Mandated caregiver training in the Veterans Health Administration: Caregiver inquiry informs national dissemination.


Background and objectives

A minority of family caregivers receive training, with implications for their own and their recipient's outcomes. Federal policy has supported implementation and expansion of caregiver training and support. The Department of Veterans Affairs (VA) has developed a national Caregiver Support Program and collaborated with VA health services researchers to explore caregivers' acceptance of an evidence-based training program in preparation for system-wide dissemination.

Research design and methods

This approach entailed a convergent mixed-methods design, which involved separate analyses of quantitative and qualitative data. Survey questions based on the Kirkpatrick model for training evaluation measured caregivers' reaction and learning and interview questions elicited caregivers' reports about the value of the program for them.


Most caregivers reported satisfaction with the training when responding to survey questions, although qualitative interviews revealed caveats suggesting need to hone the best timing and specific group of caregivers for maximal benefit.

Discussion and implications

Our findings indicate that understanding program-user fit may be particularly critical when implementing training for caregivers as they come to the program at different points along their caregiving journey, needing differing types and intensities of support. While a general program may appeal to policymakers aiming to scale caregiver training within a large, heterogeneous system, there may be shortcomings in terms of end-user acceptance and subsequent downstream outcomes such as reach and ultimately program effectiveness. Good, iterative communication flow between program developers and policymakers facilitates this understanding and, in turn, decisions about scaling.





Published Version (Please cite this version)


Publication Info

Sperber, Nina R, Nathan Boucher, Jaime M Hughes, Rebecca Bruening, Leah L Zullig, Kasey Decosimo, Matthew Tucker, Leah A Christensen, et al. (2022). Mandated caregiver training in the Veterans Health Administration: Caregiver inquiry informs national dissemination. The Gerontologist. p. gnac162. 10.1093/geront/gnac162 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Nina Sperber

Associate Professor in Population Health Sciences

My research career has centered on understanding how to improve delivery of new evidence-based practices in health care systems. I work in health services research and development for the VA health care system and have an academic appointment with the Duke University School of Medicine. I create study designs that integrate qualitative and quantitative methods (mixed-methods) and apply Implementation Science and System Science approaches. I currently have a developing body of academic work that uses participatory system dynamics modeling as a strategy to identify system level factors that affect development and implementation of equitable AI tools. For the VA health care system, I direct a cross-functional team that conducts rapid turnaround projects for high priority needs by VHA national, regional, and facility leaders.



Nathan Adam Boucher

Associate Research Professor in the Sanford School of Public Policy

I am a Research Health Scientist at Durham VA Health System’s Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) and Duke University faculty at Sanford School of Public Policy, the Medical School, and the Nursing School. I am also a Senior Fellow at the Duke Center for the Study of Aging & Human Development as well as Duke-Margolis Center for Health Policy Core Faculty. 

I have extensive experience in clinical medicine (licensed physician assistant in critical care and emergency medicine), health care administration, health professions education, hospice and palliative care quality improvement, and community-based research. Challenges and opportunities at the intersection of social care and health care inform my research agenda. My collaborations across disciplines at VA and Duke and with community organizations have afforded me deep insights into the lives and challenges of community members and family/friend care partners.

My research has been funded by Veterans Administration, NIH, Centers for Medicare/Medicaid Services, several foundations, and Duke University. Recent research includes 1) describing care partners’ social and health needs related to caring for older adults re-entering the community from prison; 2) designing and testing community health worker programs focused on older adults; 3) characterizing concerns care partners and people living with dementia have regarding the quality of care settings as well as emerging technologies; 4) systems approaches to homelessness among Veterans, and 5) defining and realigning training and employment for NC direct care workers serving in home- and community-based services.

Let's collaborate:


Leah L Zullig

Professor in Population Health Sciences

Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 150 peer-reviewed publications. 

Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.

Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research


Kelli Dominick Allen

Adjunct Professor in the Department of Medicine
  • Improving care and outcomes for individuals with osteoarthritis and other musculoskeletal conditions with an emphasis on non-pharmacological therapies including physical activity, weight management, rehabilitation services, and pain coping
    * Understanding rand reducing disparities in musculoskeletal conditions
    * Musculoskeletal conditions in U.S. military Veterans
    * Pragmatic clinical trials
    * Adaptive interventions

Susan Nicole Hastings

Professor of Medicine
Van Houtven

Courtney Harold Van Houtven

Professor in Population Health Sciences

Dr. Courtney Van Houtven is a Professor in The Department of Population Health Science, Duke University School of Medicine and Duke-Margolis Center for Health Policy. She is also a Research Career Scientist in The Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System. Dr. Van Houtven’s aging and economics research interests encompass long-term care financing, intra-household decision-making, unpaid family and friend care, and home- and community-based services. She examines how family caregiving affects health care utilization, expenditures, health and work outcomes of care recipients and caregivers. She is also interested in understanding how best to support family caregivers to optimize caregiver and care recipient outcomes.

Dr. Van Houtven  is co-PI on the QUERI Program Project, “Optimizing Function and Independence”, in which her caregiver skills training program developed as an RCT in VA, now called Caregivers FIRST, has been implemented at 125 VA sites nationally. The team will evaluate how intensification of an implementation strategy changes adoption. She directs the VA-CARES Evaluation Center, which evaluates the VA’s Caregiver Support Program. She leads a mixed methods R01 study as PI from the National Institute on Aging that will assess the value of "home time" for persons living with dementia and their caregivers (RF1 AG072364).

Areas of expertise: Health Services Research and Health Economics

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