Evaluation of a Training Program for Healthcare Professionals Supporting Informal Caregivers of People with Dementia: A Pre-Post Quasi-Experimental Study

Evaluation of a Training Program for Healthcare Professionals Supporting Informal Caregivers of People with Dementia: A Pre-Post Quasi-Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of a Training Program for Healthcare Professionals Supporting Informal Caregivers of People with Dementia: A Pre-Post Quasi-Experimental Study Coline Crutzen, Laura Deprez, Stéphane Adam This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5455672/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Despite their proven effectiveness, support interventions for caregivers of people with neurodegenerative diseases struggle to be sustainably implemented. In this context, the “Caregivers /Network-Service” (“Aidants Proches / Réseau-Service”) project (Interreg) aimed to create a network of professionals specialized in supporting family caregivers through training programs. The goal of this study was to determine the overall impact of the proposed training. Methods A total of 217 healthcare professionals participated in the training, and 108 agreed to take part in the study. Based on the Kirkpatrick-Barr framework (Barr et al., 2000) and the study by Parmar et al. (2022), the training’s outcomes were evaluated at four levels: (1) professionals’ reactions to the training, (2) changes in their learning (knowledge and skills), (3) changes in their practices, (4A) organizational changes, and (4B) clinical changes. For the latter level, a multiple case study was conducted with caregivers receiving individualized support from trained professionals. Results The training was highly appreciated and improved the knowledge, skills, and practices of the professionals. It also promoted organizational changes, such as the implementation of new support services for caregivers. The individualized support provided by the trained professionals appeared to have positive clinical effects on caregivers, who also recommended the service. Conclusion Given the demonstrated effectiveness of these support services, as highlighted by our research, and in light of the lack of initiatives in the field, we strongly recommend the implementation of such training programs for healthcare professionals. Health education training program informal caregivers healthcare professionals Kirkpatrick-Barr Figures Figure 1 Figure 2 BACKGROUND The aging of the population in modern societies is at the root of many societal challenges, including the increase in the number of people diagnosed with Alzheimer’s disease. In 2019, 57 million people worldwide were affected by this diagnosis, and this figure is expected to rise to 152 million by 2050 (1). Despite the growing number of diagnosed individuals, many uncertainties remain about these diseases, commonly referred to as "dementias" (2). Alzheimer’s disease is one of the most prevalent neurodegenerative diagnoses in Europe. However, a clear definition of this disease is still under debate (3). Some scientists even suggest the need to reconceptualize this pathology (4–9). The low effectiveness of curative treatments (such as anti-Alzheimer medications) fuels this lack of consensus (10–12). The "false promises" of medication, combined with the diagnostic uncertainties and progression of symptoms, can cause considerable distress for both individuals affected by the disease and their families. This situation calls for a shift away from a purely medical management strategy and toward a more holistic and integrative approach (9). In recent years, non-pharmacological interventions have become more common, aiming to improve the quality of life of patients and their families (13,14). Among these interventions is "caregiver support," which refers to supporting the relatives of people with the disease. Various caregiver support interventions are currently being developed and have already demonstrated real effectiveness (15). These interventions notably improve quality of life for caregivers (15,16), which can positively affect the individuals with the disease, as their well-being is directly linked to the informal caregiver’s health (17,18). This support can also delay the patient’s institutionalization (19–21), leading to a significant reduction in healthcare costs (14,19,22). A meta-analysis of 131 studies shows that caregiver support interventions significantly reduce caregiver burden/stress, depression, and anxiety, while improving well-being, physical health, disease knowledge, social support, and positive aspects of caregiving (15). The study also shows that support is more effective when the program includes multiple types of interventions or combines a psychoeducational component with a psychoaffective one. The healthcare professional’s ability to create a customized plan tailored to the specific needs of each caregiver is a key factor for effectiveness (23). Despite the demonstrated effectiveness of caregiver support, these services struggle to be sustainably implemented in Europe (14,22). To ensure the implementation of these support services, training programs are often provided to healthcare professionals. Although the effectiveness of training for professionals has been demonstrated (24–26), these programs tend to focus more on Alzheimer’s disease and the older patient than on informal caregivers. Parmar et al. (2020) (27) found little scientific research regarding the training of healthcare professionals specifically in caregiver support. Accordingly, in their systematic review, Badovinac et al. (2019) (28) note that healthcare professionals are generally poorly prepared to support caregivers, and this topic is largely overlooked in their education programs. However, many American experts believe that caregiver support should be an integral part of basic healthcare professional training (28,29). To make these recommendations a reality, Parmar et al. (2020) (27) convened an expert panel that identified six competency areas to include in healthcare professionals’ training for caregiver support. An online training program, consisting of six modules, was then offered to a group of healthcare professionals (n=161) (30). The program was evaluated, and the results revealed improvements in the professionals’ knowledge, confidence, and practices regarding caregiver support. To assess their training program, Parmar et al. (2022) (30) used the first three of the four evaluation levels proposed in the Kirkpatrick-Barr evaluation framework (see Figure 1). In this same perspective, the “Caregivers/Network-Service” project (“Aidants Proches/Réseau-Service”) (2016–2021), funded by the Interreg-V cross-border cooperation program (France-Wallonia-Flanders), was developed. The project aimed to create a network of professionals specialized in supporting caregivers of older people with neurodegenerative diseases. To build this network, a training program on caregiver support was delivered and meetings were organized in France (specifically in the Hauts-de-France region) and in three Belgian provinces (Hainaut, Namur, and Luxembourg). Two versions of the training were developed: a three-day version, primarily aimed at home care providers, and a five-day version, primarily aimed at psychologists wishing to offer individualized (counseling-type) support to informal caregivers. The training was delivered 9 times in the short version and 5 times in the long version. For more information on the training and its content, see Additional file 1. The aim of our study was to evaluate the proposed training by exploring its impact at the four levels of analysis in the Kirkpatrick-Barr model (31). Level 4B was evaluated through a multiple case study involving caregivers who received individualized (counseling-type) support from trained professionals. Based on the Kirkpatrick-Barr framework (31) and the study by Parmar et al. (2022) (30), the following objectives were defined for our study: In this same perspective, the “Caregivers/Network-Service” project (“Aidants Proches/Réseau-Service”) (2016–2021), funded by the Interreg-V cross-border cooperation program (France-Wallonia-Flanders), was developed. The project aimed to create a network of professionals specialized in supporting caregivers of older people with neurodegenerative diseases. To build this network, a training program on caregiver support was delivered and meetings were organized in France (specifically in the Hauts-de-France region) and in three Belgian provinces (Hainaut, Namur, and Luxembourg). Two versions of the training were developed: a three-day version, primarily aimed at home care providers, and a five-day version, primarily aimed at psychologists wishing to offer individualized (counseling-type) support to informal caregivers. The training was delivered 9 times in the short version and 5 times in the long version. For more information on the training and its content, see Additional file 1. The aim of our study was to evaluate the proposed training by exploring its impact at the four levels of analysis in the Kirkpatrick-Barr model (31). Level 4B was evaluated through a multiple case study involving caregivers who received individualized (counseling-type) support from trained professionals. Based on the Kirkpatrick-Barr framework (31) and the study by Parmar et al. (2022) (30), the following objectives were defined for our study: 1. Provide healthcare professionals with a satisfying and useful training program (Level 1). 2. Deepen healthcare professionals’ knowledge and improve their skills (Level 2), specifically: 2.1. Improve knowledge of aging by reducing ageist beliefs and attitudes among professionals. Indeed, compared to the general population, healthcare professionals tend to display more ageism and view older people more negatively ((32–34). However, for an unbiased and objective evaluation of clinical situations, it is essential to dismantle their preconceived ideas and stereotypes about normal and pathological aging. 2.2. Improve their knowledge about neurodegenerative diseases. 2.3. Enhance their ability to identify caregivers in need of support. 3. Increase healthcare professionals’ job satisfaction (Level 3). It has been shown that an intervention aimed at improving professionals' understanding of neurodegenerative diseases can lead to increased job satisfaction (26). The latter study focused on professionals working directly with individuals affected by these diseases. Nevertheless, based on this finding, we hypothesized that a better understanding of caregivers' experiences could improve job satisfaction for professionals working with caregivers. 4. Positively impact healthcare professionals’ organizational practices (Level 4A) (e.g., encourage the development of new individualized support services for caregivers). 5. Reduce caregivers’ psychological distress through the support offered by the healthcare professionals trained in this project (Level 4B). This will be demonstrated through a multiple case study conducted directly with caregivers. METHODS Professionals who agreed to participate in our study were evaluated twice: two weeks before the training ("pre-training evaluation") and five weeks after the end of the program ("post-training evaluation"). These evaluations were conducted through an online survey sent individually to each professional. Before answering the questions, healthcare professionals were informed about the research objectives, study process, and data handling (confidentiality, anonymity, rights). They then provided informed consent to participate in the study, which had been previously approved by the ethics committee of the University of Liège. Data collection took place throughout the project, between January 2017 and July 2019. Evaluation Tools Participant Characteristics We collected the following sociodemographic data from each participant: age, gender, nationality (French or Belgian), years of education (after high school), and current profession (nurse, social worker, caregiver, occupational therapist, psychologist, etc.). Participants’ Reactions to the Training (Level 1) Perceived usefulness and satisfaction with the training were assessed using five questions: "Are you generally satisfied with the training?"; "Are you satisfied with (a) the content of the training? (b) the format (presentation method, materials used, etc.)?"; and "Did you find this training useful for (a) your theoretical knowledge? (b) your professional practice?" Participants responded using a scale from 0 ("not at all") to 10 ("completely"). Participants’ Learning (Knowledge and Skills) (Level 2) Participants’ ageism was assessed using two tools: (1) A "5-word" fluency task (used only in the pre-training assessment) (35,36) in which participants were asked to spontaneously list the first five words that come to mind when thinking about an older person. The words were then analyzed for emotional valence (positive, negative, or neutral) and frequency of mention. To broaden the analysis, participants were asked to do the same exercise for "a young person," "a person with Alzheimer’s disease," and "a caregiver." (2) The "Ambivalent Ageism Scale" (AAS) (37), used both pre- and post-training, measures the level of ageism and distinguishes between benevolent and hostile ageism. The questionnaire consists of 13 items rated on a Likert scale from 1 ("strongly disagree") to 7 ("strongly agree"). A higher score indicates greater ageism. Knowledge about neurodegenerative diseases was assessed using the "Dementia Attitudes Scale" (DAS) (38), which includes 20 questions rated on a Likert scale from 1 ("strongly disagree") to 7 ("strongly agree"). A total score and two sub-scores were calculated: "knowledge of neurodegenerative diseases" and "social comfort" (i.e., the ability to interact appropriately with someone with Alzheimer’s). A higher score indicates better knowledge. We also included self-assessment questions asking professionals to rate their knowledge in seven areas (e.g., general aging, Alzheimer’s disease, cognitive functioning in Alzheimer’s, etc.) on a scale from 0 ("low knowledge") to 10 ("excellent knowledge"). To assess professionals' skills in identifying caregivers in need of support, we created a questionnaire with 12 clinical scenarios. These scenarios depicted daily interactions between a person with Alzheimer’s and their caregiver. Professionals were asked to evaluate the relevance of various caregiver reactions using a scale from 0 ("not at all relevant") to 10 ("completely relevant"). Their responses were compared with those of six expert psychologists from the Aging Psychology Department at the University of Liège. Inter-rater reliability (IRR) was high (>0.80), both among experts (IRR = 0.94) and among professionals (IRR pre-training = 0.98; IRR post-training = 0.99). The difference in scores between professionals and experts was calculated before and after the training, yielding two new variables: (a) pre-training difference scores and (b) post-training difference scores, for which only the absolute values were used. Participants’ Professional Practices (Job Satisfaction) (Level 3) Job satisfaction was measured using three questions: (1) perceived satisfaction, (2) perceived emotional exhaustion, and (3) perceived physical exhaustion when working with people with Alzheimer’s and/or their caregivers. Three additional questions assessed perceived competence related to job satisfaction (39) : (4) perceived competence in working with individuals with Alzheimer’s, (5) perceived competence in working with their caregivers, and (6) perceived competence in detecting caregiver burnout. For all six questions, participants were asked to answer on a scale from 0 ("not at all") to 10 ("completely"). Participants’ Organizational Practices (Level 4A) Participants were asked to provide a concrete example of how the training had impacted their professional or organizational practices. A qualitative thematic analysis was performed on these responses, providing insights into the effects of the training on both Level 3 (professional practices) and Level 4A (organizational practices). Caregivers’ Clinical Outcomes (Level 4B) To assess the clinical impact of individualized (counseling-type) support on caregivers, we conducted a multiple case study directly