Alzheimer's disease and related disorders caregiver's acceptance of a web-based structured

188 Pages·2017·4.08 MB·English

University of Iowa
Iowa Research Online
Theses and Dissertations
Fall 2011
Alzheimer's disease and related disorders caregiver's
acceptance of a web-based structured written
emotional expression intervention
Ji Woon Ko
University of Iowa
Copyright 2011 ji woon Woon Ko
This dissertation is available at Iowa Research Online: https://ir.uiowa.edu/etd/2729
Recommended Citation
Ko, Ji Woon. "Alzheimer's disease and related disorders caregiver's acceptance of a web-based structured written emotional expression
intervention." PhD (Doctor of Philosophy) thesis, University of Iowa, 2011.
https://doi.org/10.17077/etd.2fqi1los
Follow this and additional works at:https://ir.uiowa.edu/etd
Part of theNursing Commons
ALZHEIMER‟S DISEASE AND RELATED DISORDERS CAREGIVER'S
ACCEPTANCE OF A WEB-BASED STRUCTURED WRITTEN EMOTIONAL
EXPRESSION INTERVENTION

by
Ji Woon Ko

An Abstract
Of a thesis submitted in partial fulfillment
of the requirements for the Doctor of
Philosophy degree in Nursing
in the Graduate College of
The University of Iowa
December 2011

Thesis Supervisor: Associate Professor Howard K. Butcher
1

ABSTRACT

Alzheimer‟s Disease and Related Disorders (ADRD) are a major public health
problems. Major sources of care provision are family members in the community and
these ADRD caregivers encounter a variety of stressor. Currently there continues to be a
need to develop and test Internet based interventions designed to reduce stress for
caregivers for persons with ADRD. The web-based Structured Written Emotional
Expressions (SWEE) was developed to manage ADRD caregivers stress related to
caregiving experiences through writing about their thoughts and feelings. However,
differences between provided services by researchers (the web-based SWEE) and the
desired services of ADRD caregivers could be a barrier to ADRD caregivers‟ acceptance
and use of the web-based SWEE.
The purpose of this study was to assess the acceptability of implementing a web-
based nursing intervention for ADRD caregivers and to describe participants‟ experiences
in using the website to understand ADRD caregivers‟ website usage.
An experimental design was used to determine whether the web-based SWEE
helped to manage ADRD caregivers‟ stress through writing interventions. In addition, the
UTAUT model was employed for a theoretical framework to explain and predict the
web-based SWEE usage behavior by ADRD caregivers. The Finding Meaning Through
Caregiving Scale (FMTCS) was used to evaluate finding-meaning related to caregiving
experiences as a mediator between performance expectancy and behavioral intention to
use in the UTAUT model. Furthermore, the web-based research methods were assessed
throughout the web-based SWEE implementing process.
Both web-based and paper-based methods were used for recruiting potential
participants. Most people who contacted the researcher were recruited by the web-based
method. Structural Equation Modeling (SEM) was used for test ADRD caregivers‟
2

acceptability of the web-based SWEE and direct content analysis was used for describing
participants‟ experiences in using the web-based SWEE.
Fifty people completed the study out of the 90 people who enrolled. Of these 50
participants, 31 completed the study as intended and on schedule. The research showed a
good model fit with a Chi-square value (df=43) of 57.191 (p>0.05). The findings showed
that performance expectancy had a significant effect on participants‟ behavioral intention
to use (β=0.620, p<0.01) and that effort expectancy also affected the behavioral intention
to use the web-based SWEE (β=0.293, p<0.01). Performance expectancy showed
stronger effects than effort expectancy. This model explained 52% of variance in
behavioral intention to use. However, the effects of facilitating conditions on actual usage
and effects of behavioral intention to use on actual usage were not supported by this
research. The finding-meaning measure did not show a significant mediating effect on the
relationship between performance expectancy and behavioral intention to use.
Findings suggested that recruitment methods which use the Internet were an
effective way to find potential study participants. Regardless of the topic, the writing
intervention helped ADRD caregivers to express stress related to caregiving experiences.
In addition, the perceived usefulness of this nursing intervention (performance
expectancy) and the perceived ease of use (effort expectancy) were two important
constructs which predicted and explained the acceptance of the web-based SWEE by
ADRD caregivers. Finally, even though the UATAUT model was only partially
supported by a good model fit, this study‟s findings showed the potential of the UTAUT
model for providing health consumer information systems in nursing.

