CONFIDENCE Financial Education for Caregivers

Monthly out-of-pocket costs of caregiving is based on the tool used by the AARP Public Policy Institute in their 2016 report on the out-of-pocket costs of caregiving. This measure combines caregiver recall of care costs in the previous month, collected at baseline, with 5 days of daily spending diaries. Daily surveys will be sent using an email with a survey link, and a text message reminder. Monthly costs include less-frequent, high-cost expenditures (e.g., mortgage payment), while daily costs include lower-cost items caregivers may pay for more frequently (e.g., groceries). Daily self-reports of spending will be averaged and multiplied by 6 to approximate the number of days in a month, and added to estimated monthly costs. Positive scores indicate increased out-of-pocket costs. The researchers advise against relying on this outcome. In this pilot study, we found that this measure has qualitatively different meanings for adult child and spousal caregivers.

Time frame: Change in median costs from from baseline to 8 weeks post-intervention

Population: Although all 20 participants were asked to complete daily spending surveys used to calculuate monthly out-of-pocket caregiving costs, only 16 completed daily spendin surveys at baseline. Of these participants, 10 completed daily spending surveys at the 2-month follow-up time. However, one follow-up survey was removed from analyses since it was an extreme outlier (i.e., 16 times higher than next highest monthly cost calculated).

Resourcefulness is measured using the 28-item Caregiver Resourcefulness Scale (alpha=0.85). This scale has two factors: one focused on help-seeking and another on self-help. Caregivers are asked the frequency at which they use different strategies to manage challenges, and may respond: Not at all like me (0), Pretty much not like me (1), A little bit not like me (2), A little bit like me (3), Pretty much like much like me (4), or Very much like me (5). Items are added together to create a total score. Scores range from 0 to 140, where higher scores indicate higher levels of resourcefulness. The outcome measure will use the average change score from baseline scores

Time frame: Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention

Population: Six participants did not complete the first follow up and the second follow up survey. In addition, two other participants had missing item-level data in the first follow up survey and another 4 had missing item-level data on the second follow up survey, such that there are 8 missing cases for Change from baseline to post-intervention and 10 missing cases for Change from baseline to 8 weeks post-intervention.

Self-efficacy is measured using the Caregiver Self-Efficacy Scale. This 8-item scale asks about multiples domains of self-efficacy (e.g., managing behavioral symptoms, accessing respite, and controlling upsetting thoughts). It demonstrates high reliability (alpha=0.89) and good test-retest reliability (0.73). Participants rate the extent to which they are Not confident at all (1) to Totally confident (10). Scores range from 8 (lowest level of self-efficacy) to 80 (highest level of self-efficacy). The outcome measure will use the average change score from baseline scores. Positive scores indicate an increase in self-efficacy.

Time frame: Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention

Population: A participant had item-level missingness at baseline, such that baseline data is available for 19 participants. Six participants did not complete the first follow up and the second follow up survey. Another participant had missing item-level data in the first follow up survey, such that there are 7 missing cases for Change from baseline to post-intervention and 6 missing cases for Change from baseline to 8 weeks post-intervention.

The measure for psychological financial strain is from multiple scales. Items 1 to 14 ask about financial anxiety. Lastly, the investigators included the 1-item question that asks about financial worry (I worry constantly about money. Participants are asked to indicate the extent to which each statement is true (Very true \[3\], Somewhat true\[2\], Somewhat untrue\[1\], and Complete untrue\[0\]). Scores are summed such that scores range from 0 to 45, where higher scores indicate higher levels of financial strain.

Time frame: Change from baseline to post-intervention (within 1 week); change from baseline to 8 weeks post-intervention

Population: In both the first follow up and second follow up survey, there were 6 missing cases. In addition, for item-level missingness on this scale contributes to missing data for 2 additional cases.