with caregivers. Eligibility criteria included: being the caregiver of someone with Alzheimer’s or a related disease, voluntarily requesting consultation with a trained psychologist, and being French-speaking and literate. A telephone interview was conducted before the first consultation ("pre-intervention evaluation"), which included: - A brief anamnesis to gather sociodemographic and situational data (e.g., age, gender, nationality, profession, relationship status to the patient, etc.). - An assessment of subjective burden using the "12-item Zarit Burden Interview" (40)with items rated on a 5-point Likert scale from 0 ("never") to 4 ("almost always"). A higher score indicates greater burden. - An evaluation of psychological distress using the "14-item Psychological Distress Index" (IDPESQ) (41), with items rated on a 4-point Likert scale from 0 ("never") to 3 ("very often"). A higher score indicates greater distress. A similar interview was conducted six months later, after one or more support sessions with the trained psychologist ("post-intervention evaluation"). This second interview also assessed caregiver satisfaction with the support sessions using three measures: (a) a closed-ended question ("yes" or "no") asking whether they would recommend these individualized support sessions to someone in a similar situation; (b) an evaluation of their satisfaction with the support intervention and their perception of its benefits and usefulness on a scale from 0 (minimum) to 10 (maximum); and (c) a questionnaire designed to assess the potential benefits of the support intervention, consisting of 11 items (e.g., "Did this support intervention help you better understand your loved one's illness?"), rated on a 3-point Likert scale (0 = "I did not observe this effect," 1 = "I moderately observed this effect", 2 = "I fully observed this effect"). A higher score indicates more observed benefits. Before participating, informal caregivers were informed about the study’s objectives, procedures, and data handling, and gave informed consent during the first phone interview. The multiple case study was approved by the ethics committee of the University of Liège, and caregiver data were collected between January 2018 and July 2019. Data Analysis Quantitative data related to the training were analyzed using SPSS - version 25 (IBM Corp, 2018), with a significance threshold of p < 0.05. Quantitative data from the informal caregivers' support study were analyzed using the Single Case Research statistical software, which allowed for both individual and combined analyses of each case. A significance threshold of p < 0.05 was applied. We used the NAP ("Nonoverlap of All Pairs") index, which is particularly suited for assessing the effectiveness of therapeutic interventions (42). The NAP quantifies effect size by calculating the percentage of non-overlapping points between the baseline and intervention phases (43). A higher percentage of non-overlap indicates that the intervention led to significant progress and behavioral change. If the intervention aims to reduce scores (e.g., reduce the caregiver's subjective burden), the NAP value should be reversed (e.g., if NAP = 0.40, the reversed NAP = 1 – 0.40 = 0.60). NAP values between 0 and 0.65 indicate a small effect, between 0.66 and 0.92 a medium effect, and between 0.93 and 1 a large effect (44). RESULTS Characteristics of the professionals A total of 217 healthcare professionals completed the training (127 completed the 3-day training and 90 completed the 5-day training). Among them, 108 agreed to participate in the study. As shown in Table 1, the sample consisted predominantly of women (94.4%). The participants were relatively young (average age: 35.4 years) and all were native French speakers. All professionals worked in the healthcare sector, with psychologists being the most represented profession in the sample (46.3%). Table 1. Characteristics of participants Overall sample (n=108) Age (mean, SD) 35.41 (9.49) Gender (n, %) Women 102 (94.4 %) Men 6 (5.6 %) Nationality (n, %) French 56 (51.9 %) Belgian 52 (48.1%) Educational level (after high school) (mean, SD) 3.8 (1.53) Current profession (n, %) Nursing assistant 16 (14.8 %) Social worker 20 (18.5 %) Educator 2 (1.9 %) Occupational therapist 5 (4.6 %) Nurse 14 (13 %) Psychlogist 50 (46.3 %) 1. Participants’ Reactions to the Training (Level 1) Overall, the professionals were satisfied with the training and considered it highly useful, both in terms of theory and practice (see Table 2). 2. Participants’ Learning (Knowledge and Skills) (Level 2) 2.1 Ageist beliefs and attitudes The "5 words" fluency task was used as an indicative (rather than evaluative) tool, as it was not included in the post-training survey. From the healthcare professionals’ responses, we created four different word clouds illustrating professionals’ pre-training perceptions of an older person, a young person, someone with Alzheimer’s disease, and a caregiver (see Figure 2). Larger word size reflects higher frequency of mention. The word cloud related to an "older person" was generated from the 30 words most frequently mentioned by healthcare professionals. Of these, 27% were neutral (e.g., aging, grandparents), 23% were positive (e.g., experience, wisdom), and 50% were negative (e.g., isolation, need for help). The five most frequently mentioned words were "isolation" (mentioned 34 times, representing 4.75% of the total words), "need for help" (30 times, 4.20%), "wisdom" (30 times, 4.20%), "dependence" (29 times, 4.06%), and "loss of autonomy" (29 times, 4.06%). Of these five most frequent words, four were negative. In contrast, the word cloud for a "young person," composed of the 30 most frequently mentioned words, shows a majority of positive words (67%), some neutral words (30%), and only one negative word (3%), highlighting a stark contrast in the representation of older versus young people. The third word cloud illustrates the 30 most frequent words associated with Alzheimer’s disease. Here, the words are overwhelmingly negative (90%), with a small portion being neutral (7%) or positive (3%). Although this result is expected, it is worth noting that the healthcare professionals focused exclusively on the disease, rather than the person. The older person living with this pathology seems overshadowed by the diagnostic label, as positive words, already rare for older individuals, disappear entirely in this context. Finally, the word cloud for "caregiver," based on the 50 most frequently mentioned words, is predominantly negative (48%), 28% neutral and 24% positive. "Need for help" was mentioned by 46% of the professionals, "exhaustion" by 38%, and "fatigue" by 32%. While caregiving can indeed be exhausting and painful, professionals who primarily interact with caregivers seeking support may overestimate the negative aspects of this role. Several scientific studies highlight the existence of positive experiences in caregiving (e.g., feelings of satisfaction, personal fulfillment, sense of usefulness) (45–47). Regarding ageism as measured by the Ambivalent Ageism Scale (AAS), the Student's t-test indicated a significant reduction in the total score post-training. This reduction was observed for both hostile and benevolent forms of ageism (see Table 2). 2.2 Knowledge about neurodegenerative diseases Student’s t-tests were conducted to compare the pre- and post-training scores on the Dementia Attitude Scale (DAS). A significant increase in total and sub-scores was observed after the training (see Table 2), indicating improved knowledge about dementia and more positive attitudes toward individuals with dementia. Additionally, we compared professionals’ self-assessment of their knowledge before and after the training. For each domain surveyed, a significant increase in self-reported knowledge was observed (see Table 2). 2.3 Skills regarding caregivers The ability to identify caregivers in need of support was measured using 12 fictional scenarios assessed by both professional participants and experts. A paired-sample Student’s t-test on the difference scores showed that professionals’ post-training responses were significantly closer to experts’ responses compared to pre-training (see Table 2). 3. Participants’ Professional Practices (Job Satisfaction) (Level 3) Using a Student’s t-test, we compared self-reported job satisfaction before and after the training. For 4 of the 6 dimensions in the questionnaire, a significant increase in job satisfaction was observed post-training. No significant differences were found for physical and emotional exhaustion related to work (see Table 2). Table 2. Scores of professionals (n=108) before and after training on Level 1, 2, and 3 questionnaires Level of analysis Questionnaire Pre-training Mean (SD) Post-training Mean (SD) Statistical values t (p) Level 1 Participants’Reactions Questionnaire General satisfaction - 8.81 (1.31) - Satisfaction with the content - 8.96 (1.26) - Satisfaction with the format - 8.99 (1.25) - Theoretical usefulness - 8.63 (1.56) - Practical usefulness - 8.27 (1.52) - Level 2 « Ambivalent Ageism Scale » (AAS) Questionnaire Total score 29.40 (12.43) 21.16 (8.76) t (106)= 8.73 (0.00) ** Subscore "malignant ageism" 8.53 (4.26) 6.91 (2.90) t (106)= 4.537 (0.00) ** Subscore "benevolent ageism" 20.87 (9.78) 14.25 (6.90) t (106)= 8.79 (0.00) ** « Dementia Attitude Scale » (DAS) Questionnaire Total score 117.44 (12.11) 122.05 (9.79) t(107)=-5.48 (0.00) ** Subscore "knowledge" 61.34 (6.04) 62.44 (5.33) t(107)=-2.08 (0,04) * Subscore "social comfort" 56.10 (8.05) 59.60 (6.57) t(107)=-6.02 (0.00) ** Self-assessment Questionnaire of Knowledge About general aging 6.69 (1.28) 7.14 (1.16) t(107)=-3.68 (0.00)** About Alzheimer's disease (AD) 6.94 (1.41) 7.55 (1.05) t(107)=-4.55 (0.00)** About cognitive functioning in people with AD 6.47 (1.91) 7.36 (1.32) t(107)=-6.24 (0.00)** About behavioural problems in people with AD 6.56 (1.72) 7.28 (1.07) t(107)=-5.10 (0.00)** About other forms of "dementia" 5.69 (1.93) 6.60 (1.66) t(107)=-4.96 (0.00)** About caregiver burnout 6.28 (1.84) 7.38 (1.14) t(107)=-7.11 (0.00)** About existing support services for caregivers 6.32 (2.16) 7.44 (1.43) t(107)=-6.91 (0.00)** Skills regarding Family Caregivers (Scenarios) Difference score between participants and the expert group 1.69 (1.42) 0.77 (0.68) t(37=)-5.01 (0.00)** Level 3 Self-assessment Questionnaire of Professional Satisfaction / Professional Exhaustion Perceived satisfaction with work done with individuals with AD and/or their family caregivers 6.75 (1.39) 7.21 (1.36) t(107)=-3.88 (0.00)** Perceived emotional exhaustion from work with individuals with AD and/or their caregivers a 7.19 (2.09) 7.17 (2.54) t(107)=0.14 (0.89) Perceived physical exhaustion from work with individuals with AD and/or their caregivers a 7.76 (2.07) 7.78 (2.30) t(107)=-0.09 (0.93) Perceived competence in working with individuals with AD 6.44 (1.80) 7.25 (1.39) t(107)=-5.22 (0.00)** Perceived competence in working with the family caregivers 6.42 (1.77) 7.36 (1.23) t(107)=-6.59 (0.00)** Perceived competence in detecting the distress (or 'burnout') of family caregivers 5.90 (1.99) 7.40 (1.13) t(107)=-9.23 (0.00)** ** p<0,01; *p<0,05; a reverse-scored item: 10 = less exhaustion INSERT TABLE 2. (See end of document) 4. Participants' Organizational Practices (Level 4A) Among the 108 participants, 6 did not provide responses regarding the practical and/or organizational impact of the training, 3 professionals indicated that they had not had the opportunity to implement a specific initiative after the training, and 2 professionals’ responses were excluded from the analysis due to overly general information. A total of 97 responses were processed and categorized (see Table 3). Table 3. Practical and/or organizational impacts of the training (n=97) Professionals’ responses n (%) The training allowed them to: Better support family caregivers 41 (42%) o To be more capable of explaining Alzheimer's disease/dementias 14 (14%) o To identify caregivers' difficulties and refer them for individualized support 7 (7%) o To use practical tools in support interventions 6 (6%) o To acknowledge the caregiver's role, pay attention to their difficulties, and listen to them 5 (5%) o To provide better advice to caregivers 4 (4%) o To better support caregivers (overall) 1 (1%) o To gain a better understanding of caregivers' experiences 2 (2%) o To enhance the individualization of caregiver support 2 (2%) Utilize specific theoretical knowledge in practice (improved understanding of “dementias” / family caregivers) 14 (14%) Adopt a new perspective and reduce misconceptions about "dementias," caregivers, or aging in general 11 (11%) Feel reassured or supported in one's practice (feel more confident) 8 (8%) Better understand and address the management of behavioral issues in the patient 6 (6%) Exchange ideas with other professionals in the field 6 (6%) Develop or promote the development of new support services for family caregivers 3 (3%) Use practical tools developed within the research project 2 (2%) 5. Caregivers’ Clinical Outcomes (Level 4B) A multiple case study was conducted with 23 caregivers who received individual (counseling-type) support from a trained professional. Among these, 2 caregivers experienced the death of their loved one during the study and 2 others were not available to complete the post-intervention interview. Thus, post-intervention data were collected for 19 caregivers of individuals with Alzheimer’s disease or a related illness. In order to assess the impact of the support intervention, we compared caregivers' subjective burden (Zarit-12) and psychological distress (IDPESQ-14) before and after the intervention. Among the 19 caregivers in our sample, 6 experienced the permanent institutionalization of their relative during the study. Our analysis therefore focuses on the 13 participants whose relatives remained at home during the study (for more information on the participants’ characteristics, see Additional file 2.). The pre- and post-intervention comparison was conducted using the Single Case Research software, which allows for the analysis of the intervention’s effect on each participant individually and then combines these individual comparisons to determine the overall intervention effect. Since subjective burden and psychological distress are two closely related concepts - both theoretically (48) and psychometrically (49) - and we observed a strong, significant correlation (rs= 0.614, p < 0.05) between these two measures, we analyzed them together. Scores on the two measures were standardized to the same scale (converted to percentages) to allow for grouping. We then compared pre- and post-intervention scores (Zarit-12 and IDPESQ-14 scores pooled together) for each participant. The overall effect of the intervention was calculated by combining the 13 individual analyses (see Table 4). Table 4. Subjective burden (Zarit-12) and psychological distress (IDPESQ-14) of caregivers before and after intervention (n=13) Zarit-12 pre-intervention Raw score (%) Zarit-12 post-intervention Raw score (%) IDPESQ-14 pre-intervention Raw score (%) IDPESQ-14 post-intervention Raw score (%) Statistical values NAP a (p) Subject 1 27 (56.25) 24 (50.00) 39 (69.64) 33 (58.92) 0.25 (0.44) Subject 2 27 (56.25) 26 (54.16) - - 0.00 (0.31) Subject 3 22 (45.83) 19 (39.58) 30 (53.57) 20 (35.71) 0.00 (0.12) Subject 4 15 (31.25) 15 (31.25) 24 (42.86) 27 (48.21) 0.65 (0.69) Subject 5 20 (41.66) 24 (50.00) 38(67.86) 25 (44.64) 0.50 (1.00) Subject 6 17 (35.41) 25 (52.08) 44(78.57) 37 (66.07) 0.50 (1.00) Subject 7 36 (75.00) 35 (72.91) 45 (80.35) 36 (64.28) 0.00 (0.12) Subject 8 23 (47.91) 30 (62.50) 27(48.21) 34 (60.71) 0.87 (0.24) Subject 9 26 (54.16) 16 (33.33) 34 (60.71) 16 (28.57) 0.00 (0.12) Subject 10 11 (22.91) 17 (35.41) 21 (37.50) 22 (39.28) 0.75 (0.43) Subject 11 12 (25.00) 14 (29.16) 21 (37.50) 20 (35.71) 0.50 (1.00) Subject 12 26 (54.16) 19 (39.58) 36 (64.29) 28 (50.00) 0.00 (0.12) Subject 13 33 (68.75) 38 (79.16) 23 (41.07) 43 (76.78) 1.00 (0.12) Combination of individual analyses 0.40 (0,02)* *p<0,05; a Nonoverlap of All Pairs Although no significant effect emerged from individual comparisons, the combined analysis showed a statistically significant effect of the intervention (p = 0.02), supporting our hypothesis of an overall reduction in caregiver burden and psychological distress following the individualized support intervention. The effect size of the intervention is determined by the NAP index, which in this case must be reversed as we aimed to reduce the participants' scores through the intervention. Therefore, the NAP index for our intervention is: 1 – 0.40 = 0.60, indicating a modest reduction in scores due to the intervention (small effect size: NAP <0.65). Caregiver satisfaction with the support intervention received was assessed using three indicators. (a) To the question: "If you met someone in a similar situation to yours (i.e., caring for a loved one with Alzheimer's disease), would you recommend these individualized support sessions?", 18 of the 19 caregivers in our overall sample responded favorably. (b) All 19 caregivers reported high satisfaction with the individualized support intervention, with an average satisfaction rating of 8.72/10. This intervention was considered beneficial (mean score of 8.38/10) and useful (mean score of 8.94/10) by those interviewed. (c) Specifically, the benefits of the intervention most commonly reported by caregivers were: (1) an increased ability to be more positive and optimistic, (2) improved emotional management, and (3) better communication and/or reactions with their loved one. Table 5 provides an overview of all 11 specific intervention effects. Table 5. Specific effects of individualized support consultations (n=19) 0 “I did not observe this effect” (%) 1 “I moderately observed this effect" (%) 2 "I fully observed this effect" (%) Effect 1 – Did the consultations help you better understand your relative’s illness? 