Latino family caregivers of people with dementia face significant challenges and limited access to support. Community health workers (CHWs) may help deliver culturally tailored education in primary care settings. This qualitative study explored barriers and facilitators to implementing ¡Unidos Podemos! a caregiver support intervention using a comic-style educational booklet, group discussions, and follow-up calls by CHWs. We conducted interviews with 20 CHWs, primary care providers, and clinic staff across the U.S. and analyzed transcripts using deductive methods guided by the Consolidated Framework for Implementation Research. Twenty-one themes emerged across five domains, highlighting enthusiasm for the intervention and its simplicity, particularly the booklet format. Participants recommended addressing logistical challenges including reimbursement for group sessions, staff training, and support infrastructure. Findings offer practical insights to inform future implementation strategies, supporting the integration of CHWs into dementia care for Latino families in primary care.
AdamsB.ArandaM. P.KempB.TakagiK. (2002). Ethnic and gender differences in distress among Anglo American, African American, Japanese American, and Mexican American spousal caregivers of persons with dementia. Journal of Clinical Geropsychology, 8(4), 279–301. https://doi.org/10.1023/a:1019627323558
2.
Administration on Aging, Administration for Community Living, & US Department of Health & Human Services. (2016). A profile of older Americans: 2016.
AndersonM. (2016). Who relies on public transit in the U.S. Pew Research Center.
7.
ArandaM. P.KremerI. N.HintonL.ZissimopoulosJ.WhitmerR. A.HummelC. H.TrejoL.FabiusC. (2021). Impact of dementia: Health disparities, population trends, care interventions, and economic costs. Journal of the American Geriatrics Society, 69(7), 1774–1783. https://doi.org/10.1111/jgs.17345
8.
AreánP. A.Gallagher-ThompsonD. (1996). Issues and recommendations for the recruitment and retention of older ethnic minority adults into clinical research. Journal of Consulting and Clinical Psychology, 64(5), 875–880. https://doi.org/10.1037//0022-006x.64.5.875
BertrandR. M.FredmanL.SaczynskiJ. (2006). Are all caregivers created equal? Stress in caregivers to adults with and without dementia. Journal of Aging and Health, 18(4), 534–551. https://doi.org/10.1177/0898264306289620
11.
ChenC.ThunellJ.ZissimopoulosJ. (2020). Changes in physical and mental health of Black, Hispanic, and White caregivers and non-caregivers associated with onset of spousal dementia. Alzheimer’s & Dementia (New York, N. Y.), 6(1), Article e12082. https://doi.org/10.1002/trc2.12082
12.
ChodoshJ.ColaiacoB. A.ConnorK. I.CopeD. W.LiuH.GanzD. A.RichmanM. J.CherryD. L.BlankJ. M.CarboneR. d. P.WolfS. M.VickreyB. G. (2015). Dementia care management in an underserved community: The comparative effectiveness of two different approaches. Journal of Aging and Health, 27(5), 864–893. https://doi.org/10.1177/0898264315569454
13.
CollinsL. M.MurphyS. A.StrecherV. (2007). The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): New methods for more potent eHealth interventions. American Journal of Preventive Medicine, 32(5 Suppl), S112–S118. https://doi.org/10.1016/j.amepre.2007.01.022
14.
CoxC.MonkA. (1990). Minority caregivers of dementia victims: A comparison of Black and Hispanic families. Journal of Applied Gerontology, 9(3), 340–354. https://doi.org/10.1177/073346489000900308
15.
CzajaS. J.LoewensteinD.SchulzR.NairS. N.PerdomoD. (2013). A videophone psychosocial intervention for dementia caregivers. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 21(11), 1071–1081. https://doi.org/10.1016/j.jagp.2013.02.019
16.
DamschroderL. J.AronD. C.KeithR. E.KirshS. R.AlexanderJ. A.LoweryJ. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 1–15. https://doi.org/10.1186/1748-5908-4-50
17.
DessyA.ZhaoA. J.KyawK.VieiraD.SalinasJ. (2022). Non-pharmacologic interventions for Hispanic caregivers of persons with dementia: Systematic review and meta-analysis. Journal of Alzheimer’s Disease: JAD, 89(3), 769–788. https://doi.org/10.3233/JAD-220005
18.
