Skip to main content

Table 2 Feedback from the Caregivers and Trainers Participated in the Preliminary Adaptation Testing and Recommended Changes

From: Cultural adaptation of the savvy caregiver program for Korean Americans with limited English proficiency: a feasibility and acceptability study

Domain/Theme

Comment from Caregivers

Comment from Trainers

Recommended Change

Logistical issues

Program name

Participants noted that the word “savvy” is a bit unfamiliar but fits well with the program.

Trainers felt that the program name was well-received, but they were not sure that all participants had fully appreciated the intention behind it. The word “savvy” had a powerful impact.

• To keep the English word “Savvy” without translation: Savvy 부양인 프로그램

• To include a brief discussion of the program’s name during the first session

• To brand the program as “K-Savvy”

Session frequency and length

There was consensus that the frequency of 6 weekly sessions was relevant but that the session length of 75 min was rather short. Participants expressed their strong desire to have more time for discussion.

Trainers noted their challenges with time management. In some cases, they had to stop meaningful discussions to cover the course materials allocated for the week. During the session, all participants seemed to stay focused, and no fatigue was observed. Trainers also recommended adding 10–15 min to each session.

• To keep the frequency of 6 weekly sessions

• To increase the session length to 90 min

Class size and composition

A majority reported that the six or seven participants per session were adequate. One participant stated that adding one or two more would be beneficial for generating more diverse conversations. Participants indicated that they felt more comfortable when there were other members who shared similar characteristics.

Trainers stated that a bigger class size than six or seven participants would be hard to manage. Trainers were concerned that each participant would then have even less time to share their opinions. Trainers also noticed diversity among participants (e.g., age, gender, relation to care recipient, dementia severity of care recipient) and made efforts to make all participants feel included.

• To limit the number of participants to six or seven

• To consider participants’ characteristics in class assignment

• To prepare trainers to better attend to diversity among class participants

Accommodation for schedule conflict

One participant in the afternoon class had to miss Session 4 due to a schedule conflict. Another person in the afternoon session who had to miss Session 5 volunteered to attend the morning session. She enjoyed attending the alternative class and interacting with new people. There was another case of cross-group participation in the Session 6.

In Session 5, the trainer in the morning session noted that having a guest from the afternoon class brought new energy to the class. The trainer in the afternoon session stated that the smaller class size than usual made the participants more engaged in conversations, and she felt more control over the class.

• To inform participants of the option of attending an alternative class in case of schedule conflict (Not accepted, owing to concerns about protection of participants’ privacy)

Manual

In general, the quality of Korean translation of the Savvy manual was rated high, but there were parts to be revisited. With regard to the length of the manual (290 pages), participants’ response was mixed. Some participants demonstrated deep appreciation of the detailed information, but others reported that they were overwhelmed by its volume and could not find time to read the entire document.

Trainers stated that they were very impressed that many participants read the manual carefully and were well prepared for the sessions. They also noted the value of the manual’s extensive content, because they were not able to cover all of the information during the limited session time. Trainers strongly endorsed the value of the manual as a reference.

• To refine and finalize the K-Savvy manual (Not accepted, in order to maintain the program’s integrity)

Trainer training

Participants made favorable comments on the trainers (e.g., knowledgeable, teaching/listening well, responsive, calm). Some participants were interested in learning about the Savvy trainer certification.

Trainers expressed initial discomfort in teaching participants who were older and had everyday caregiving experience. They noted that the pre-session preparation and post-session debriefing were very helpful. They also indicated a need for more training, particularly on coaching skills.

• To develop an introductory video clip, including endorsement of Savvy trainers by the SCP developer (K.H) and the Project Lead (Y.J.)

• To enhance the pre-session prep/post-session debriefing sessions for trainers

• To consider developing a booster training session for the K-Savvy trainers

Formal acknowledgement of achievement

In the closing session, participants enjoyed sharing their experiences and changes over the past 6 weeks. They expressed regret for not participating in person. One said that she felt awkward to exit the Zoom meeting without properly thanking the trainer and other participants.

Trainers noted that they became quite emotional during the last session, with the feeling that they had built a strong bond with participants. They had given much thought to their final remarks but still wondered what would be a proper closing. Trainers wished that they had a more formal way to recognize participants’ achievement.