0 % 38.46 % 61.54 % Effect 2 – Did the consultations help you feel less stressed / anxious than before? 38.46 % 7.69 % 53.85 % Effect 3 – Did the consultations help you be more optimistic / positive than before? 23.08 % 0 % 76.92 % Effect 4 – Did the consultations help you take more time for yourself? 30.77 % 30.77 % 38.46 % Effect 5 – Did the consultations help you manage your emotions better? 20 % 10 % 70 % Effect 6 – Did the consultations provide you with tips and strategies for managing daily life? 38.46 % 23.08 % 38.46 % Effect 7 – Did the consultations help you find concrete solutions to problems / difficulties? 20 % 30% 50 % Effect 8 – Did the consultations help you react and/or communicate better with your relative? 23.08 % 7.69 % 69.23% Effect 9 – Did the consultations help improve your relationship with your relative? 46.15 % 0 % 53.85 % Effect 10 – Did the consultations have a positive (indirect) impact on your relative? 30.77 % 7.69 % 61.54 % Effect 11 – Did the consultations help you better support your relative? 25 % 16.67 % 58.33 % DISCUSSION The aim of our study was to evaluate the outcomes of a healthcare professional training program on supporting caregivers of people with neurodegenerative diseases. As in Parmar et al.'s study (2022) (30), we based our assessment on the Kirkpatrick-Barr training evaluation framework (31), which proposes an analysis across four distinct levels. At the first level, we observed a positive reaction from the participants, who found the training both satisfactory and useful. The second level of analysis assessed the changes in the knowledge and skills of the trained professionals. Post-training, there was a significant reduction in ageist beliefs and attitudes among professionals, an improvement in knowledge regarding Alzheimer’s disease, and a greater ability to identify caregivers facing adaptation difficulties in response to the disease. Professionals also self-reported having better knowledge on these topics after the training. The third level of analysis focused on professional practices and, more specifically, on job satisfaction. After the training, professionals felt more competent and more professionally satisfied. However, emotional and physical exhaustion related to work did not appear to be impacted by the training. In the Kirkpatrick-Barr framework, level 4A looks at changes in professionals’ organizational practices. For this study, our assessment positioned itself between levels 3 and 4A (impact on professional practices and organizational practices). Exploratively, we observed that the training helped improve caregiver support practices (e.g., professionals reported being better able to explain the diseases or use more concrete tools in their support intervention). Regarding organizational outcomes, key findings include the creation of opportunities to discuss and collaborate with other professionals in the field (through the creation of a network of trained professionals) and, in some cases, the development of new caregiver support services that did not exist before the training. Finally, the last level of analysis (4B) focuses on the clinical impact of the training. To assess this level, we conducted a multiple case study directly involving caregivers who received individualized (counseling-type) support from trained professionals. When individual caregiver comparisons are combined, we observe a significant reduction in their subjective burden and psychological distress. Limitations In this study, we chose to perform an extensive evaluation of the training's effects. Five levels of analysis were considered together in our research: professionals’ reactions (level 1), changes in their knowledge and skills (level 2), changes in their professional practices (level 3), changes in their organizational practices (level 4A), and clinical outcomes (level 4B). We opted for a relatively broad analysis providing an overview of the impacts of this type of training program, given the limited number of studies on this subject (30). However, this choice does not allow for exhaustive evaluations at each level of analysis, leading to certain methodological weaknesses. The latter include the lack of validated questionnaires. Several questionnaires were created for this research, which is common in exploratory studies like this one. However, it would have been useful to select additional validated questionnaires to facilitate comparison of our results with those of other studies. Regarding the questionnaires, we also regret the lack of "positive" measures. Concerning caregiver support, there are multiple questionnaires that, unlike the Zarit scale or the psychological distress scale (IDPESQ-14), also measure the positive aspects of caregiving (e.g., The “Caregiving Ambivalence Scale” (50); the “CADI-CASI-CAMI” (51)). Another limitation of our research concerns level 4A of the Kirkpatrick-Barr framework, i.e., the organizational outcomes of the training. This level was examined through a single (open-ended) question, which also considered practice-level impacts (level 3), making it difficult to obtain specific information about the organizational transformations related to the training. In our multiple case study (level 4B), as we combined individual analysis results, it would have been interesting to compare them with those of a control group (caregivers who did not receive support). Our participant recruitment method also presents a limitation as the professionals recruited were volunteers, which may increase the likelihood of receiving positive reactions to the training (compared to designated professionals). Finally, our study design does not allow us to understand the long-term impact of the training. Only the direct repercussions were considered in this study, and we cannot determine whether the observed changes are maintained over time. Recommendations Caregiver support interventions have long been recognized as valid and effective (15,52,53). Despite these findings, in practice, it appears difficult to truly implement these initiatives in a sustainable way (22), which may be explained by several barriers. First, the lack of flexibility (particularly within institutional settings) hinders the individualization of support interventions, even though it is a key criterion for effectiveness (15). The heterogeneity of clinical situations is such that support programs must be tailor-made (23). This is one of the reasons why "multi-component" interventions are generally recognized as more effective (15). Similarly, support interventions that can adapt to the evolving needs of caregivers over time are more appropriate (15). In this research project, we found that professionals encountered difficulties in developing support services for caregivers when their practice was constrained by a set of directives dependent on their institutional framework (e.g., in a hospital setting, professionals may be constrained by billing rules, inclusion criteria, or a limited number of sessions). We therefore recommend that these services be offered within a flexible framework, in which professionals are free to adjust the quantity, frequency, location (e.g., home visits if necessary), and content of the sessions. The lack of political and institutional mobilization is a second barrier to the implementation of family caregivers support services. Despite evidence of their effectiveness, there is insufficient political awareness of the importance of these programs to lead to strong measures promoting the popularization and sustainability of these services. In this research project, we observed a significant difference between the service offerings available in France (Hauts-de-France) compared to those in Belgium (Wallonia). In the Hauts-de-France region, over twenty “Caregiver Support and Respite Platforms” provide caregivers with free services such as respite, information, and individualized support. In Wallonia, only a few hospital clinics and non-profit organizations offer inconsistent (often non-reimbursed) caregiver support. Thus, there are significant local differences regarding the availability and accessibility of support services (54). Additionally, these services often rely on already overburdened healthcare professionals (22) and typically depend on a single individual rather than a team (55). We recommend that health policies and organizations be more engaged in the implementation of these services. Lastly, the lack of healthcare professionals' training in caregiver support also constitutes a barrier to service implementation. Many researchers in the field advocate for the development of skills in family caregiver support (27–29,56). However, Badovinac et al. (2019) (28) observed that there are few educational opportunities on this topic. The issue of caregiver support (identification, needs, and assistance) should be an integral part of the curriculum for healthcare professionals (doctors, nurses, social workers, nursing assistants, etc.) to promote collaborative initiatives in practice. CONCLUSION This study confirms the value of providing training to healthcare professionals on supporting family caregivers of individuals with Alzheimer’s disease. In addition to improving professionals’ knowledge, skills, and practices, these training sessions have fostered organizational changes, such as the development of new support services. Given the demonstrated effectiveness of these services, as highlighted by our research, and in light of the current lack of concrete initiatives in practice, we strongly recommend the implementation of such training programs for professionals. Abbreviations - AAS: The Ambivalent Ageism Scale - DAS: The Dementia Attitudes Scale - IRR: Inter-rater reliability - IDPESQ: 14-item Psychological Distress Index - NAP: Nonoverlap of All Pairs Declarations Ethics approval and consent to participate The ethics committee of the University of Liège approved the study protocol. All participants provided explicit informed consent. All research methods were conducted in accordance with ethical guidelines and regulations. Consent for publication Not applicable Availability of data and materials The quantitative dataset generated and analyzed during the current study is available in the Additional File 3 (.xls). Qualitative data and data from the multiple case study are available from the corresponding author. Competing interests The authors declare they have no competing interests. Funding This study was supported by grants from the Interreg-V cross-border cooperation program (France-Wallonia-Flanders). The funding had no influence on the design of the study, collection, analysis, and interpretation of data, and in the writing of the manuscript. Authors' contributions SA designed the training program proposed to healthcare professionals. CC developed the evaluation protocol for this training. SA delivered the training sessions, and CC collected data from the professionals. CC and SA developed the protocol for the multiple case study, and CC collected data from informal caregivers. CC performed data encoding, as well as the statistical and qualitative analysis of the data. CC drafted the manuscript. SA and LD critically reviewed the manuscript and provided revisions. The final version of the manuscript was approved by all authors. Acknowledgements We would like to thank the professionals and organizations we collaborated with as part of the INTERREG project. We also thank the healthcare professionals who participated in the training and the study, as well as the informal caregivers who agreed to be interviewed. Authors' information (optional) References Nichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105–25. Visser LNC, Pelt SAR, Kunneman M, Bouwman FH, Claus JJ, Kalisvaart KJ, et al. Communicating uncertainties when disclosing diagnostic test results for (Alzheimer’s) dementia in the memory clinic: The ABIDE project. Health Expectations. 2020 Feb 22;23(1):52–62. Pringault S. 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Association Between Positive Age Stereotypes and Recovery From Disability in Older Persons. JAMA. 2012 Nov 21;308(19):1972. Cary LA, Chasteen AL, Remedios J. The Ambivalent Ageism Scale: Developing and Validating a Scale to Measure Benevolent and Hostile Ageism. Gerontologist. 2016 Aug 12;gnw118. O’Connor ML, McFadden SH. Development and Psychometric Validation of the Dementia Attitudes Scale. Int J Alzheimers Dis. 2010;2010:1–10. Liu HY, Chao CY, Kain VJ, Sung SC. The relationship of personal competencies, social adaptation, and job adaptation on job satisfaction. Nurse Educ Today. 2019 Dec;83:104199. Bédard M, Molloy DW, Squire L, Dubois S, Lever JA, O’Donnell M. The Zarit Burden Interview. Gerontologist. 2001 Oct 1;41(5):652–7. Boyer R, Préville M, Légaré G, Valois P. La Détresse Psychologique dans la Population du Québec non Institutionnalisée: Résultats Normatifs de L’enquête Santé Québec. The Canadian Journal of Psychiatry. 1993 May 1;38(5):339–43. Manolov R, Solanas A, Sierra V, Evans JJ. Choosing Among Techniques for Quantifying Single-Case Intervention Effectiveness. Behav Ther. 2011 Sep;42(3):533–45. Gage NA, Lewis TJ. Analysis of Effect for Single-Case Design Research. J Appl Sport Psychol. 2013 Jan;25(1):46–60. Parker RI, Vannest K. An Improved Effect Size for Single-Case Research: Nonoverlap of All Pairs. Behav Ther. 2009 Dec;40(4):357–67. Sanders S. Is the Glass Half Empty or Half Full? Soc Work Health Care. 2005 May 11;40(3):57–73. Rigaux N. Informal care: Burden or significant experience? Psychologie et NeuroPsychiatrie du Vieillissement. 2009;7(1):57–63. Roth DL, Fredman L, Haley WE. Informal Caregiving and Its Impact on Health: A Reappraisal From Population-Based Studies. Gerontologist. 2015 Apr 1;55(2):309–19. Ankri J, Andrieu S, Beaufils B, Grand A, Henrard JC. Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. Int J Geriatr Psychiatry. 2005 Mar 16;20(3):254–60. Vitaliano PP, Russo J, Young HM, Becker J, Maiuro RD. The Screen for Caregiver Burden. Gerontologist. 1991 Feb 1;31(1):76–83. Losada A, Pillemer K, Márquez-González M, Romero-Moreno R, Gallego-Alberto L. Measuring Ambivalent Feelings in Dementia Family Caregivers: The Caregiving Ambivalence Scale. Gerontologist. 2017 Sep 7;gnw144. McKee K, Spazzafumo L, Nolan M, Wojszel B, Lamura G, Bien B. Components of the difficulties, satisfactions and management strategies of carers of older people: A principal component analysis of CADI-CASI-CAMI. Aging Ment Health. 2009 Mar 1;13(2):255–64. Cravello L, Martini E, Viti N, Campanello C, Assogna F, Perotta D. Effectiveness of a Family Support Intervention on Caregiving Burden in Family of Elderly Patients With Cognitive Decline After the COVID-19 Lockdown. Front Psychiatry. 