Evaluation of the educational technology "Caring for dependent people" by family caregivers in changes and transfers of patients and tube feeding 1

ABSTRACT Objective: to assess the contributions of interactive educational technology "Caring for Dependent People" in the development of knowledge to family caregivers of dependent people in a household context and their satisfaction in its use. Method: quasi-experimental study, not randomized, of the before and after type, with a convenience sample of 65 family caregivers, from two Medicine services of a hospital in Porto, Portugal. The Control Group consisted of 33 family caregivers and the Experimental Group of 32, identified by consecutive sampling. The experimental group had access to educational technology at home. Data were collected by socio-demographic, satisfaction and evaluation of knowledge questionnaire, about how to feed by nasogastric tube, positioning and transferring the dependent person. The assessment in both groups had two moments: initial, during hospitalization and one month after discharge. Results: the experimental group had a larger increase in knowledge related to the use of the educational technology. In the control group the knowledge did not differ in the two evaluation time points. Conclusion: these results confirm the improvement of interactive educational technologies and in the training of family caregivers to care for dependents. This technology successfully met the technical quality and learning needs of caregivers, and was considered easy and stimulating.

for Commitments (5) . This commitment has to do in this phase of the project, with the "Development of toolkit / guidance for user empowerment" which consists in the production and implementation of tools/guidance for users' training, incorporating co-creation, raising awareness and building reliable and friendly tools.
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Objective
To evaluate the contributions of the educational interactive technology: "Caring for Dependent People" in the development of knowledge in the family caregivers at home, and evaluate their satisfaction with its use.

Method
Quasi-experimental, not randomized study, of the before and after type. The sample of convenience -The Barthel Index (BI), adapted Portuguese version (7) consisting in ten questions concerning the independence in performing activities of daily living, with the lowest score related to greater dependence.
-The questionnaire for evaluation of the knowledge of family caregivers was built specifically for this study. It included ten questions to assess each segment (nasogastric tube, positioning and transfer).  Both groups had the same procedure except that the interactive educational technology was not presented to the control group, nor provided a guide for navigation.
A telephone contact between the 1st and 2nd contact was done for the EG, in order to identify whether the participants had any problems or doubts with interactive educational technology. After the second evaluation, the CG was granted access to the tool.
For the data analysis the information was processed through the statistical program SPSS version 22.0 IBM ® using parametric statistics (8) . The t-Student test was used to compare the averages between independent samples comparing EG with the CG in relation to the evaluation questionnaires knowledge. The intra-subject comparison was performed using the Student t test for paired samples to compare variations within the groups in the two evaluated periods. To assess the accuracy and reliability of each of the knowledge questionnaires, it was used the Cronbach's alpha. This procedure is the most used and reported in the literature, and its value is calculated based on the average of the interrelations among all test items (8) . According to the same author, a good internal consistency exceeds an alpha of 0,80. The Pearson correlation (8)  Thus, the groups showed to be equivalent at the baseline as presented in Table 1.
In Table 1 are specified the results of the initial evaluation and after the knowledge intervention in the first moment and after intervention Lumini MJ, Peres HHC, Martins T.
There was a moderate positive correlation between educational status and total knowledge before the intervention (r = 0,528; p = 0,000) and also with the total knowledge after the intervention (r = 0,407; p = 0,002).
In the EG (32)  One recent study (15) shows similar results when looking to identify the cause of dependency in the elderly. This dependence has an average duration of 4,4 years, similar to other reports (14)(15) .
It was also found that the introduction of an interactive educational technology contributed to the development of knowledge in the family caregivers in order to take care of the dependent person. These results are similar to an international multicenter study (16)  Other studies (17)(18) have also shown that people who received instruction only from written material presented worse performance than people who received learning by using technology. In the same way, patients who received internet-based education improved their level of knowledge more significantly than those who underwent face-to-face guidance.
The present study has shown that there is decrease of the knowledge relating to the care of "positioning the patient" in the CG between the 1 st moment of assessment carried out at the hospital and the 2 nd time, a month after discharge. This fact confirms the importance of guidance and continuing education by health professionals to family caregivers. This result also highlights the need to strengthen prioritized and essential information during the recovery process immediately after discharge, emphasizing the key role of nurses in the monitoring and management of this process.
The consequences of inappropriate decisions in the field of information transmitted to family caregivers can have the care of dependent persons are remarked, as already reported in some studies (13,15,19) .
In this context, interactive educational technology applied to health education emerges as an essential and innovative intervention in ensuring the hospital and home transition, to provide support and ongoing guidance to caregivers. It also highlights the importance of leveraged partnerships with healthcare professionals and their interaction with the health system, improving the quality of life and care for dependent person.
It also denotes the power of education considered as a facilitator in the teaching and learning process related with the information about home care. In this sense, given the socio-demographic characteristics of caregivers, access to technology is an expressive reality.
A recent study (16) that describes family caregivers aged ≥ 50 years and with low education considered the ICT as most useful than family caregivers aged <50 years (p <0,0001) and those with high educational level (p <0, 0001). However, the basic skills to use computers to access the Internet and to seek health information, are clearly higher in those with more years of formal education and strongly correlated with the level of e-literacy in health (20)(21)(22) .
The data obtained by family caregivers were very acceptable and confirmed the overall satisfaction of caregivers with the use of interactive educational technology. They considered this technology as widely satisfactory, stimulating and easy to use. The assessment of the tool was directly related to the quality of it. However, we find similar results in another study (23) that also evaluated the satisfaction of website users.

Conclusion
From the results obtained in this study, we could demonstrate the effective contribution of interactive technology and achieve its mastery in the educational processes of family caregivers.