Janice Hernandez

Background: Latino millennial caregivers comprise over one-quarter of millennial family caregivers in the United States. Latino millennial family caregivers face unique challenges due to cultural, structural, and economic burdens that may increase stress and stress-related health effects. These caregivers also report time limitations due to their multiple roles. Technology may be a way to deliver an accessible and flexible intervention to support stress management and emotional regulation in this population. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of a culturally tailored mobile health (mHealth) intervention to support stress management and emotional regulation for Latino millennial caregivers. Methods: Participants (N=30) were recruited nationally in the United States using a recruitment agency and were randomized to the intervention or waitlist control groups. The 4-week fully automated intervention included daily mindfulness exercises and journaling prompts delivered via a custom mHealth platform. The waitlist control group received a written handout with mindfulness, journaling, and support information. Feasibility data, including recruitment and retention rates and intervention adherence, and postintervention acceptability surveys were collected. Study outcome measures were collected electronically at baseline and 2, 4, and 6 weeks. Primary outcomes included caregiver burden and perceived stress, and secondary outcomes included well-being, informational support, and emotional support. Feasibility and acceptability data were analyzed descriptively alongside study outcome measure data from participants who completed week 6 data collection (n=21). No efficacy testing was conducted. Results: Enrollment was completed in 12 weeks (N=30), with a 70% (21/30) retention. Participants showed differential adherence, with 60% (6/10) completing a daily journal activity and 30% (3/10) completing a daily mindfulness activity. Adherence patterns were reflected in the acceptability findings, with journaling being preferred over mindfulness. Preliminary outcomes showed varying patterns between the intervention and control groups, with the intervention group showing decreased median burden levels from before (median 20, IQR 15-27.25) to after the intervention (median 15, IQR 10.50-28.75) but increased median stress levels from 19.50 (IQR 12-26.75) to 21 (IQR 8.75-22.75), while the control group burden and stress levels remained the same before and after the intervention. Positive affect and well-being and informational support increased for both groups. Median emotional support levels increased from 15 (IQR 12-20) before the intervention to 16 (IQR 13-19) after the intervention for the control group and decreased from 14.5 (IQR 11.5-17.75) to 14 (IQR 12-17.25) for the intervention group. Conclusions: Findings demonstrate areas for further intervention iteration to address both adherence and acceptability issues with the mindfulness component of the intervention. Intervention implementation also needs to be addressed, including participant retention rates. Our team will use lessons learned alongside feedback from Latino millennial caregivers to address these issues.

BACKGROUND Latino Millennial caregivers face unique challenges and elevated stress due to cultural, structural, and economic burdens. Culturally responsive, technology-based stress management interventions are needed to support emotional well-being in this population. OBJECTIVE To evaluate the feasibility and acceptability of a culturally tailored mobile health (mHealth) intervention to support stress management and emotional regulation for Latino Millennial caregivers. METHODS A four-week feasibility and acceptability pilot study was conducted with 21 Latino Millennial caregivers. The intervention included daily mindfulness exercises and journaling prompts, delivered via a custom mHealth platform. RESULTS The intervention was feasible, with enrollment completed in 12 weeks and 70% retention. Participants showed differential adherence with 60% of participants completing a daily journal activity and 30% completing a daily mindfulness activity. Adherence patterns were reflected in acceptability findings, with journaling being preferred more than mindfulness due to flexibility and cultural fit. CONCLUSIONS Findings support the intervention’s feasibility and highlight the importance of flexible, culturally responsive features. Tailoring mHealth tools to match caregivers’ stress demands and preferences can enhance engagement and emotional well-being. CLINICALTRIAL N/A

Background: This study aimed to adapt a stress and well-being intervention delivered via a mobile health (mHealth) app for Latinx millennial caregivers. This demographic, born between 1981 and 1996, represents a significant portion of caregivers in the United States, with unique challenges due to higher mental distress and poorer physical health than noncaregivers. Latinx millennial caregivers face additional barriers, including higher rates of being uninsured and increased caregiving burdens. Objective: We used a community-informed and user-centered design approach to tailor an existing mHealth app to better meet the stress and well-being needs of Latinx millennial caregivers. Methods: We used a 2-step, multifeedback approach. In step 1, Latinx millennial caregivers participated in focus groups to evaluate wireframes for the proposed mHealth app. In step 2, participants engaged in usability testing for 1 week, concluding with short interviews for feedback. Participants were recruited through various channels, including social media and community clinics. Data were analyzed inductively using a rapid qualitative content analysis approach. Results: A total of 29 caregivers (n=20, 69% women) participated in the study. Participants had a mean age of 31 (SD 4.10) years, with most (n=28, 97%) caring for an adult and 3% (1/29) caring for children with chronic conditions. All participants completed the step 1 focus groups, with a subset of 10% (3/29) of the caregivers completing the usability testing in step 2. The most liked features included (1) the stress rating scale because it helped them understand stress and mental health; (2) the mindfulness options, which allowed for flexible timing of activities; (3) the journaling prompts for addressing daily challenges and positive experiences; and (4) the resource list for its employment and financial content. One concern was that the journaling prompts may take too much time to complete after a long and hard day. Some suggestions for improvement included a better tracking system, gamification, caregiving education, a checklist of emotions to use with the journal, tailored resources, and ways to connect with other caregivers. During step 2, participants noted that the app was user-friendly but had some glitches and unclear privacy policies. Participants liked the meditation options, resource variety, and daily stress log but wanted more journaling space, longer meditations, and additional relaxation activities. Conclusions: Future iterations should consider integrating more personalized and community-specific resources, leveraging platforms such as podcasts for broader engagement, and the use of information-based videos to support caregiver skill acquisition. Caregivers expressed needs beyond the scope of the app, such as resource access, demonstrating the need for upstream and downstream interventions. This study reinforces that user-informed design is an ongoing and iterative process that requires balancing the needs of stakeholders and the feasibility of the recommended adaptations.