DraboE. F.BartholdD.JoyceG.FeridoP.ChuiH. C.ZissimopoulosJ. (2019). Longitudinal analysis of dementia diagnosis and specialty care among racially diverse medicare beneficiaries. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, 15(11), 1402–1411. https://doi.org/10.1016/j.jalz.2019.07.005
19.
FifeS. T.GossnerJ. D. (2024). Deductive qualitative analysis: Evaluating, expanding, and refining theory. International Journal of Qualitative Methods, 23(1), Article 16094069241244856. https://doi.org/10.1177/16094069241244856
20.
FriedmanE. M.ShihR. A.LangaK. M.HurdM. D. (2015). US prevalence and predictors of informal caregiving for dementia. Health Affairs, 34(10), 1637–1641. https://doi.org/10.1377/hlthaff.2015.0510
21.
Gallagher-ThompsonD.HaleyW.GuyD.RupertM.ArgüellesT.ZeissL. M.LongC.TennstedtS.OryM. (2003b). Tailoring psychological interventions for ethnically diverse dementia caregivers. Clinical Psychology: Science and Practice, 10(4), 423–438. https://doi.org/10.1093/clipsy.bpg042
22.
Gallagher-ThompsonD.SolanoN.CoonD.AreanP. (2003a). Recruitment and retention of Latino dementia family caregivers in intervention research: Issues to face, lessons to learn. The Gerontologist, 43(1), 45–51. https://doi.org/10.1093/geront/43.1.45
23.
Gallagher-ThompsonD.TzuangM.HintonL.AlvarezP.RengifoJ.ValverdeI.ChenN.EmraniT.ThompsonL. W. (2015). Effectiveness of a fotonovela for reducing depression and stress in Latino dementia family caregivers. Alzheimer Disease and Associated Disorders, 29(2), 146–153. https://doi.org/10.1097/WAD.0000000000000077
GitlinL. N.BaierR. R.JutkowitzE.BakerZ. G.GustavsonA. M.SefcikJ. S.HodgsonN. A.KoeuthS.GauglerJ. E. (2020). Dissemination and implementation of evidence-based dementia care using embedded pragmatic trials. Journal of the American Geriatrics Society, 68(Suppl 2), S28–S36. https://doi.org/10.1111/jgs.16622
26.
GitlinL. N.MarxK.StanleyI. H.HodgsonN. (2015). Translating evidence-based dementia caregiving interventions into practice: State-of-the-science and next steps. The Gerontologist, 55(2), 210–226. https://doi.org/10.1093/geront/gnu123
27.
HartzlerA. L.TuzzioL.HsuC.WagnerE. H. (2018). Roles and functions of community health workers in primary care. Annals of Family Medicine, 16(3), 240–245. https://doi.org/10.1370/afm.2208
28.
HarwoodD. G.BarkerW. W.CantillonM.LoewensteinD. A.OwnbyR.DuaraR. (1998). Depressive symptomatology in first-degree family caregivers of Alzheimer disease patients: A cross-ethnic comparison. Alzheimer Disease and Associated Disorders, 12(4), Article 340. https://doi.org/10.1097/00002093-199812000-00015
29.
HintonL.ChambersD.VelásquezA.GonzalezH.HaanM. (2006). Dementia neuropsychiatric symptom severity, help-seeking patterns, and family caregiver unmet needs in the Sacramento Area Latino Study on Aging (SALSA). Clinical Gerontologist, 29(4), 1–15. https://doi.org/10.1300/j018v29n04_01
30.
HintonL.FranzC. E.ReddyG.FloresY.KravitzR. L.BarkerJ. C. (2007). Practice constraints, behavioral problems, and dementia care: Primary care physicians’ perspectives. Journal of General Internal Medicine, 22(11), 1487–1492. https://doi.org/10.1007/s11606-007-0317-y
31.
HintonL.HaanM.GellerS.MungasD. (2003). Neuropsychiatric symptoms in Latino elders with dementia or cognitive impairment without dementia and factors that modify their association with caregiver depression. The Gerontologist, 43(5), 669–677. https://doi.org/10.1093/geront/43.5.669
32.