2021 Mar 4;12. de Araujo EL, Rodrigues MR, Kozasa EH, Lacerda SS. Psychoeducation versus psychoeducation integrated with yoga for family caregivers of people with Alzheimer’s disease: a randomized clinical trial. Eur J Ageing. 2023 Dec 25;20(1):46. Birkenhäger-Gillesse EG, Kollen BJ, Zuidema SU, Achterberg WP. The “more at home with dementia” program: a randomized controlled study protocol to determine how caregiver training affects the well-being of patients and caregivers. BMC Geriatr. 2018 Dec 22;18(1):252. Christie HL. The implementation of EHealth in dementia care. maastricht university; 2020. Schulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family Caregiving for Older Adults. Annu Rev Psychol. 2020 Jan 4;71(1):635–59. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5455672","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379400771,"identity":"4322b82f-81bd-4bcf-85c9-f37aa71d3f03","order_by":0,"name":"Coline Crutzen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAklEQVRIiWNgGAWjYFAC5oYDSDwbBj5mMOMANrVQwAjTAlaaxsBGjBaYdSDiMAMbAwEt/O2NjYcLKhjkzWfkH/7wccf5xDZ25sMvPjDckcOlReLMwYbDM84wGM65kcxgOPPM7cQ2ZrY0yxkMz4xxaTGQSGw4zNvGkCAhkcyQzNsG0sJjZszDcDixAa+WfxAth/+2nQNq4f9m/IfhcD1+LQ1gLYzNjG0HQLYwPwaGQwJev/AckzCcwfPYmLG3LdkY6Bczxh6DZ4a4bOFvbz78mafGRl6CPfHxh59tdrL9/Icff/hRcUcely0wy1B4bBIMBgQ0oAPmDyRqGAWjYBSMguENAHPOVeT5kavCAAAAAElFTkSuQmCC","orcid":"","institution":"University of Liège","correspondingAuthor":true,"prefix":"","firstName":"Coline","middleName":"","lastName":"Crutzen","suffix":""},{"id":379400773,"identity":"76a9b522-f37b-4f8a-bb96-1cf472bbbd3e","order_by":1,"name":"Laura Deprez","email":"","orcid":"","institution":"University of Liège","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Deprez","suffix":""},{"id":379400774,"identity":"447365e2-4ff2-49f7-97b4-9a1b306c48ad","order_by":2,"name":"Stéphane Adam","email":"","orcid":"","institution":"University of Liège","correspondingAuthor":false,"prefix":"","firstName":"Stéphane","middleName":"","lastName":"Adam","suffix":""}],"badges":[],"createdAt":"2024-11-14 17:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5455672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5455672/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71876749,"identity":"a7f4a399-8936-4e6a-81db-e1e1cf975e65","added_by":"auto","created_at":"2024-12-19 11:01:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73996,"visible":true,"origin":"","legend":"\u003cp\u003eKirkpatrick-Barr framework (31) adapted from Parmar et al. (2022) (30) and revisited for our training assessment\u003c/p\u003e\n\u003cp\u003e- \u003cem\u003eLevel 1: Participant satisfaction with the training (e.g., training content, training quality)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- \u003cem\u003eLevel 2: Changes in participants’ knowledge, skills, and attitudes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- \u003cem\u003eLevel 3: Changes in practice with caregivers (e.g., communication with caregivers, participants’ job satisfaction, etc.)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- \u003cem\u003eLevel 4A: Changes in organizational practices (e.g., improvements in healthcare systems, access to care, service referral, etc.)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e- \u003cem\u003eLevel 4B: Changes in clinical outcomes (e.g., reduced caregiver distress, improved caregiver well-being, etc.)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5455672/v1/ede8cf9ff09940b5eb2eb70f.png"},{"id":71876748,"identity":"d8b32ea4-a780-45a8-90c2-b28a96e35396","added_by":"auto","created_at":"2024-12-19 11:01:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":261647,"visible":true,"origin":"","legend":"\u003cp\u003eWord clouds\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5455672/v1/153577bf16266ced3e0f93fb.png"},{"id":103399990,"identity":"fdd61336-8b9b-4409-923b-f8d1fd8999fb","added_by":"auto","created_at":"2026-02-25 09:13:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1463411,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5455672/v1/f3b977ca-3ab9-454c-9d52-d1e40b5335c4.pdf"},{"id":71876751,"identity":"3ff61343-d193-4c8f-991f-a5e02b95b305","added_by":"auto","created_at":"2024-12-19 11:01:10","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":33364,"visible":true,"origin":"","legend":"","description":"","filename":"ADDITIONALFILES1and2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5455672/v1/674c546c1ec6edd026de0a2c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of a Training Program for Healthcare Professionals Supporting Informal Caregivers of People with Dementia: A Pre-Post Quasi-Experimental Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe aging of the population in modern societies is at the root of many societal challenges, including the increase in the number of people diagnosed with Alzheimer\u0026rsquo;s disease. In 2019, 57 million people worldwide were affected by this diagnosis, and this figure is expected to rise to 152 million by 2050 (1). Despite the growing number of diagnosed individuals, many uncertainties remain about these diseases, commonly referred to as \u0026quot;dementias\u0026quot; (2). Alzheimer\u0026rsquo;s disease is one of the most prevalent neurodegenerative diagnoses in Europe. However, a clear definition of this disease is still under debate (3). Some scientists even suggest the need to reconceptualize this pathology (4\u0026ndash;9). The low effectiveness of curative treatments (such as anti-Alzheimer medications) fuels this lack of consensus (10\u0026ndash;12). The \u0026quot;false promises\u0026quot; of medication, combined with the diagnostic uncertainties and progression of symptoms, can cause considerable distress for both individuals affected by the disease and their families. This situation calls for a shift away from a purely medical management strategy and toward a more holistic and integrative approach (9).\u003c/p\u003e\n\u003cp\u003eIn recent years, non-pharmacological interventions have become more common, aiming to improve the quality of life of patients and their families (13,14). Among these interventions is \u0026quot;caregiver support,\u0026quot; which refers to supporting the relatives of people with the disease. Various caregiver support interventions are currently being developed and have already demonstrated real effectiveness (15). These interventions notably improve quality of life for caregivers (15,16), which can positively affect the individuals with the disease, as their well-being is directly linked to the informal caregiver\u0026rsquo;s health (17,18). This support can also delay the patient\u0026rsquo;s institutionalization (19\u0026ndash;21), leading to a significant reduction in healthcare costs (14,19,22). A meta-analysis of 131 studies shows that caregiver support interventions significantly reduce caregiver burden/stress, depression, and anxiety, while improving well-being, physical health, disease knowledge, social support, and positive aspects of caregiving (15). The study also shows that support is more effective when the program includes multiple types of interventions or combines a psychoeducational component with a psychoaffective one. The healthcare professional\u0026rsquo;s ability to create a customized plan tailored to the specific needs of each caregiver is a key factor for effectiveness (23).\u003c/p\u003e\n\u003cp\u003eDespite the demonstrated effectiveness of caregiver support, these services struggle to be sustainably implemented in Europe (14,22). To ensure the implementation of these support services, training programs are often provided to healthcare professionals. Although the effectiveness of training for professionals has been demonstrated (24\u0026ndash;26), these programs tend to focus more on Alzheimer\u0026rsquo;s disease and the older patient than on informal caregivers. Parmar et al. (2020) (27) found little scientific research regarding the training of healthcare professionals specifically in caregiver support. Accordingly, in their systematic review, Badovinac et al. (2019) (28) note that healthcare professionals are generally poorly prepared to support caregivers, and this topic is largely overlooked in their education programs. However, many American experts believe that caregiver support should be an integral part of basic healthcare professional training (28,29). To make these recommendations a reality, Parmar et al. (2020) (27) convened an expert panel that identified six competency areas to include in healthcare professionals\u0026rsquo; training for caregiver support. An online training program, consisting of six modules, was then offered to a group of healthcare professionals (n=161) (30). The program was evaluated, and the results revealed improvements in the professionals\u0026rsquo; knowledge, confidence, and practices regarding caregiver support.\u003c/p\u003e\n\u003cp\u003eTo assess their training program, Parmar et al. (2022) (30) used the first three of the four evaluation levels proposed in the Kirkpatrick-Barr evaluation framework (see Figure 1).\u003c/p\u003e\n\u003cp\u003eIn this same perspective, the \u0026ldquo;Caregivers/Network-Service\u0026rdquo; project (\u0026ldquo;Aidants Proches/R\u0026eacute;seau-Service\u0026rdquo;) (2016\u0026ndash;2021), funded by the Interreg-V cross-border cooperation program (France-Wallonia-Flanders), was developed. The project aimed to create a network of professionals specialized in supporting caregivers of older people with neurodegenerative diseases. To build this network, a training program on caregiver support was delivered and meetings were organized in France (specifically in the Hauts-de-France region) and in three Belgian provinces (Hainaut, Namur, and Luxembourg).\u0026nbsp;Two versions of the training were developed: a three-day version, primarily aimed at home care providers, and a five-day version, primarily aimed at psychologists wishing to offer individualized (counseling-type) support to informal caregivers. The training was delivered 9 times in the short version and 5 times in the long version. For more information on the training and its content, see Additional file 1.\u003c/p\u003e\n\u003cp\u003eThe aim of our study was to evaluate the proposed training by exploring its impact at the four levels of analysis in the Kirkpatrick-Barr model (31). Level 4B was evaluated through a multiple case study involving caregivers who received individualized (counseling-type) support from trained professionals.\u003c/p\u003e\n\u003cp\u003eBased on the Kirkpatrick-Barr framework (31) and the study by Parmar et al. (2022) (30), the following objectives were defined for our study:\u003c/p\u003e\n\u003cp\u003eIn this same perspective, the \u0026ldquo;Caregivers/Network-Service\u0026rdquo; project (\u0026ldquo;Aidants Proches/R\u0026eacute;seau-Service\u0026rdquo;) (2016\u0026ndash;2021), funded by the Interreg-V cross-border cooperation program (France-Wallonia-Flanders), was developed. The project aimed to create a network of professionals specialized in supporting caregivers of older people with neurodegenerative diseases. To build this network, a training program on caregiver support was delivered and meetings were organized in France (specifically in the Hauts-de-France region) and in three Belgian provinces (Hainaut, Namur, and Luxembourg).\u0026nbsp;Two versions of the training were developed: a three-day version, primarily aimed at home care providers, and a five-day version, primarily aimed at psychologists wishing to offer individualized (counseling-type) support to informal caregivers. The training was delivered 9 times in the short version and 5 times in the long version. For more information on the training and its content, see Additional file 1.\u003c/p\u003e\n\u003cp\u003eThe aim of our study was to evaluate the proposed training by exploring its impact at the four levels of analysis in the Kirkpatrick-Barr model (31). Level 4B was evaluated through a multiple case study involving caregivers who received individualized (counseling-type) support from trained professionals.\u003c/p\u003e\n\u003cp\u003eBased on the Kirkpatrick-Barr framework (31) and the study by Parmar et al. (2022) (30), the following objectives were defined for our study:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Provide healthcare professionals with a satisfying and useful training program (Level 1).\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Deepen healthcare professionals\u0026rsquo; knowledge and improve their skills (Level 2), specifically:\u003c/p\u003e\n\u003cp\u003e2.1.\u0026nbsp;Improve knowledge of aging by reducing ageist beliefs and attitudes among professionals. Indeed, compared to the general population, healthcare professionals tend to display more ageism and view older people more negatively ((32\u0026ndash;34). However, for an unbiased and objective evaluation of clinical situations, it is essential to dismantle their preconceived ideas and stereotypes about normal and pathological aging.\u003c/p\u003e\n\u003cp\u003e2.2.\u0026nbsp;Improve their knowledge about neurodegenerative diseases.\u003c/p\u003e\n\u003cp\u003e2.3.\u0026nbsp;Enhance their ability to identify caregivers in need of support.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Increase healthcare professionals\u0026rsquo; job satisfaction (Level 3). It has been shown that an intervention aimed at improving professionals\u0026apos; understanding of neurodegenerative diseases can lead to increased job satisfaction (26). The latter study focused on professionals working directly with individuals affected by these diseases. Nevertheless, based on this finding, we hypothesized that a better understanding of caregivers\u0026apos; experiences could improve job satisfaction for professionals working with caregivers.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp;Positively impact healthcare professionals\u0026rsquo; organizational practices (Level 4A) (e.g., encourage the development of new individualized support services for caregivers).\u003c/p\u003e\n\u003cp\u003e5. \u0026nbsp; Reduce caregivers\u0026rsquo; psychological distress through the support offered by the healthcare professionals trained in this project (Level 4B). This will be demonstrated through a multiple case study conducted directly with caregivers.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eProfessionals who agreed to participate in our study were evaluated twice: two weeks before the training (\"pre-training evaluation\") and five weeks after the end of the program (\"post-training evaluation\"). These evaluations were conducted through an online survey sent individually to each professional. Before answering the questions, healthcare professionals were informed about the research objectives, study process, and data handling (confidentiality, anonymity, rights). They then provided informed consent to participate in the study, which had been previously approved by the ethics committee of the University of Liège. Data collection took place throughout the project, between January 2017 and July 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEvaluation Tools\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipant Characteristics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eWe collected the following sociodemographic data from each participant: age, gender, nationality (French or Belgian), years of education (after high school), and current profession (nurse, social worker, caregiver, occupational therapist, psychologist, etc.).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants’ Reactions to the Training (Level 1)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ePerceived usefulness and satisfaction with the training were assessed using five questions: \"Are you generally satisfied with the training?\"; \"Are you satisfied with (a) the content of the training? (b) the format (presentation method, materials used, etc.)?\"; and \"Did you find this training useful for (a) your theoretical knowledge? (b) your professional practice?\" Participants responded using a scale from 0 (\"not at all\") to 10 (\"completely\").