and meaning ul en i onmen .
2.- Iden i ica ion o al e na i e beha io s in
esponse o PBSs and o he beha io al
p oblems, in acco dance wi h he PCC
app oach.
3.- Coping wi h s ess / anxie y by p ac icing
isualiza ion.
Du ing he session:
PCC domains: p omo ing
independence and
au onomy, space and
meaning ul en i onmen .
Al e na i e esponse
beha io s.
Visualiza ion.
Homewo k:
Relaxa ion and eco ding.
P ac icing he PCC
app oach and eco ding.
6: Lea e aking
1.- Re iew o he echniques and skills lea ned.
2.- Iden i ica ion o he long- e m bene i s ha
come wi h con inued p ac ice.
3.- P e en ion o elapse.
Du ing he session:
Coping wi h anxie y
( elaxa ion), unpleasan
emo ions ( hough -s opping,
sel -ins uc ions and
pleasan ac i i ies), BPSDs
and o he beha io al
p oblems (PCC, posi i e
ein o cemen , e c.).
Feedback o paid
ca egi e s.
E alua ion o he p og am.
Homewo k:
40
ONLINE PROGRAM FOR HOME CARE WORKERS
Con inue o p ac ice he
skills and echniques
lea ned.
41
ONLINE PROGRAM FOR HOME CARE WORKERS
Table 3
Cha ac e is ics Linked o he Heal h o he Pa icipan s a Baseline (N = 20)
Va iables
M
SD
Cu o poin s
n (%)
Bu nou
High
A e age
Low
Emo ional exhaus ion
20.39
12.51
6 (30%)
5 (25%)
9 (45%)
Depe sonaliza ion
5.35
6.40
4 (20%)
4 (20%)
23 (60%)
Pe sonal accomplishmen
41.68
5.70
15 (75%)
4 (20%)
1 (5%)
Sel - a ed heal h
O e 50
Unde 50
Physical dimension
46.61
8.57
9 (45%)
11 (55%)
Men al dimension
49.03
11.46
13 (65%)
7 (35%)
Anxie y and dep ession
No case
P obable case
Case
Anxie y
6.95
4.33
11 (55%)
5 (25%)
4 (20%)
Dep ession
4.35
3.94
17 (85%)
1 (5%)
2 (10%)
