Defense Date


Document Type


Degree Name

Doctor of Philosophy


Health Related Sciences

First Advisor

Iris A. Parham


The purpose of the research is to examine the family experience of dementia caregiving and design an educational intervention to assist family members in the caregiving role. Stress results when a caregiver confronts environmental demands (dementia behaviors) that threaten personal well-being. The perception of threat is the process of primary stress appraisal. Caregivers evaluate coping options, a process of secondary stress appraisal. Positive secondary appraisal (view the situation as amenable to change) has the potential to trigger re-appraisal of the primary threat, and to reduce overall stress.

Education is one way to affect secondary appraisal. Adult learners benefit from progressive (problem solving) approaches using self-directed learning principles. With self-directed learning, the educator facilitates the learner’s access to the information. Distance education is a form of self-directed learning. Distance techniques include postal mail, facsimile, telephone, video, teleconferencing, satellite conferencing, and the Internet. The research question is: to what extent can distance education (by postal mail, passive Internet, and multimedia, interactive Internet) alter the primary and secondary stress appraisals of dementia caregivers?

A total of 189 caregivers participated in the study. The study design, Switching Replications, includes three waves of measurement over a two month period. With the design, some participants receive the intervention upon entry into the study, while others wait until after the second wave of measurement.

Three study hypotheses relate to the construct of primary appraisal and the dependent variable of threat perception. Analysis of Variance (ANOVA) results do not support hypotheses that posit the form of education affects threat perception. Four hypotheses address the construct of secondary appraisal and the dependent variable of home modifications. ANOVA results support hypotheses that posit the form of education affects home modifications. Active web education is statistically better than receiving no education or receiving information by postal mail.

Assuming no cure or effective treatment, the number of people diagnosed with dementia will increase to 8.6 million by 2040 (General Accounting Office,1998). Despite the stress, families are and will likely remain the primary caregivers. Distance education merits further study as a way to reach and help family caregivers.


Scanned, with permission from the author, from the original print version, which resides in University Archives.


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