\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants’ Learning (Knowledge and Skills) (Level 2)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants’ ageism was assessed using two tools: (1) A \"5-word\" fluency task (used only in the pre-training assessment) (35,36) in which participants were asked to spontaneously list the first five words that come to mind when thinking about an older person. The words were then analyzed for emotional valence (positive, negative, or neutral) and frequency of mention. To broaden the analysis, participants were asked to do the same exercise for \"a young person,\" \"a person with Alzheimer’s disease,\" and \"a caregiver.\" (2) The \"Ambivalent Ageism Scale\" (AAS) (37), used both pre- and post-training, measures the level of ageism and distinguishes between benevolent and hostile ageism. The questionnaire consists of 13 items rated on a Likert scale from 1 (\"strongly disagree\") to 7 (\"strongly agree\"). A higher score indicates greater ageism.\u003c/p\u003e\n\u003cp\u003eKnowledge about neurodegenerative diseases was assessed using the \"Dementia Attitudes Scale\" (DAS) (38), which includes 20 questions rated on a Likert scale from 1 (\"strongly disagree\") to 7 (\"strongly agree\"). A total score and two sub-scores were calculated: \"knowledge of neurodegenerative diseases\" and \"social comfort\" (i.e., the ability to interact appropriately with someone with Alzheimer’s). A higher score indicates better knowledge. We also included self-assessment questions asking professionals to rate their knowledge in seven areas (e.g., general aging, Alzheimer’s disease, cognitive functioning in Alzheimer’s, etc.) on a scale from 0 (\"low knowledge\") to 10 (\"excellent knowledge\").\u003c/p\u003e\n\u003cp\u003eTo assess professionals' skills in identifying caregivers in need of support, we created a questionnaire with 12 clinical scenarios. These scenarios depicted daily interactions between a person with Alzheimer’s and their caregiver. Professionals were asked to evaluate the relevance of various caregiver reactions using a scale from 0 (\"not at all relevant\") to 10 (\"completely relevant\"). Their responses were compared with those of six expert psychologists from the Aging Psychology Department at the University of Liège. Inter-rater reliability (IRR) was high (\u0026gt;0.80), both among experts (IRR = 0.94) and among professionals (IRR pre-training = 0.98; IRR post-training = 0.99). The difference in scores between professionals and experts was calculated before and after the training, yielding two new variables: (a) pre-training difference scores and (b) post-training difference scores, for which only the absolute values were used.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants’ Professional Practices (Job Satisfaction) (Level 3)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eJob satisfaction was measured using three questions: (1) perceived satisfaction, (2) perceived emotional exhaustion, and (3) perceived physical exhaustion when working with people with Alzheimer’s and/or their caregivers. Three additional questions assessed perceived competence related to job satisfaction (39) : (4) perceived competence in working with individuals with Alzheimer’s, (5) perceived competence in working with their caregivers, and (6) perceived competence in detecting caregiver burnout. For all six questions, participants were asked to answer on a scale from 0 (\"not at all\") to 10 (\"completely\").\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants’ Organizational Practices (Level 4A)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were asked to provide a concrete example of how the training had impacted their professional or organizational practices. A qualitative thematic analysis was performed on these responses, providing insights into the effects of the training on both Level 3 (professional practices) and Level 4A (organizational practices).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCaregivers’ Clinical Outcomes (Level 4B)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the clinical impact of individualized (counseling-type) support on caregivers, we conducted a multiple case study directly with caregivers. Eligibility criteria included: being the caregiver of someone with Alzheimer’s or a related disease, voluntarily requesting consultation with a trained psychologist, and being French-speaking and literate. A telephone interview was conducted before the first consultation (\"pre-intervention evaluation\"), which included:\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;A brief anamnesis to gather sociodemographic and situational data (e.g., age, gender, nationality, profession, relationship status to the patient, etc.).\u003c/p\u003e\n\u003cp\u003e- An assessment of subjective burden using the \"12-item Zarit Burden Interview\"\u0026nbsp;(40)with items rated on a 5-point Likert scale from 0 (\"never\") to 4 (\"almost always\"). A higher score indicates greater burden.\u003c/p\u003e\n\u003cp\u003e- An evaluation of psychological distress using the \"14-item Psychological Distress Index\" (IDPESQ)\u0026nbsp;(41), with items rated on a 4-point Likert scale from 0 (\"never\") to 3 (\"very often\"). A higher score indicates greater distress.\u003c/p\u003e\n\u003cp\u003eA similar interview was conducted six months later, after one or more support sessions with the trained psychologist (\"post-intervention evaluation\"). This second interview also assessed caregiver satisfaction with the support sessions using three measures: (a) a closed-ended question (\"yes\" or \"no\") asking whether they would recommend these individualized support sessions to someone in a similar situation; (b) an evaluation of their satisfaction with the support intervention and their perception of its benefits and usefulness on a scale from 0 (minimum) to 10 (maximum); and (c) a questionnaire designed to assess the potential benefits of the support intervention, consisting of 11 items (e.g., \"Did this support intervention help you better understand your loved one's illness?\"), rated on a 3-point Likert scale (0 = \"I did not observe this effect,\" 1 = \"I moderately observed this effect\", 2 = \"I fully observed this effect\"). A higher score indicates more observed benefits.\u003c/p\u003e\n\u003cp\u003eBefore participating, informal caregivers were informed about the study’s objectives, procedures, and data handling, and gave informed consent during the first phone interview. The multiple case study was approved by the ethics committee of the University of Liège, and caregiver data were collected between January 2018 and July 2019.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Analysis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuantitative data related to the training were analyzed using SPSS - version 25 (IBM Corp, 2018), with a significance threshold of p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQuantitative data from the informal caregivers' support study were analyzed using the Single Case Research statistical software, which allowed for both individual and combined analyses of each case. A significance threshold of p \u0026lt; 0.05 was applied. We used the NAP (\"Nonoverlap of All Pairs\") index, which is particularly suited for assessing the effectiveness of therapeutic interventions (42). The NAP quantifies effect size by calculating the percentage of non-overlapping points between the baseline and intervention phases (43). A higher percentage of non-overlap indicates that the intervention led to significant progress and behavioral change. If the intervention aims to reduce scores (e.g., reduce the caregiver's subjective burden), the NAP value should be reversed (e.g., if NAP = 0.40, the reversed NAP = 1 – 0.40 = 0.60). NAP values between 0 and 0.65 indicate a small effect, between 0.66 and 0.92 a medium effect, and between 0.93 and 1 a large effect (44).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCharacteristics of the professionals\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 217 healthcare professionals completed the training (127 completed the 3-day training and 90 completed the 5-day training). Among them, 108 agreed to participate in the study. As shown in Table 1, the sample consisted predominantly of women (94.4%). The participants were relatively young (average age: 35.4 years) and all were native French speakers. All professionals worked in the healthcare sector, with psychologists being the most represented profession in the sample (46.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eCharacteristics of participants\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall sample (n=108)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eAge \u003cem\u003e(mean, SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e35.41 (9.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eGender \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e102 (94.4 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e6 (5.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNationality \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eFrench\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e56 (51.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eBelgian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e52 (48.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eEducational level (after high school) \u003cem\u003e(mean, SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.8 (1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eCurrent profession \u003cem\u003e(n, %)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNursing assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e16 (14.8 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eSocial worker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e20 (18.5 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eEducator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e2 (1.9 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eOccupational therapist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e5 (4.6 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e14 (13 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003ePsychlogist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 236px;\"\u003e\n \u003cp\u003e50 (46.3 %)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e1. Participants\u0026rsquo; Reactions to the Training (Level 1)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, the professionals were satisfied with the training and considered it highly useful, both in terms of theory and practice (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e2. Participants\u0026rsquo; Learning (Knowledge and Skills) (Level 2)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.1 Ageist beliefs and attitudes\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe \u0026quot;5 words\u0026quot; fluency task was used as an indicative (rather than evaluative) tool, as it was not included in the post-training survey. From the healthcare professionals\u0026rsquo; responses, we created four different word clouds illustrating professionals\u0026rsquo; pre-training perceptions of an older person, a young person, someone with Alzheimer\u0026rsquo;s disease, and a caregiver (see Figure 2). Larger word size reflects higher frequency of mention.\u003c/p\u003e\n\u003cp\u003eThe word cloud related to an \u0026quot;older person\u0026quot; was generated from the 30 words most frequently mentioned by healthcare professionals. Of these, 27% were neutral (e.g., aging, grandparents), 23% were positive (e.g., experience, wisdom), and 50% were negative (e.g., isolation, need for help). The five most frequently mentioned words were \u0026quot;isolation\u0026quot; (mentioned 34 times, representing 4.75% of the total words), \u0026quot;need for help\u0026quot; (30 times, 4.20%), \u0026quot;wisdom\u0026quot; (30 times, 4.20%), \u0026quot;dependence\u0026quot; (29 times, 4.06%), and \u0026quot;loss of autonomy\u0026quot; (29 times, 4.06%). Of these five most frequent words, four were negative. In contrast, the word cloud for a \u0026quot;young person,\u0026quot; composed of the 30 most frequently mentioned words, shows a majority of positive words (67%), some neutral words (30%), and only one negative word (3%), highlighting a stark contrast in the representation of older versus young people. The third word cloud illustrates the 30 most frequent words associated with Alzheimer\u0026rsquo;s disease. Here, the words are overwhelmingly negative (90%), with a small portion being neutral (7%) or positive (3%). Although this result is expected, it is worth noting that the healthcare professionals focused exclusively on the disease, rather than the person. The older person living with this pathology seems overshadowed by the diagnostic label, as positive words, already rare for older individuals, disappear entirely in this context. Finally, the word cloud for \u0026quot;caregiver,\u0026quot; based on the 50 most frequently mentioned words, is predominantly negative (48%), 28% neutral and 24% positive. \u0026quot;Need for help\u0026quot; was mentioned by 46% of the professionals, \u0026quot;exhaustion\u0026quot; by 38%, and \u0026quot;fatigue\u0026quot; by 32%. While caregiving can indeed be exhausting and painful, professionals who primarily interact with caregivers seeking support may overestimate the negative aspects of this role. Several scientific studies highlight the existence of positive experiences in caregiving (e.g., feelings of satisfaction, personal fulfillment, sense of usefulness) (45\u0026ndash;47).\u003c/p\u003e\n\u003cp\u003eRegarding ageism as measured by the Ambivalent Ageism Scale (AAS), the Student\u0026apos;s t-test indicated a significant reduction in the total score post-training. This reduction was observed for both hostile and benevolent forms of ageism (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2 Knowledge about neurodegenerative diseases\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eStudent\u0026rsquo;s t-tests were conducted to compare the pre- and post-training scores on the Dementia Attitude Scale (DAS). A significant increase in total and sub-scores was observed after the training (see Table 2), indicating improved knowledge about dementia and more positive attitudes toward individuals with dementia.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, we compared professionals\u0026rsquo; self-assessment of their knowledge before and after the training. For each domain surveyed, a significant increase in self-reported knowledge was observed (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3 Skills regarding caregivers\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe ability to identify caregivers in need of support was measured using 12 fictional scenarios assessed by both professional participants and experts. A paired-sample Student\u0026rsquo;s t-test on the difference scores showed that professionals\u0026rsquo; post-training responses were significantly closer to experts\u0026rsquo; responses compared to pre-training (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e3. Participants\u0026rsquo; Professional Practices (Job Satisfaction) (Level 3)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing a Student\u0026rsquo;s t-test, we compared self-reported job satisfaction before and after the training. For 4 of the 6 dimensions in the questionnaire, a significant increase in job satisfaction was observed post-training. No significant differences were found for physical and emotional exhaustion related to work (see Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Scores of professionals (n=108) before and after training on Level 1, 2, and 3 questionnaires\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1012\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 567px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre-training\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost-training\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMean (SD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical values\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003et (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"6\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u0026rsquo;Reactions Questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eGeneral satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.81 (1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSatisfaction with the content\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.96 (1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSatisfaction with the format\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.99 (1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eTheoretical usefulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.63 (1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePractical usefulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e8.27 (1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"18\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel 2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u0026laquo; Ambivalent Ageism Scale \u0026raquo; (AAS) Questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e29.40 (12.