IBM Corp. (2023). Released 2023. IBM SPSS statistics for windows, version 29.0. IBM Corp.
33.
KajiyamaB.FernandezG.CarterE. A.HumberM. B.ThompsonL. W. (2018). Helping Hispanic dementia caregivers cope with stress using technology-based resources. Clinical Gerontologist, 41(3), 209–216. https://doi.org/10.1080/07317115.2017.1377797
34.
KasperJ. D.FreedmanV. A.SpillmanB. C.WolffJ. L. (2015). The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Affairs, 34(10), 1642–1649. https://doi.org/10.1377/hlthaff.2015.0536
35.
LiS.-A.JeffsL.BarwickM.StevensB. (2018). Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: A systematic integrative review. Systematic Reviews, 7(1), 1–19. https://doi.org/10.1186/s13643-018-0734-5
36.
LiuC.BadanaA. N.BurgdorfJ.FabiusC. D.RothD. L.HaleyW. E. (2021). Systematic review and meta-analysis of racial and ethnic differences in dementia caregivers’ well-being. The Gerontologist, 61(5), e228–e243. https://doi.org/10.1093/geront/gnaa028
37.
LouridaI.AbbottR. A.RogersM.LangI. A.SteinK.KentB.Thompson CoonJ. (2017). Dissemination and implementation research in dementia care: A systematic scoping review and evidence map. BMC Geriatrics, 17(1), Article 147. https://doi.org/10.1186/s12877-017-0528-y
38.
LyketsosC. G.SteinbergM.TschanzJ. T.NortonM. C.SteffensD. C.BreitnerJ. C. (2000). Mental and behavioral disturbances in dementia: Findings from the cache county study on memory in aging. The American Journal of Psychiatry, 157(5), 708–714. https://doi.org/10.1176/appi.ajp.157.5.708
MedinaV.WattsA.Fracachan-CabreraM.HazlewoodC.Ramirez-MantillaM.VidoniE.Perales-PuchaltJ. (2024). Analysis of the intensity of engagement with CuidaTEXT, a text message intervention for dementia caregiver support among Latinos/as. Ethnicity & health, 29(8), 924–945. https://doi.org/10.1080/13557858.2024.2387111
41.
MoonH.TownsendA. L.Dilworth-AndersonP.WhitlatchC. J. (2016). Predictors of discrepancy between care recipients with mild-to-moderate dementia and their caregivers on perceptions of the care recipients’ quality of life. American Journal of Alzheimer’s Disease and Other Dementias, 31(6), 508–515. https://doi.org/10.1177/1533317516653819
42.
NapolesA. M.ChadihaL.EversleyR.Moreno-JohnG. (2010). Reviews: Developing culturally sensitive dementia caregiver interventions: Are we there yet?American Journal of Alzheimer's Disease and Other Dementias, 25(5), 389–406. https://doi.org/10.1177/1533317510370957
43.
National Academies of Sciences & Medicine. (2016). Families caring for an aging America (0309448093).
OryM. G.HoffmanR. R.YeeJ. L.TennstedtS.SchulzR. (1999). Prevalence and impact of caregiving: A detailed comparison between dementia and nondementia caregivers. The Gerontologist, 39(2), 177–186. https://doi.org/10.1093/geront/39.2.177
46.
ParkJ.RegensteinM.ChongN.OnyiloforC. L. (2021). The use of community health workers in community health centers. Medical Care, 59(Suppl 5), S457–s462. https://doi.org/10.1097/mlr.0000000000001607
Perales-PuchaltJ. (2021). Access to dementia services among Latinos. In Diversity and disparities PIA: Innovative approaches to improving accessibility and quality of dementia diagnostic, care and caregiver support services: Updates from equity-driven projects in the U.S. and Australia. Online.
49.
Perales-PuchaltJ.Acosta-RullánM.Ramírez-MantillaM.Espinoza-KissellP.VidoniE.NiedensM.EllerbeckE.HintonL.LoeraL.RamírezA. S.LaraE.WattsA.WilliamsK.ResendezJ.BurnsJ. (2022a). A text messaging intervention to support latinx family caregivers of individuals with dementia (CuidaTEXT): Development and usability study. JMIR Aging, 5(2), Article e35625. https://doi.org/10.2196/35625
50.