Abstract Approved: _____________________________
Thesis Supervisor

______________________________
Title and Department

______________________________
Date
ALZHEIMER‟S DISEASE AND RELATED DISORDERS CAREGIVER'S
ACCEPTANCE OF A WEB-BASED STRUCTURED WRITTEN EMOTIONAL
EXPRESSION INTERVENTION
by
Ji Woon Ko
A thesis submitted in partial fulfillment
of the requirements for the Doctor of
Philosophy degree in Nursing
in the Graduate College of
The University of Iowa
December 2011

Thesis Supervisor: Associate Professor Howard K. Butcher
Copyright by
JI WOON KO
2011
All Rights Reserved
Graduate College
The University of Iowa
Iowa City, Iowa
CERTIFICATE OF APPROVAL
_______________________
PH.D. THESIS
_______________
This is to certify that the Ph.D. thesis of
Ji Woon Ko
has been approved by the Examining Committee
for the thesis requirement for the Doctor of Philosophy
degree in Nursing at the December 2011 graduation.
Thesis Committee: __________________________________
Howard K. Butcher, Thesis Supervisor
___________________________________
Martha Craft-Rosenberg
___________________________________
Anna M. McDaniel
___________________________________
Jane M. Brokel
___________________________________
Timothy N. Ansley
ACKNOWLEDGEMENTS

I would like to thank my committee members: Dr. Howard K, Butcher (Chair and
Advisor), Dr. Martha Craft-Rosenberg, Dr. Anna M. McDaniel, Dr. Jane M. Brokel, and
Dr. Timothy N. Ansley, for their support and guidance during the process of writing this
dissertation. I am grateful to my advisor, Dr. Howard K. Butcher, who guided the
development, implementation and analysis of this research project and encouraged me to
complete the doctoral program. Special thank Andrew Rinner who was the webmaster of
the study website and provided invaluable technical support. I could not have completed
this research project without to his help.
Without the love and support of my parents and my parents-in-law, I would have
had a much harder time during my doctoral program and especially during the
dissertation process. In addition, my loving husband, Yongjoo Kim, supported me in
every way as I completed my study. Thanks and love to my daughter, Kayeon, who has
been very good in Korea without me. Special thanks to Sarah who is my dearest friend
and spent time with me when I had trouble and difficult times here.
This study was supported in part by the Iowa Informatics Initiative, which
supported the development the website for testing the effect of an Internet-based
Structured Emotional Expressive Writing Intervention with Alzheimer disease family
caregivers as well as by the Gerontological Nursing Area of Study at the University of
Iowa College of Nursing which supported the redesign of the original SWEE website for
the purpose of this study.
ii
ABSTRACT
Alzheimer‟s Disease and Related Disorders (ADRD) are a major public health
problems. Major sources of care provision are family members in the community and
these ADRD caregivers encounter a variety of stressor. Currently there continues to be a
need to develop and test Internet based interventions designed to reduce stress for
caregivers for persons with ADRD. The web-based Structured Written Emotional
Expressions (SWEE) was developed to manage ADRD caregivers stress related to
caregiving experiences through writing about their thoughts and feelings. However,
differences between provided services by researchers (the web-based SWEE) and the
desired services of ADRD caregivers could be a barrier to ADRD caregivers‟ acceptance
and use of the web-based SWEE.
The purpose of this study was to assess the acceptability of implementing a web-
based nursing intervention for ADRD caregivers and to describe participants‟ experiences
in using the website to understand ADRD caregivers‟ website usage.
An experimental design was used to determine whether the web-based SWEE
helped to manage ADRD caregivers‟ stress through writing interventions. In addition, the
UTAUT model was employed for a theoretical framework to explain and predict the
web-based SWEE usage behavior by ADRD caregivers. The Finding Meaning Through
Caregiving Scale (FMTCS) was used to evaluate finding-meaning related to caregiving
experiences as a mediator between performance expectancy and behavioral intention to
use in the UTAUT model. Furthermore, the web-based research methods were assessed
throughout the web-based SWEE implementing process.
Both web-based and paper-based methods were used for recruiting potential
participants. Most people who contacted the researcher were recruited by the web-based
method. Structural Equation Modeling (SEM) was used for test ADRD caregivers‟
iii
acceptability of the web-based SWEE and direct content analysis was used for describing
participants‟ experiences in using the web-based SWEE.
Fifty people completed the study out of the 90 people who enrolled. Of these 50
participants, 31 completed the study as intended and on schedule. The research showed a
good model fit with a Chi-square value (df=43) of 57.191 (p>0.05). The findings showed
that performance expectancy had a significant effect on participants‟ behavioral intention
to use (β=0.620, p<0.01) and that effort expectancy also affected the behavioral intention
to use the web-based SWEE (β=0.293, p<0.01). Performance expectancy showed
stronger effects than effort expectancy. This model explained 52% of variance in
behavioral intention to use. However, the effects of facilitating conditions on actual usage
and effects of behavioral intention to use on actual usage were not supported by this
research. The finding-meaning measure did not show a significant mediating effect on the
relationship between performance expectancy and behavioral intention to use.
Findings suggested that recruitment methods which use the Internet were an
effective way to find potential study participants. Regardless of the topic, the writing
intervention helped ADRD caregivers to express stress related to caregiving experiences.
In addition, the perceived usefulness of this nursing intervention (performance
expectancy) and the perceived ease of use (effort expectancy) were two important
constructs which predicted and explained the acceptance of the web-based SWEE by
ADRD caregivers. Finally, even though the UATAUT model was only partially
supported by a good model fit, this study‟s findings showed the potential of the UTAUT
model for providing health consumer information systems in nursing.
iv