Effectiveness of Internet-based emotional healing with an expressive arts therapy program on burden, depression, and self-esteem among family caregivers of older adults with dementia compered to usual care: A randomized control trial.

INTERVENTION: Setting: The Alzheimer’s Disease and Related Disorders Association of Thailand (ADRA) (Alzheimer Thailand, 2023). Randomization: The experimental and control groups will be randomly assigned following stratified block randomization. Intervention: The Internet‐based emotional healing with expressive arts therapy program is an Internet‐based intervention that supports family caregivers of older adults with dementia. It is delivered in groups, and focuses on emotional healing. The program includes expressive arts therapy, defined as visual arts, music, and storytelling. The program emphasizes the following themes: fostering social support, creative expression, personal growth, a positive attitude, and making meaning. The researcher will give the participants the necessary tools and materials and then encourage them to continue with their groups (3–12 people per group). The researcher will give assignments and materials for the participants to do art activities at home with one assignment/2 weeks. The completed program is eight weeks and consists of 6 sessions. The researcher meets with the group in weeks 1, 2, 4, 6, and 8 via LINE, Facebook, Google Meet, or Zoom application. The researcher will give the participants the tools and materials they need and encourage them to continue in groups (3–12 people per group) online and do an activity for 6 sessions (45–60 min./session). Session1: Introduction by visual art, and storytelling (Week 1) Session2: art activities by music, Body movement, writing and storytelling (Week 2) Session3: art activities by visual art, writing (Week 3) Session4: art activities by music, visual art, writing and storytelling (Week 4) Session 5: Art activities by visual art, music, Body movement, writing and storytelling (Weeks 5, 6). Session 6: Ar CONDITION: Mental Health of carers in dementia PRIMARY OUTCOME: The burden of caregiving as assessed by the Burden of Caregiving Scale; the Zarit Burden Interview, translated into Thai. The Zarit Burden Interview for dementia caregivers contains 22 questions with scoring for each question divided into a 5‐point rating scale. [Week 0 (baseline), After week 4, Week 8. ]; Depression of caregivers as assessed by a Depression Scale; The Center for Epidemiological Studies‐Depression (CES‐D) Thai version. This consists of a 20‐item measure that asks caregivers to rate the frequency with which they experienced depressive symptoms such as restless sleep, poor appetite, and feelings of isolation during the past week. [Week 0 (baseline), After week 4, Week 8.]; Self‐esteem of carers as assessed by a Self‐esteem Scale; the Rosenberg’s Self‐esteem scale, Thai version (RSES‐TR‐10). The scale was created to measure feelings of self‐acceptance and self‐esteem. The ten questions consist of five positive questions, five negative questions, and an inverse rating on 5‐point scales. [Week 0 (baseline), After week 4, Week 8.]; INCLUSION CRITERIA: (1) A family caregiver, male and female aged 20–59 years, unpaid and living as a family member with an older adult diagnosed with moderate to severe dementia. (2) Able to read, speak, and write in Thai. (3) Able to use Internet‐based communication; the family caregivers of older adults with mid‐term/severe dementia will use video calls via the LINE application, Facebook, Google Meet, or Zoom application. (4) Provision of care for at least 3 months and performing caregiving tasks for at least 4 hours daily. (5) Mild to moderate level perception of depression. (****9Q =7‐18 score) ***Patient Health Questionnaire for Screening Major Depression (9Q), Thai Version.