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e21.16 (8.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e(106)= 8.73 (0.00) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSubscore \u0026quot;malignant ageism\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e8.53 (4.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e6.91 (2.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e(106)= 4.537 (0.00) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSubscore \u0026quot;benevolent ageism\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e20.87 (9.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e14.25 (6.90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et\u003c/em\u003e(106)= 8.79 (0.00) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026laquo;\u0026nbsp;Dementia Attitude Scale\u0026nbsp;\u0026raquo; (DAS) Questionnaire\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eTotal score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e117.44 (12.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e122.05 (9.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-5.48 (0.00)\u0026nbsp;**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSubscore \u0026quot;knowledge\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e61.34 (6.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e62.44 (5.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-2.08 (0,04)\u0026nbsp;*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eSubscore \u0026quot;social comfort\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e56.10 (8.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e59.60 (6.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-6.02 (0.00) **\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-assessment Questionnaire of Knowledge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout general aging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.69 (1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.14 (1.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-3.68 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout Alzheimer\u0026apos;s disease (AD)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.94 (1.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.55 (1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-4.55 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout cognitive functioning in people with AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.47 (1.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.36 (1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-6.24 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout behavioural problems in people with AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.56 (1.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.28 (1.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-5.10 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout other forms of \u0026quot;dementia\u0026quot;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e5.69 (1.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e6.60 (1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-4.96 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout caregiver burnout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.28 (1.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.38 (1.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-7.11 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eAbout existing support services for caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6.32 (2.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e7.44 (1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-6.91 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkills regarding Family Caregivers (Scenarios)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003eDifference score between participants and the expert group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1.69 (1.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e0.77 (0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(37=)-5.01 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 927px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-assessment Questionnaire of Professional Satisfaction / Professional Exhaustion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived satisfaction with work done with individuals with AD and/or their family caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.75 (1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.21 (1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-3.88 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived emotional exhaustion from work with individuals with AD and/or their caregivers \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.19 (2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.17 (2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=0.14 (0.89)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived physical exhaustion from work with individuals with AD and/or their caregivers\u003csup\u003e\u0026nbsp;a\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e7.76 (2.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.78 (2.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-0.09 (0.93)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived competence in working with individuals with AD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.44 (1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.25 (1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-5.22 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived competence in working with the family caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e6.42 (1.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.36 (1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-6.59 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 567px;\"\u003e\n \u003cp\u003ePerceived competence in detecting the distress (or \u0026apos;burnout\u0026apos;) of family caregivers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e5.90 (1.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e7.40 (1.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003e\u003cem\u003et(107)=-9.23 (0.00)**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e** p\u0026lt;0,01; *p\u0026lt;0,05;\u003cstrong\u003e\u003csup\u003e\u0026nbsp;a\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003ereverse-scored item: 10 = less exhaustion\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eINSERT TABLE 2. (See end of document)\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e4. Participants\u0026apos; Organizational Practices (Level 4A)\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 108 participants, 6 did not provide responses regarding the practical and/or organizational impact of the training, 3 professionals indicated that they had not had the opportunity to implement a specific initiative after the training, and 2 professionals\u0026rsquo; responses were excluded from the analysis due to overly general information. A total of 97 responses were processed and categorized (see Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003ePractical and/or organizational impacts of the training (n=97)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessionals\u0026rsquo; responses\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eThe training allowed them to:\u003c/p\u003e\n \u003cp\u003eBetter support family caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To be more capable of explaining Alzheimer\u0026apos;s disease/dementias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To identify caregivers\u0026apos; difficulties and refer them for individualized support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e7 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To use practical tools in support interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To acknowledge the caregiver\u0026apos;s role, pay attention to their difficulties, and listen to them\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e5 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To provide better advice to caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To better support caregivers (overall)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To gain a better understanding of caregivers\u0026apos; experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eo To enhance the individualization of caregiver support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eUtilize specific theoretical knowledge in practice (improved understanding of \u0026ldquo;dementias\u0026rdquo; / family caregivers)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eAdopt a new perspective and reduce misconceptions about \u0026quot;dementias,\u0026quot; caregivers, or aging in general\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e11 (11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eFeel reassured or supported in one\u0026apos;s practice (feel more confident)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e8 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eBetter understand and address the management of behavioral issues in the patient\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eExchange ideas with other professionals in the field\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e6 (6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eDevelop or promote the development of new support services for family caregivers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 480px;\"\u003e\n \u003cp\u003eUse practical tools developed within the research project\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 139px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e5. Caregivers\u0026rsquo; Clinical Outcomes\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u003cstrong\u003e(Level 4B)\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA multiple case study was conducted with 23 caregivers who received individual (counseling-type) support from a trained professional. Among these, 2 caregivers experienced the death of their loved one during the study and 2 others were not available to complete the post-intervention interview. Thus, post-intervention data were collected for 19 caregivers of individuals with Alzheimer\u0026rsquo;s disease or a related illness.\u003c/p\u003e\n\u003cp\u003eIn order to assess the impact of the support intervention, we compared caregivers\u0026apos; subjective burden (Zarit-12) and psychological distress (IDPESQ-14) before and after the intervention. Among the 19 caregivers in our sample, 6 experienced the permanent institutionalization of their relative during the study. Our analysis therefore focuses on the 13 participants whose relatives remained at home during the study (for more information on the participants\u0026rsquo; characteristics, see Additional file 2.). The pre- and post-intervention comparison was conducted using the Single Case Research software, which allows for the analysis of the intervention\u0026rsquo;s effect on each participant individually and then combines these individual comparisons to determine the overall intervention effect. Since subjective burden and psychological distress are two closely related concepts - both theoretically (48) and psychometrically (49) - and we observed a strong, significant correlation (rs= 0.614, p \u0026lt; 0.05) between these two measures, we analyzed them together. Scores on the two measures were standardized to the same scale (converted to percentages) to allow for grouping. We then compared pre- and post-intervention scores (Zarit-12 and IDPESQ-14 scores pooled together) for each participant. The overall effect of the intervention was calculated by combining the 13 individual analyses (see Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eSubjective burden (Zarit-12) and psychological distress (IDPESQ-14) of caregivers before and after intervention (n=13)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZarit-12 pre-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRaw score (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eZarit-12\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003epost-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRaw score\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIDPESQ-14 \u0026nbsp;pre-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRaw score\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIDPESQ-14 post-intervention\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eRaw score\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistical values\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eNAP \u003csup\u003ea\u003c/sup\u003e (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (56.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e24 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e39 (69.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e33 (58.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.25 (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e27 (56.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e26 (54.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e- \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.00 (0.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e22 (45.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e19 (39.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e30 (53.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e20 (35.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.00 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e15 (31.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e15 (31.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e24 (42.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e27 (48.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.65 (0.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e20 (41.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e24 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e38(67.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e25 (44.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.50 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e17 (35.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e25 (52.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e44(78.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e37 (66.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.50 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e36 (75.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e35 (72.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e45 (80.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e36 (64.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.00 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e23 (47.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e30 (62.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e27(48.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e34 (60.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.87 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26 (54.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e16 (33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e34 (60.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e16 (28.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.00 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e11 (22.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e17 (35.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e21 (37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e22 (39.