• To ensure enough time for all participants to share their final remarks

• To offer a Savvy Caregiver Certificate for those who complete the program

Technical issues

Virtual class environment

All participants attended the sessions without any major technical difficulty. However, a few participants noted that there were times that they were bothered by an unstable Internet connection, poor sound quality, and background noise of other participants.

Trainers reported that it took some time to get used to the Zoom functions (e.g., screen share). Session technical assistance by research staff (e.g., muting participants with background noise, changing names on participants’ screens, playing video clips on behalf of the trainer) was helpful.

• To utilize the pre-meeting with participants to help them become technically prepared (e.g., equipment checking, Zoom tutorial, overview of online etiquette)

• To enhance technical training for trainers

• To continue in-session technical assistance

Cultural issues

Cultural orientation of Savvy core principles

Participants indicated their strong endorsement of the SCP core principles. They were appreciative of learning new concepts of “personhood,” “contented involvement,” and “self-care.”

Trainers noted that discussions on personhood and self-care went very well. They noticed that several caregivers never thought of self-care and some associated with feelings of guilt.

• To reframe the seemingly individualistic SCP values in the context of collectivistic cultures

Cultural context of caregiving

Three female participants were caring for their mothers-in-law, and they noted unique challenges that put them apart from other caregivers. One participant called attention to the fact that some caregiving situations are based on obligation and duty.

Trainers noted a need to address culturally specific issues in caregiving and use various forms of caregiving situations as examples.

• To ensure ways to address participants’ unique situations and foster everyone’s sense of belonging

Special interest in family issues

Participants wanted to have more information and discussion of the caregiving resource map in Session 5 and caregiving arrangement type in the Session 6.

Trainers noted participants’ strong interest in the family-related topics and the shortage of time for enriched discussion on those topics. One trainer noted that leading discussion on a sensitive topic was challenging. She felt she was not prepared to properly respond to the comments made by participants.

• To allocate more time to cover the caregiving resource map in Session 5 and caregiving arrangement types in Session 6

• To include how to handle sensitive topics in trainer training

• To develop a list of potential questions and responses for trainers

Cultures in group discussion

Some participants reported that they were a bit reluctant to speak in group discussion. A 31-year-old participant said that she usually waited out of respect until older participants were done speaking, but she often ended up not having a turn. Another participant said that he yielded opportunities to speak for others who were in a more desperate situation. One female caregiver of a patient in an early stage of dementia stated that she was quite reluctant to talk about her mother because she felt sorry for another participant whose mother was in an advanced stage.

Trainers stated that they made efforts to offer a comfortable space to share opinions. They tried to give all participants an equal opportunity to speak. The online mode was a bit challenging for reading all participants’ momentary reactions and intentions to speak. Trainers also noted their challenge in embracing diversity not only in participants but also in their care recipients. Trainers also noted that they were impressed by the fact that many participants made a great effort in doing home activities and reporting them back in class. They felt that their acknowledgement of the effort was not enough.

• To train trainers on how to facilitate discussions, make all participants engaged, and address issues of diversity

• To include a brief talk on group discussion encouraging all participants’ active engagement in the first session

• To set rules and expectation for class participation addressing traditional culture influenced communication style (e.g., passive communication, self-effacement, expressing empathy)

• To include coaching strategies for positive reinforcement in trainer training

Cultural relevance of audiovisual materials

Participants made favorable comments on the use of audiovisual materials. The individuals featured in the video clips and photos were mostly Whites, and responses were mixed. Some participants stated that they would feel much closer if the individuals featured were Korean or other Asian individuals, while others noted that the audiovisual materials in themselves had an impact beyond the language and cultures.

Trainers felt that the audiovisual materials had a powerful impact, and they highly enjoyed leading those activities. Although the general message from the video clips seemed to be conveyed well, they were not sure that all participants had a full understanding of the detailed conversations presented in the video clips.

• To include Korean subtitles in the video clips

• To replace some photos in the manual with those featuring Korean/Asian individuals

Culture-specific example

Although the examples of tasks and activities used in the class (e.g., making sandwiches, baking cookies) were generally approachable, participants enjoyed talking about comparable tasks and activities that were culturally specific.

Trainers noticed that discussions naturally led to application in the tasks and activities common in the lives of Koreans. Examples included cooking rice, trimming beansprouts/green onions, and finding matching lids for side-dish containers.

• To allocate time for culturally specific discussion in each session