Characterizing communication in dementia family caregiving: Identifying breakdown and repairs using the trouble source repair (TSR) framework via video observations

Abstract

AbstractBackgroundFamilies who provide care at home for people living with dementia (PLWD) are an integral part of dementia care worldwide and improving in‐home care is crucial. Communication is fundamental for daily care and communication breakdown presents additional stress to the caregiver‐PLWD dyad. In order to identify effective strategies that will minimize communication breakdown, we adapted the Trouble Source Repair (TSR) framework, a linguistic tool, to create a second‐by‐second behavioral coding scheme for video observations. This pilot study used the adapted TSR coding scheme to reliability identify communication breakdown and repair.MethodThis pilot study analyzed videos from a randomized controlled trial of a family caregiver telehealth intervention (FamTechCare). The videos were created by caregivers in their home, providing observations of natural caregiver‐PLWD interactions across a variety of daily care activities. Operational definitions from the TSR were adapted to create a coding scheme (Table 1). Video data collection and analysis were completed using Noldus software. Two independent coders obtained reliability.ResultThe video sample includes 51 dyads with 201 videos averaging 5.8 minutes in length. Caregivers were primarily female (80%), mean age 65 years, and were mostly a spouse (69%) while the PLWDs were primarily male (55%) with moderate to severe dementia (64.7%). The mean interrater reliability was excellent; Kappa = .93. Preliminary descriptive results (n=106) indicate 53.7% of the dyad communication was interactive, 8% was communication breakdown, and the remainder was silence or talking to others. During a typical breakdown sequence, the caregiver’s communication creates the breakdown (Trouble Source, 67%), the PLWD indicates not understanding (Flag, 71%) and the caregiver initiates the Repair (72%). Breakdowns were successfully resolved 71% of the time. Types of trouble sources, flags, and repairs can be seen in Table 2.ConclusionThe results support the use of the adapted TSR framework to reliability identify communication breakdowns via video observation. Future analyses will identify the most effective strategies to prevent and repair communication breakdown as well identify how strategies varies by dementia stage, diagnosis, and dyad characteristics.