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      Web-Based STAR E-Learning Course Increases Empathy and Understanding in Dementia Caregivers: Results from a Randomized Controlled Trial in the Netherlands and the United Kingdom

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          Abstract

          Background

          The doubling of the number of people with dementia in the coming decades coupled with the rapid decline in the working population in our graying society is expected to result in a large decrease in the number of professionals available to provide care to people with dementia. As a result, care will be supplied increasingly by untrained informal caregivers and volunteers. To promote effective care and avoid overburdening of untrained and trained caregivers, they must become properly skilled. To this end, the European Skills Training and Reskilling (STAR) project, which comprised experts from the domains of education, technology, and dementia care from 6 countries (the Netherlands, Sweden, Italy, Malta, Romania, and the United Kingdom), worked together to create and evaluate a multilingual e-learning tool. The STAR training portal provides dementia care training both for informal and formal caregivers.

          Objective

          The objective of the current study was to evaluate the user friendliness, usefulness, and impact of STAR with informal caregivers, volunteers, and professional caregivers.

          Methods

          For 2 to 4 months, the experimental group had access to the STAR training portal, a Web-based portal consisting of 8 modules, 2 of which had a basic level and 6 additional modules at intermediate and advanced levels. The experimental group also had access to online peer and expert communities for support and information exchange. The control group received free access to STAR after the research had ended. The STAR training portal was evaluated in a randomized controlled trial among informal caregivers and volunteers in addition to professional caregivers (N=142) in the Netherlands and the United Kingdom. Assessments were performed with self-assessed, online, standardized questionnaires at baseline and after 2 to 4 months. Primary outcome measures were user friendliness, usefulness, and impact of STAR on knowledge, attitudes, and approaches of caregivers regarding dementia. Secondary outcome measures were empathy, quality of life, burden, and caregivers’ sense of competence.

          Results

          STAR was rated positively by all user groups on both usefulness and user friendliness. Significant effects were found on a person-centered care approach and on the total score on positive attitudes to dementia; both the experimental and the control group increased in score. Regarding empathy, significant improvements were found in the STAR training group on distress, empathic concern, and taking the perspective of the person with dementia. In the experimental group, however, there was a significant reduction in self-reported sense of competence.

          Conclusions

          The STAR training portal is a useful and user-friendly e-learning method, which has demonstrated its ability to provide significant positive effects on caregiver attitudes and empathy.

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          Most cited references27

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          Random allocation software for parallel group randomized trials

          Background Typically, randomization software should allow users to exert control over the different aspects of randomization including block design, provision of unique identifiers and control over the format and type of program output. While some of these characteristics have been addressed by available software, none of them have all of these capabilities integrated into one package. The main objective of the Random Allocation Software project was to enhance the user's control over different aspects of randomization in parallel group trials, including output type and format, structure and ordering of generated unique identifiers and enabling users to specify group names for more than two groups. Results The program has different settings for: simple and blocked randomizations; length, format and ordering of generated unique identifiers; type and format of program output; and saving sessions for future use. A formatted random list generated by this program can be used directly (without further formatting) by the coordinator of the research team to prepare and encode different drugs or instruments necessary for the parallel group trial. Conclusions Random Allocation Software enables users to control different attributes of the random allocation sequence and produce qualified lists for parallel group trials.
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            Interactive Health Communication Applications for people with chronic disease.

