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Dementia (London). 2018 Nov 29:1471301218814121. doi: 10.1177/1471301218814121. [Epub ahead of print]

The Care Ecosystem: Promoting self-efficacy among dementia family caregivers.

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Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA.
Philip R. Lee Institute for Health Policy Studies; Global Brain Health Institute, University of California, San Francisco, CA, USA.
Division of Geriatrics, Department of Internal Medicine, Home Instead Center for Successful Aging, Omaha, NE, USA.
Department of Clinical Pharmacy, University of California, San Francisco, CA, USA.



To illustrate specific psychosocial interventions aimed at improving self-efficacy among family caregivers enrolled in the Care Ecosystem, a model of navigated care designed to support persons with dementia and their primary caregivers. Enrolled family caregivers work with unlicensed care team navigators who are trained in dementia care and provide information, linkages to community resources, and emotional support by phone and email.


We conducted focus groups and interviews with the care team navigators to identify the approaches they used to target caregiver self-efficacy. We assessed mean self-efficacy scores in a sample of 780 family caregivers and selected three exemplary cases in which the caregivers had low self-efficacy scores at baseline with significantly higher scores after six months of participation in the Care Ecosystem intervention.


Multiple psychosocial strategies were utilized by care team navigators working with patients with dementia and their family caregivers. Using thematic coding we identified three categories of Care Team Navigator intervention: emotional, informational, and instrumental support. These are consistent with a psychosocial approach to building self-efficacy.


Self-efficacy represents a family caregiver's knowledge and preparedness in managing the challenges of care. Psychosocial support shows benefit in improving caregiver self-efficacy that in turn, may positively influence caregiver health and well-being. The findings in this manuscript demonstrate how a model of navigated care can positively impact self-efficacy among dementia family caregivers.


Alzheimer's disease; care navigation; caregiver self-efficacy; caregiving; dementia


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