Process evaluation of the residential care transition module

BACKGROUND: Dementia caregiver intervention research often lacks focus on mechanisms of benefit. This study addresses this gap through a process evaluation of the Residential Care Transition Module (RCTM), a telehealth intervention designed to assist family caregivers of persons with dementia post-institutionalization, consisting of six sessions with flexible ad hoc support over a 12-month period. This process evaluation describes the RCTM's content and delivery, examines treatment fidelity, identifies implementation factors that influenced the primary outcomes (caregiver subjective stress and depressive symptoms), and clarifies mechanisms of intervention benefit. METHODS: The RCTM enrolled 240 primary caregivers randomly assigned to the intervention or attention control group (n = 120 each). Process/implementation data were collected through study logs documenting session duration, modality, and content, and treatment review checklists completed at four, eight, and 12 months, capturing caregiver ratings of intervention content, utility, and acceptability. Additionally, 30 purposively selected caregivers completed semi-structured interviews probing their perceptions of the intervention. This process evaluation employed a parallel convergent mixed-methods design, integrating quantitative data from longitudinal surveys with qualitative thematic analysis of interviews. RESULTS: Most caregivers (107; 89%) completed all six intervention sessions; of these, the majority (80; 75%) completed the intervention in four months. Caregivers found the intervention beneficial across multiple domains, expressing strong support for its utility and acceptability. Interviews revealed nine intervention components that facilitated treatment enactment and highlighted mechanisms of benefit. Longitudinal models showed participation in ad hoc intervention sessions was associated with greater benefit over the 12-month period, with higher frequency and longer duration of ad hoc sessions significantly associated with larger reductions in depressive symptoms and care-related stress, respectively. CONCLUSIONS: The RCTM was delivered with high fidelity, demonstrating strong caregiver participation and positive feedback. Qualitative and quantitative data highlight the RCTM's value in providing emotional support and informational counseling to help caregivers build mastery for managing residential care-related issues. In particular, results demonstrated the potential importance of flexible ad hoc sessions in complementing the core intervention. These insights can inform future adaptation/implementation of the RCTM to support dementia caregivers within residential long-term care settings. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02915939; 09-26-2016.