ED PLWD/Care Partner Text Messaging

• CAPTURE Text Message Care Transition Support (Behavioral): The CAPTURE intervention is a tailored, automated text messaging program designed to support care partners of persons living with cognitive impairment (PLWCI) during the 30-day period following an emergency department (ED) visit. It provides up to two messages per day, customized based on caregiver-identified needs, and addresses topics such as care transition guidance, symptom monitoring, caregiver well-being, community resources, and communication strategies. The content is evidence-informed and was developed through a user-centered design process involving caregivers and clinician stakeholders. Unlike generic text messaging interventions, CAPTURE specifically targets caregiver support needs in the acute post-ED setting for PLWCI.

Primary outcomes

• Enrollment rates [30 days after ED visit]: Enrollment rate will be used to assess Feasibility.
• Message engagement [30 days after ED visit]: Message engagement, assessed via text message response and interaction metrics, will be used to assess Feasibility. Engagement will be operationalized through quantitative metrics including (1) the number of text messages delivered, (2) the number and proportion of text messages that received responses from care partners, (3) the time-to-response for interactive messages, and (4) the number of unique interactions per participant over the 30-day intervention period. These metrics will be captured via backend system logs of the text messaging platform used to deliver the intervention.
• Retention rate [30 days after ED visit]: Participant retention at 30 days post-enrollment, assessed through completion of final follow-up assessment Retention is defined as the proportion of enrolled care partners who remain active in the study and complete the 30-day follow-up assessment. Completion is operationalized as successfully providing outcome data through a structured telephone-based survey at the end of the 30-day intervention period. This includes response to caregiver-reported outcome measures collected by the research team (e.g., burden, satisfaction, preparedness). Retention rate will be calculated as a percentage: (# of participants who complete the 30-day follow-up ÷ total number enrolled) × 100. Participants lost to follow-up or who withdraw consent prior to completing the final assessment will be considered non-retained.
• System Usability Scale (SUS) [30 days after ED visit]: The System Usability Scale (SUS) will be used to assess the usability of the CAPTURE text message intervention. The SUS is a validated 10-item questionnaire that measures perceived ease of use, efficiency, and satisfaction with a digital system. Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), and item scores are converted to yield a total score ranging from 0 to 100, with higher scores indicating better usability. The SUS total score will be calculated for each participant at the 30-day follow-up. Mean and distributional statistics will be reported for the intervention group.
• Acceptability [30 days after ED visit]: Acceptability of the CAPTURE text message intervention will be assessed through a structured participant satisfaction survey and open-ended qualitative feedback. The survey includes multiple items rated on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree), with higher scores indicating greater acceptability and satisfaction. Domains assessed include overall satisfaction, perceived helpfulness, relevance, and willingness to recommend the intervention to others. In addition, participants will be invited to provide brief qualitative comments via open-ended items assessing their experience and suggestions for improvement. Quantitative results will be summarized using descriptive statistics, and qualitative feedback will be analyzed using thematic content analysis.

Secondary outcomes

• Preparedness for Caregiving Scale [30 days after ED visit]: Preparedness for Caregiving Scale to assess Care partner preparedness. Total score range 0 to 32. Higher scores indicate greater perceived readiness for caregiving.
• Zarit Burden Interview score [30 days after ED visit]: Zarit Burden Interview, self-efficacy scales used to assess Emotional well-being and burden. Total score 0-88, higher scores indicate more severe burden.
• Emergency Department revisits and hospitalizations [30 days after ED visit]: Return healthcare utilization assessed as mean number ED revisits

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Care partners (family members or close contacts) of persons living with cognitive impairment (PLWCI) who were evaluated and discharged from the emergency department (ED)
* Age 18 years or older
* Able to read and understand English or Spanish
* Owns a mobile phone capable of receiving SMS text messages
* Provides informed consent to participate in the study
* Care recipient (PLWCI) resides in a community setting (i.e., not in a long-term care facility)

Exclusion Criteria:

* Care partner of a patient who is admitted to the hospital from the ED or transferred to a facility (e.g., skilled nursing facility)
* Care partner who is already enrolled in another caregiving support trial or intervention study
* Care partner who does not have regular access to a mobile phone with SMS capabilities
* Care partner who is unable or unwilling to participate in follow-up over 30 days
* Care partner of a patient enrolled in hospice or receiving end-of-life care

• Cameron Gettel, Principal investigator, Yale University

NIH grants: K76AG094954