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.75 (0.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12 (25.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e14 (29.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e21 (37.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e20 (35.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.50 (1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e26 (54.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e19 (39.58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e36 (64.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e28 (50.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e0.00 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSubject 13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e33 (68.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 103px;\"\u003e\n \u003cp\u003e38 (79.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 94px;\"\u003e\n \u003cp\u003e23 (41.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 91px;\"\u003e\n \u003cp\u003e43 (76.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e1.00 (0.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 633px;\"\u003e\n \u003cp\u003eCombination of individual analyses \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 0.40 (0,02)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p\u0026lt;0,05; \u003csup\u003ea\u0026nbsp;\u003c/sup\u003eNonoverlap of All Pairs\u003c/p\u003e\n\u003cp\u003eAlthough no significant effect emerged from individual comparisons, the combined analysis showed a statistically significant effect of the intervention (p = 0.02), supporting our hypothesis of an overall reduction in caregiver burden and psychological distress following the individualized support intervention. The effect size of the intervention is determined by the NAP index, which in this case must be reversed as we aimed to reduce the participants\u0026apos; scores through the intervention. Therefore, the NAP index for our intervention is: 1 \u0026ndash; 0.40 = 0.60, indicating a modest reduction in scores due to the intervention (small effect size: NAP \u0026lt;0.65).\u003c/p\u003e\n\u003cp\u003eCaregiver satisfaction with the support intervention received was assessed using three indicators. (a) To the question: \u0026quot;If you met someone in a similar situation to yours (i.e., caring for a loved one with Alzheimer\u0026apos;s disease), would you recommend these individualized support sessions?\u0026quot;, 18 of the 19 caregivers in our overall sample responded favorably. (b) All 19 caregivers reported high satisfaction with the individualized support intervention, with an average satisfaction rating of 8.72/10. This intervention was considered beneficial (mean score of 8.38/10) and useful (mean score of 8.94/10) by those interviewed. (c) Specifically, the benefits of the intervention most commonly reported by caregivers were: (1) an increased ability to be more positive and optimistic, (2) improved emotional management, and (3) better communication and/or reactions with their loved one. Table 5 provides an overview of all 11 specific intervention effects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eSpecific effects of individualized support consultations (n=19)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I did not observe this effect\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I moderately observed this effect\u0026quot;\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026quot;I fully observed this effect\u0026quot;\u003c/p\u003e\n \u003cp\u003e(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 1 \u0026ndash;\u0026nbsp;Did the consultations help you better understand your relative\u0026rsquo;s illness?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e38.46 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e61.54 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 2 \u0026ndash; Did the consultations help you feel less stressed / anxious than before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e38.46 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7.69 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e53.85 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 3 \u0026ndash; Did the consultations help you be more optimistic / positive than before?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e23.08 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e76.92 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 4 \u0026ndash; Did the consultations help you take more time for yourself?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30.77 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30.77 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e38.46 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 5 \u0026ndash; Did the consultations help you manage your emotions better?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e20 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e10 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e70 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 6 \u0026ndash; Did the consultations provide you with tips and strategies for managing daily life?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e38.46 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e23.08 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e38.46 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 7 \u0026ndash; Did the consultations help you find concrete solutions to problems / difficulties?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e20 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e50 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 8 \u0026ndash; Did the consultations help you react and/or communicate better with your relative?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e23.08 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7.69 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e69.23%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 9 \u0026ndash; Did the consultations help improve your relationship with your relative?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e46.15 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e0 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e53.85 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 10 \u0026ndash; Did the consultations have a positive (indirect) impact on your relative?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e30.77 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e7.69 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e61.54 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 378px;\"\u003e\n \u003cp\u003eEffect 11 \u0026ndash; Did the consultations help you better support your relative?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e25 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e16.67 %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 94px;\"\u003e\n \u003cp\u003e58.33 %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e The aim of our study was to evaluate the outcomes of a healthcare professional training program on supporting caregivers of people with neurodegenerative diseases. As in Parmar et al.'s study (2022) (30), we based our assessment on the Kirkpatrick-Barr training evaluation framework (31), which proposes an analysis across four distinct levels.\u003c/p\u003e \u003cp\u003eAt the first level, we observed a positive reaction from the participants, who found the training both satisfactory and useful. The second level of analysis assessed the changes in the knowledge and skills of the trained professionals. Post-training, there was a significant reduction in ageist beliefs and attitudes among professionals, an improvement in knowledge regarding Alzheimer\u0026rsquo;s disease, and a greater ability to identify caregivers facing adaptation difficulties in response to the disease. Professionals also self-reported having better knowledge on these topics after the training. The third level of analysis focused on professional practices and, more specifically, on job satisfaction. After the training, professionals felt more competent and more professionally satisfied. However, emotional and physical exhaustion related to work did not appear to be impacted by the training. In the Kirkpatrick-Barr framework, level 4A looks at changes in professionals\u0026rsquo; organizational practices. For this study, our assessment positioned itself between levels 3 and 4A (impact on professional practices and organizational practices). Exploratively, we observed that the training helped improve caregiver support practices (e.g., professionals reported being better able to explain the diseases or use more concrete tools in their support intervention). Regarding organizational outcomes, key findings include the creation of opportunities to discuss and collaborate with other professionals in the field (through the creation of a network of trained professionals) and, in some cases, the development of new caregiver support services that did not exist before the training. Finally, the last level of analysis (4B) focuses on the clinical impact of the training. To assess this level, we conducted a multiple case study directly involving caregivers who received individualized (counseling-type) support from trained professionals. When individual caregiver comparisons are combined, we observe a significant reduction in their subjective burden and psychological distress.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eIn this study, we chose to perform an extensive evaluation of the training's effects. Five levels of analysis were considered together in our research: professionals\u0026rsquo; reactions (level 1), changes in their knowledge and skills (level 2), changes in their professional practices (level 3), changes in their organizational practices (level 4A), and clinical outcomes (level 4B). We opted for a relatively broad analysis providing an overview of the impacts of this type of training program, given the limited number of studies on this subject (30). However, this choice does not allow for exhaustive evaluations at each level of analysis, leading to certain methodological weaknesses. The latter include the lack of validated questionnaires. Several questionnaires were created for this research, which is common in exploratory studies like this one. However, it would have been useful to select additional validated questionnaires to facilitate comparison of our results with those of other studies. Regarding the questionnaires, we also regret the lack of \"positive\" measures. Concerning caregiver support, there are multiple questionnaires that, unlike the Zarit scale or the psychological distress scale (IDPESQ-14), also measure the positive aspects of caregiving (e.g., The \u0026ldquo;Caregiving Ambivalence Scale\u0026rdquo; (50); the \u0026ldquo;CADI-CASI-CAMI\u0026rdquo; (51)). Another limitation of our research concerns level 4A of the Kirkpatrick-Barr framework, i.e., the organizational outcomes of the training. This level was examined through a single (open-ended) question, which also considered practice-level impacts (level 3), making it difficult to obtain specific information about the organizational transformations related to the training. In our multiple case study (level 4B), as we combined individual analysis results, it would have been interesting to compare them with those of a control group (caregivers who did not receive support). Our participant recruitment method also presents a limitation as the professionals recruited were volunteers, which may increase the likelihood of receiving positive reactions to the training (compared to designated professionals). Finally, our study design does not allow us to understand the long-term impact of the training. Only the direct repercussions were considered in this study, and we cannot determine whether the observed changes are maintained over time.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eCaregiver support interventions have long been recognized as valid and effective (15,52,53). Despite these findings, in practice, it appears difficult to truly implement these initiatives in a sustainable way (22), which may be explained by several barriers. First, the lack of flexibility (particularly within institutional settings) hinders the individualization of support interventions, even though it is a key criterion for effectiveness (15). The heterogeneity of clinical situations is such that support programs must be tailor-made (23). This is one of the reasons why \"multi-component\" interventions are generally recognized as more effective (15). Similarly, support interventions that can adapt to the evolving needs of caregivers over time are more appropriate (15). In this research project, we found that professionals encountered difficulties in developing support services for caregivers when their practice was constrained by a set of directives dependent on their institutional framework (e.g., in a hospital setting, professionals may be constrained by billing rules, inclusion criteria, or a limited number of sessions). We therefore recommend that these services be offered within a flexible framework, in which professionals are free to adjust the quantity, frequency, location (e.g., home visits if necessary), and content of the sessions.\u003c/p\u003e \u003cp\u003eThe lack of political and institutional mobilization is a second barrier to the implementation of family caregivers support services. Despite evidence of their effectiveness, there is insufficient political awareness of the importance of these programs to lead to strong measures promoting the popularization and sustainability of these services. In this research project, we observed a significant difference between the service offerings available in France (Hauts-de-France) compared to those in Belgium (Wallonia). In the Hauts-de-France region, over twenty \u0026ldquo;Caregiver Support and Respite Platforms\u0026rdquo; provide caregivers with free services such as respite, information, and individualized support. In Wallonia, only a few hospital clinics and non-profit organizations offer inconsistent (often non-reimbursed) caregiver support. Thus, there are significant local differences regarding the availability and accessibility of support services (54). Additionally, these services often rely on already overburdened healthcare professionals (22) and typically depend on a single individual rather than a team (55). We recommend that health policies and organizations be more engaged in the implementation of these services.\u003c/p\u003e \u003cp\u003eLastly, the lack of healthcare professionals' training in caregiver support also constitutes a barrier to service implementation. Many researchers in the field advocate for the development of skills in family caregiver support (27\u0026ndash;29,56). However, Badovinac et al. (2019) (28) observed that there are few educational opportunities on this topic. The issue of caregiver support (identification, needs, and assistance) should be an integral part of the curriculum for healthcare professionals (doctors, nurses, social workers, nursing assistants, etc.) to promote collaborative initiatives in practice.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study confirms the value of providing training to healthcare professionals on supporting family caregivers of individuals with Alzheimer\u0026rsquo;s disease. In addition to improving professionals\u0026rsquo; knowledge, skills, and practices, these training sessions have fostered organizational changes, such as the development of new support services. Given the demonstrated effectiveness of these services, as highlighted by our research, and in light of the current lack of concrete initiatives in practice, we strongly recommend the implementation of such training programs for professionals.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;AAS: The Ambivalent Ageism Scale\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;DAS: The Dementia Attitudes Scale\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;IRR: Inter-rater reliability\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp; \u0026nbsp; \u0026nbsp;IDPESQ: 14-item Psychological Distress Index\u003c/p\u003e\n\u003cp\u003e- \u0026nbsp; \u0026nbsp; NAP: Nonoverlap of All Pairs\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe ethics committee of the University of Li\u0026egrave;ge approved the study protocol. All participants provided explicit informed consent. All research methods were conducted in accordance with ethical guidelines and regulations.