Multilingual Dementia Training for Paid Caregivers: A RE-AIM Mixed-Methods Evaluation

Background and Objectives This study evaluated the IHSS+ ADRD Training Project, a multilingual intervention for caregivers serving individuals living with Alzheimer’s disease and related dementias (ADRD) through California’s In-Home Supportive Services (IHSS) program, using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Research Design and Methods A quasi-experimental, mixed-methods evaluation was conducted from July 2019 to June 2024 across Alameda and Los Angeles counties. By applying the RE-AIM framework, Reach and Effectiveness dimensions were assessed through surveys completed by 488 caregivers in English (n = 297), Spanish (n = 102), and Chinese (n = 89) at pre-training, post-training, and 3-month follow-up. Caregivers were diverse among English speakers (38% Black/African American, 23% Hispanic/Latino, and 20% Asian), averaged 49.9 years old, and were predominantly women (88%). Quantitative measures assessed dementia knowledge, self-efficacy, distress, and depression. Qualitative interviews with stakeholders (n = 11) and open-ended caregiver survey responses explored Adoption, Implementation, and Maintenance dimensions Results RE-AIM findings demonstrated: Reach across diverse caregiver populations in multilingual formats; Effectiveness with significant improvements in dementia knowledge and self-efficacy sustained at 3-month follow-up, plus 88-99% satisfaction; Adoption facilitated by union partnership; Implementation successfully transitioned to virtual delivery during COVID-19 despite technology barriers; and Maintenance supported by increased caregiver confidence, self-care awareness, and stress management skills, though sustainability required ongoing funding. Discussion and Implications Language-concordant training produced meaningful, sustained improvements across a diverse paid caregiver workforce, demonstrating its value as an equity strategy in home care workforce development. While virtual delivery was feasible and cost-effective, long-term success depends on securing dedicated funding and reliable technology infrastructure.