            Interactive Health Communication Applications (IHCAs) are computer-based, usually web-based, information packages for patients that combine health information with at least one of social support, decision support, or behaviour change support. These are innovations in health care and their effects on health are uncertain. To assess the effects of IHCAs for people with chronic disease. We designed a four-part search strategy. First, we searched electronic bibliographic databases for published work; second, we searched the grey literature; and third, we searched for ongoing and recently completed clinical trials in the appropriate databases. Finally, researchers of included studies were contacted, and reference lists from relevant primary and review articles were followed up. As IHCAs require relatively new technology, the search time period commenced at 1990, where possible, and ran until 31 December 2003. Randomised controlled trials (RCTs) of IHCAs for adults and children with chronic disease. One reviewer screened abstracts for relevance. Two reviewers screened all candidate studies to determine eligibility, apply quality criteria, and extract data from included studies. Authors of included RCTs were contacted for missing data. Results of RCTs were pooled using random-effects model with standardised mean differences (SMDs) for continuous outcomes and odds ratios for binary outcomes; heterogeneity was assessed using the I(2 )statistic. We identified 24 RCTs involving 3739 participants which were included in the review.IHCAs had a significant positive effect on knowledge (SMD 0.46; 95% confidence interval (CI) 0.22 to 0.69), social support (SMD 0.35; 95% CI 0.18 to 0.52) and clinical outcomes (SMD 0.18; 95% CI 0.01 to 0.35). Results suggest it is more likely than not that IHCAs have a positive effect on self-efficacy (a person's belief in their capacity to carry out a specific action) (SMD 0.24; 95% CI 0.00 to 0.48). IHCAs had a significant positive effect on continuous behavioural outcomes (SMD 0.20; 95% CI 0.01 to 0.40). Binary behavioural outcomes also showed a positive effect for IHCAs, although this result was not statistically significant (OR 1.66; 95% CI 0.71 to 3.87). It was not possible to determine the effects of IHCAs on emotional or economic outcomes. IHCAs appear to have largely positive effects on users, in that users tend to become more knowledgeable, feel better socially supported, and may have improved behavioural and clinical outcomes compared to non-users. There is a need for more high quality studies with large sample sizes to confirm these preliminary findings, to determine the best type and best way to deliver IHCAs, and to establish how IHCAs have their effects for different groups of people with chronic illness.
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              Usability and User Experience

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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                October 2015
                30 October 2015
                : 17
                : 10
                : e241
                Affiliations
                [1] 1VU University medical center Amsterdam Department of Psychiatry AmsterdamNetherlands
                [2] 2Staffordshire University Faculty of Health Sciences StaffordUnited Kingdom
                [3] 3Medea FirenzeItaly
                [4] 4Internit LuleaSweden
                [5] 5Across Limits HamrunMalta
                [6] 6University of Ulster Faculty of Computing and Engineering NewtownabbeyUnited Kingdom
                [7] 7University of Chester Department of Health & Social Care ChesterUnited Kingdom
                Author notes
                Corresponding Author: Bart Hattink b.hattink@ 123456vumc.nl
                Author information
                http://orcid.org/0000-0002-9472-2201
                http://orcid.org/0000-0001-6219-5390
                http://orcid.org/0000-0001-9898-923X
                http://orcid.org/0000-0001-9874-8874
                http://orcid.org/0000-0002-8456-7957
                http://orcid.org/0000-0003-1568-6562
                http://orcid.org/0000-0002-2281-6970
                http://orcid.org/0000-0002-2340-4580
                http://orcid.org/0000-0001-7556-7739
                http://orcid.org/0000-0002-3526-6170
                http://orcid.org/0000-0003-0882-7902
                http://orcid.org/0000-0002-8726-6084
                http://orcid.org/0000-0002-4812-1229
                Article
                v17i10e241
                10.2196/jmir.4025
                4642792
                26519106
                6acbbf6b-2a76-407b-b8e1-b80b210ee312
                ©Bart Hattink, Franka Meiland, Henriëtte van der Roest, Peter Kevern, Francesca Abiuso, Johan Bengtsson, Angele Giuliano, Annalise Duca, Jennifer Sanders, Fern Basnett, Chris Nugent, Paul Kingston, Rose-Marie Dröes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.10.2015.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

                History
                : 12 November 2014
                : 12 February 2015
                : 7 April 2015
                : 21 June 2015
                Categories
                Original Paper
                Original Paper

                Medicine
                dementia,caregivers,distance-learning,empathy
                Medicine
                dementia, caregivers, distance-learning, empathy

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