A Mixed-Methods Analysis of Response to NOVELA Among Hospice Family Caregivers

Background and Aims: Telenovelas are a promising educational mode for teaching hospice family caregivers (HFCGs) to manage distress for themselves and their care recipients. We sought to understand the relationship between HFCGs’ change in anxiety and self-efficacy scores and their feedback regarding the NOVELA intervention (guided viewing of a hospice-related telenovela) using a mixed methods post-hoc analysis. Methods: This single-group pretest-posttest clinical trial included HFCGs from three hospices in the U.S. Mid-Atlantic region. At baseline and following each session, participants completed a web-based survey assessing two outcomes: anxiety and self-efficacy. Descriptive statistics, including t-test and chi-square, were computed. We also used semi-structured interviews to compare perceptions of HFCGs with improved vs non-improved outcome measures. Results: Participants (N = 50) were mainly home-bound, well-educated, White, female, adult children of people with an advanced non-cancer diagnosis. In total, 44 participants completed the outcome measures, with 12 in the non-improved group and 32 in the improved group. As shown by between-group differences comparing those with improvement and those without improvement, we identified three mixed-methods themes: (1) NOVELA participants valued interventionist interactions, but video content was not always relevant; (2) NOVELA enhanced understanding of hospice caregiving tasks, but timing was critical and caregivers with prior experience may have benefited less; and (3) barriers to NOVELA such as telehealth challenges and needing flexibility for caregiving demands (including more self-care content) must be addressed. Conclusion: NOVELA’s acceptability among HFCGs differed by improvement status and called for intervention adaptations that could potentiate NOVELA’s impact. Clinical Trial Name, Number, And Url: Improving Self-Efficacy Through a Telenovela: Feasibility Study (NOVELA), NCT04533594, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A6QU&ts=0&selectaction=Edit