Perales-PuchaltJ.BartonK.PtomeyL.NiedensM.YeagerA.GilmanL.SeymourP.GeorgeA.SpragueS.Mirás NeiraA.Van DykeR.TeriL.VidoniE. D. (2021). Effectiveness of “Reducing Disability in Alzheimer’s Disease” among dyads with moderate dementia. Journal of Applied Gerontology: The Official Journal of the Southern Gerontological Society, 40(10), 1163–1171. https://doi.org/10.1177/0733464820934683
51.
Perales-PuchaltJ.Ramírez-MantillaM.Fracachán-CabreraM.VidoniE. D.EllerbeckE. F.RamírezA. S.WattsA.WilliamsK.BurnsJ. (2022b). A text message intervention to support Latino dementia family caregivers (CuidaTEXT): Feasibility study. Clinical Gerontologist, 47(1), 1–16. https://doi.org/10.1080/07317115.2022.2137449
52.
Perales-PuchaltJ.StrubeK.TownleyR.NiedensM.ArreazaH.ZaudkeJ.BurnsJ. M. (2023). Primary care provider preferences on dementia training: A qualitative study. Journal of Alzheimer’s Disease: JAD, 92(3), 1–9. https://doi.org/10.3233/JAD-221014
53.
PérezL. M.MartinezJ. (2008). Community health workers: Social justice and policy advocates for community health and well-being. American Journal of Public Health, 98(1), 11–14. https://doi.org/10.2105/AJPH.2006.100842
54.
PinquartM.SörensenS. (2005). Ethnic differences in stressors, resources, and psychological outcomes of family caregiving: A meta-analysis. The Gerontologist, 45(1), 90–106. https://doi.org/10.1093/geront/45.1.90
55.
RanklF.JohnsonG. A.Vindrola-PadrosC. (2021). Examining what we know in relation to how we know it: A team-based reflexivity model for rapid qualitative health research. Qualitative Health Research, 31(7), 1358–1370. https://doi.org/10.1177/1049732321998062
56.
RosenstockI. M.StrecherV. J.BeckerM. H. (1988). Social learning theory and the health belief model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203
57.
RoteS. M.AngelJ. L.MoonH.MarkidesK. (2019). Caregiving across diverse populations: New evidence from the national study of caregiving and Hispanic EPESE. Innovation in Aging, 3(2), igz033. https://doi.org/10.1093/geroni/igz033
58.
SalazarR.DwivediA. K.RoyallD. R. (2017). Cross-ethnic differences in the severity of neuropsychiatric symptoms in persons with mild cognitive impairment and Alzheimer’s disease. The Journal of Neuropsychiatry and Clinical Neurosciences, 29(1), 13–21. https://doi.org/10.1176/appi.neuropsych.15120423
59.
SinkK. M.CovinskyK. E.NewcomerR.YaffeK. (2004). Ethnic differences in the prevalence and pattern of dementia-related behaviors. Journal of the American Geriatrics Society, 52(8), 1277–1283. https://doi.org/10.1111/j.1532-5415.2004.52356.x
60.
TalamantesM. A.ArandaM. P. (2004). Cultural competency in working with Latino family caregivers. San Francisco, CA: Family Caregiver Alliance.
U.S. Department of Commerce. (2021). Quick facts: USA census. Hispanics and latinos.
63.
WalterE.PinquartM. (2020). How effective are dementia caregiver interventions? An updated comprehensive meta-analysis. The Gerontologist, 60(8), e609–e619. https://doi.org/10.1093/geront/gnz118
64.
WuS.VegaW.ResendezJ.JinH. (2016). Latinos & Alzheimer’s disease: New numbers behind the crisis. In Projection of the costs for U.S. Latinos living with Alzheimer’s disease through 2060 [Report]. University of Southern California, Alzheimer’s Association, & UsAgainstAlzheimer’s. https://health.ucdavis.edu/latinoaging/images/pdf/Latinos-and-AD_USC_UsA2-Impact-Report.pdf.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