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNot applicable\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe quantitative dataset generated and analyzed during the current study is available in the Additional File 3\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e(.xls). Qualitative data and data from the multiple case study are available from the corresponding author.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare they have no competing interests.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis study was supported by grants from the Interreg-V cross-border cooperation program (France-Wallonia-Flanders). The funding had no influence on the design of the study, collection, analysis, and interpretation of data, and in the writing of the manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSA designed the training program proposed to healthcare professionals. CC developed the evaluation protocol for this training. SA delivered the training sessions, and CC collected data from the professionals. CC and SA developed the protocol for the multiple case study, and CC collected data from informal caregivers. CC performed data encoding, as well as the statistical and qualitative analysis of the data. CC drafted the manuscript. SA and LD critically reviewed the manuscript and provided revisions. The final version of the manuscript was approved by all authors.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eWe would like to thank the professionals and organizations we collaborated with as part of the INTERREG project. We also thank the healthcare professionals who participated in the training and the study, as well as the informal caregivers who agreed to be interviewed.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eVisser LNC, Pelt SAR, Kunneman M, Bouwman FH, Claus JJ, Kalisvaart KJ, et al. Communicating uncertainties when disclosing diagnostic test results for (Alzheimer\u0026rsquo;s) dementia in the memory clinic: The ABIDE project. Health Expectations. 2020 Feb 22;23(1):52\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003ePringault S. 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Conflit d\u0026rsquo;int\u0026eacute;r\u0026ecirc;ts et traitements anti-Alzheimer : de la construction \u0026agrave; la contestation d\u0026rsquo;une promesse m\u0026eacute;dicale. In 2020. p. 77\u0026ndash;104. Available from: https://www.cairn.info/revue-sciences-sociales-et-sante-2020-3-page-77.htm\u003c/li\u003e\n\u003cli\u003ePancrazi MP, M\u0026eacute;tais P. Prise en charge non m\u0026eacute;dicamenteuse dans les d\u0026eacute;mences s\u0026eacute;v\u0026egrave;res. Psychol Neuropsychiatr Vieil. 2005;3(1):42\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eMilders M, Bell S, Lorimer A, Jackson H, McNamee P. Improving access to a multi-component intervention for caregivers and people with dementia. Dementia. 2019 Jan 6;18(1):347\u0026ndash;59. \u003c/li\u003e\n\u003cli\u003eCheng ST, Li KK, Losada A, Zhang F, Au A, Thompson LW, et al. The effectiveness of nonpharmacological interventions for informal dementia caregivers: An updated systematic review and meta-analysis. Psychol Aging. 2020 Feb;35(1):55\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eDickinson C, Dow J, Gibson G, Hayes L, Robalino S, Robinson L. Psychosocial intervention for carers of people with dementia: What components are most effective and when? A systematic review of systematic reviews. Int Psychogeriatr. 2017 Jan 26;29(1):31\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eVan\u0026rsquo;t Leven N, de Lange J, Prick AE, Pot AM. How do activating interventions fit the personal needs, characteristics and preferences of people with dementia living in the community and their informal caregivers? Dementia. 2019 Jan 10;18(1):157\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eAblitt A, Jones G V., Muers J. Living with dementia: A systematic review of the influence of relationship factors. Aging Ment Health. 2009 Jul;13(4):497\u0026ndash;511. \u003c/li\u003e\n\u003cli\u003eMittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006 Nov 14;67(9):1592\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eGaugler JE, Reese M, Mittelman MS. Effects of the NYU Caregiver Intervention-Adult Child on Residential Care Placement. Gerontologist. 2013 Dec;53(6):985\u0026ndash;97. \u003c/li\u003e\n\u003cli\u003eTerum TM, Testad I, Rongve A, Aarsland D, Svendsboe E, Andersen JR. The association between aspects of carer distress and time until nursing home admission in persons with Alzheimer\u0026rsquo;s disease and dementia with Lewy bodies. Int Psychogeriatr. 2021 Apr 11;33(4):337\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eBalvert SCE, Milders M V., Bosmans JE, Heymans MW, van Bommel S, Dr\u0026ouml;es RM, et al. The MOMANT study, a caregiver support programme with activities at home for people with dementia: a study protocol of a randomised controlled trial. BMC Geriatr. 2022 Apr 7;22(1):295. \u003c/li\u003e\n\u003cli\u003eM\u0026aacute;rquez-Gonz\u0026aacute;lez M, Romero-Moreno R, Cabrera I, Olmos R, P\u0026eacute;rez-Miguel A, Losada A. Tailored versus manualized interventions for dementia caregivers: The functional analysis-guided modular intervention. Psychol Aging. 2020 Feb;35(1):41\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eMackenzie CS, Peragine G. Measuring and enhancing self-efficacy among professional caregivers of individuals with dementia. Am J Alzheimers Dis Other Demen. 2003 Sep 1;18(5):291\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eParks SM, Haines C, Foreman D, McKinstry E, Maxwell TL. Evaluation of an educational program for long-term care nursing assistants. J Am Med Dir Assoc. 2005 Jan;6(1):61\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eCoogle CL, Head CA, Parham IA. The Long-Term Care Workforce Crisis: Dementia-Care Training Influences on Job Satisfaction and Career Commitment. Educ Gerontol. 2006 Sep;32(8):611\u0026ndash;31. \u003c/li\u003e\n\u003cli\u003eParmar J, Anderson S, Duggleby W, Holroyd‐Leduc J, Pollard C, Br\u0026eacute;mault‐Phillips S. Developing person‐centred care competencies for the healthcare workforce to support family caregivers: Caregiver centred care. Health Soc Care Community. 2020 Sep 19;29(5):1327\u0026ndash;38. \u003c/li\u003e\n\u003cli\u003eBadovinac LM, Nicolaysen L, Harvath TA. Are We Ready for the CARE Act?: Family Caregiving Education for Health Care Providers. J Gerontol Nurs. 2019 Mar;45(3):7\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eSchulz R, Beach SR, Friedman EM, Martsolf GR, Rodakowski J, James AE. Changing Structures and Processes to Support Family Caregivers of Seriously Ill Patients. J Palliat Med. 2018 Mar;21(S2):S-36-S-42. \u003c/li\u003e\n\u003cli\u003eParmar JK, L\u0026rsquo;Heureux T, Anderson S, Duggleby W, Pollard C, Poole L, et al. Optimizing the integration of family caregivers in the delivery of person-centered care: evaluation of an educational program for the healthcare workforce. BMC Health Serv Res. 2022 Mar 18;22(1):364. \u003c/li\u003e\n\u003cli\u003eBarr H, Freeth D, Hammick M, Koppel I, Reeves S. The United Kingdom Centre for the Advancement of Interprofessional Education with The British Educational Research Association EVALUATIONS OF INTERPROFESSIONAL EDUCATION A United Kingdom Review for Health and Social Care. 2000. \u003c/li\u003e\n\u003cli\u003eGaymard S. THE REPRESENTATION OF OLD PEOPLE: COMPARISON BETWEEN THE PROFESSIONALS AND STUDENTS The representation of old people: comparison between the professionals and students La repr\u0026eacute;sentation de la personne \u0026acirc;g\u0026eacute;e : comparaison entre les professionnels et les \u0026eacute;tudiants [Internet]. 2006. Available from: https://www.cairn.info/revue-internationale\u003c/li\u003e\n\u003cli\u003eAdam S, Missotten P, Flamion A, Marquet M, Clesse A, Piccard S, et al. Vieillir en bonne sant\u0026eacute; dans une soci\u0026eacute;t\u0026eacute; \u0026acirc;giste\u0026hellip;. NPG Neurologie - Psychiatrie - G\u0026eacute;riatrie. 2017 Dec;17(102):389\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eCrutzen C, Missotten P, Adam S, Schroyen S. Does caring lead to stigmatisation? The perception of older people among healthcare professionals and the general population: A cross‐sectional study. Int J Older People Nurs. 2022 Sep 10;17(5). \u003c/li\u003e\n\u003cli\u003eLevy B, Ashman O, Dror I. To be or Not to be: The Effects of Aging Stereotypes on the Will to Live. OMEGA - Journal of Death and Dying. 2000 May 1;40(3):409\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eLevy BR, Slade MD, Murphy TE, Gill TM. Association Between Positive Age Stereotypes and Recovery From Disability in Older Persons. JAMA. 2012 Nov 21;308(19):1972. \u003c/li\u003e\n\u003cli\u003eCary LA, Chasteen AL, Remedios J. The Ambivalent Ageism Scale: Developing and Validating a Scale to Measure Benevolent and Hostile Ageism. Gerontologist. 2016 Aug 12;gnw118. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Connor ML, McFadden SH. Development and Psychometric Validation of the Dementia Attitudes Scale. Int J Alzheimers Dis. 2010;2010:1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eLiu HY, Chao CY, Kain VJ, Sung SC. The relationship of personal competencies, social adaptation, and job adaptation on job satisfaction. Nurse Educ Today. 2019 Dec;83:104199. \u003c/li\u003e\n\u003cli\u003eB\u0026eacute;dard M, Molloy DW, Squire L, Dubois S, Lever JA, O\u0026rsquo;Donnell M. The Zarit Burden Interview. Gerontologist. 2001 Oct 1;41(5):652\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eBoyer R, Pr\u0026eacute;ville M, L\u0026eacute;gar\u0026eacute; G, Valois P. La D\u0026eacute;tresse Psychologique dans la Population du Qu\u0026eacute;bec non Institutionnalis\u0026eacute;e: R\u0026eacute;sultats Normatifs de L\u0026rsquo;enqu\u0026ecirc;te Sant\u0026eacute; Qu\u0026eacute;bec. The Canadian Journal of Psychiatry. 1993 May 1;38(5):339\u0026ndash;43. \u003c/li\u003e\n\u003cli\u003eManolov R, Solanas A, Sierra V, Evans JJ. Choosing Among Techniques for Quantifying Single-Case Intervention Effectiveness. Behav Ther. 2011 Sep;42(3):533\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eGage NA, Lewis TJ. Analysis of Effect for Single-Case Design Research. J Appl Sport Psychol. 2013 Jan;25(1):46\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eParker RI, Vannest K. An Improved Effect Size for Single-Case Research: Nonoverlap of All Pairs. Behav Ther. 2009 Dec;40(4):357\u0026ndash;67. \u003c/li\u003e\n\u003cli\u003eSanders S. Is the Glass Half Empty or Half Full? Soc Work Health Care. 2005 May 11;40(3):57\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eRigaux N. Informal care: Burden or significant experience? Psychologie et NeuroPsychiatrie du Vieillissement. 2009;7(1):57\u0026ndash;63. \u003c/li\u003e\n\u003cli\u003eRoth DL, Fredman L, Haley WE. Informal Caregiving and Its Impact on Health: A Reappraisal From Population-Based Studies. Gerontologist. 2015 Apr 1;55(2):309\u0026ndash;19. \u003c/li\u003e\n\u003cli\u003eAnkri J, Andrieu S, Beaufils B, Grand A, Henrard JC. Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. Int J Geriatr Psychiatry. 2005 Mar 16;20(3):254\u0026ndash;60. \u003c/li\u003e\n\u003cli\u003eVitaliano PP, Russo J, Young HM, Becker J, Maiuro RD. The Screen for Caregiver Burden. Gerontologist. 1991 Feb 1;31(1):76\u0026ndash;83. \u003c/li\u003e\n\u003cli\u003eLosada A, Pillemer K, M\u0026aacute;rquez-Gonz\u0026aacute;lez M, Romero-Moreno R, Gallego-Alberto L. Measuring Ambivalent Feelings in Dementia Family Caregivers: The Caregiving Ambivalence Scale. Gerontologist. 2017 Sep 7;gnw144. \u003c/li\u003e\n\u003cli\u003eMcKee K, Spazzafumo L, Nolan M, Wojszel B, Lamura G, Bien B. Components of the difficulties, satisfactions and management strategies of carers of older people: A principal component analysis of CADI-CASI-CAMI. Aging Ment Health. 2009 Mar 1;13(2):255\u0026ndash;64. \u003c/li\u003e\n\u003cli\u003eCravello L, Martini E, Viti N, Campanello C, Assogna F, Perotta D. Effectiveness of a Family Support Intervention on Caregiving Burden in Family of Elderly Patients With Cognitive Decline After the COVID-19 Lockdown. Front Psychiatry. 2021 Mar 4;12. \u003c/li\u003e\n\u003cli\u003ede Araujo EL, Rodrigues MR, Kozasa EH, Lacerda SS. Psychoeducation versus psychoeducation integrated with yoga for family caregivers of people with Alzheimer\u0026rsquo;s disease: a randomized clinical trial. Eur J Ageing. 2023 Dec 25;20(1):46. \u003c/li\u003e\n\u003cli\u003eBirkenh\u0026auml;ger-Gillesse EG, Kollen BJ, Zuidema SU, Achterberg WP. The \u0026ldquo;more at home with dementia\u0026rdquo; program: a randomized controlled study protocol to determine how caregiver training affects the well-being of patients and caregivers. BMC Geriatr. 2018 Dec 22;18(1):252. \u003c/li\u003e\n\u003cli\u003eChristie HL. The implementation of EHealth in dementia care. maastricht university; 2020. \u003c/li\u003e\n\u003cli\u003eSchulz R, Beach SR, Czaja SJ, Martire LM, Monin JK. Family Caregiving for Older Adults. Annu Rev Psychol. 2020 Jan 4;71(1):635\u0026ndash;59. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Health education, training program, informal caregivers, healthcare professionals, Kirkpatrick-Barr","lastPublishedDoi":"10.21203/rs.3.rs-5455672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5455672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDespite their proven effectiveness, support interventions for caregivers of people with neurodegenerative diseases struggle to be sustainably implemented. In this context, the \u0026ldquo;Caregivers /Network-Service\u0026rdquo; (\u0026ldquo;Aidants Proches / R\u0026eacute;seau-Service\u0026rdquo;) project (Interreg) aimed to create a network of professionals specialized in supporting family caregivers through training programs. The goal of this study was to determine the overall impact of the proposed training.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 217 healthcare professionals participated in the training, and 108 agreed to take part in the study. Based on the Kirkpatrick-Barr framework (Barr et al., 2000) and the study by Parmar et al. (2022), the training\u0026rsquo;s outcomes were evaluated at four levels: (1) professionals\u0026rsquo; reactions to the training, (2) changes in their learning (knowledge and skills), (3) changes in their practices, (4A) organizational changes, and (4B) clinical changes. For the latter level, a multiple case study was conducted with caregivers receiving individualized support from trained professionals.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe training was highly appreciated and improved the knowledge, skills, and practices of the professionals. It also promoted organizational changes, such as the implementation of new support services for caregivers. The individualized support provided by the trained professionals appeared to have positive clinical effects on caregivers, who also recommended the service.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eGiven the demonstrated effectiveness of these support services, as highlighted by our research, and in light of the lack of initiatives in the field, we strongly recommend the implementation of such training programs for healthcare professionals.\u003c/p\u003e","manuscriptTitle":"Evaluation of a Training Program for Healthcare Professionals Supporting Informal Caregivers of People with Dementia: A Pre-Post Quasi-Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-19 11:01:05","doi":"10.21203/rs.3.rs-5455672/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f277803a-6d86-4fd9-adc6-034bf1913f23","owner":[],"postedDate":"December 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-25T09:12:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-19 11:01:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5455672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5455672","identity":"rs-5455672","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}