Pneumonia is a leading cause of death and hospitalization among the elderly in Taiwan. High-quality home care is essential to recovery and reducing readmission, yet primary caregivers often lack the specific skills needed, such as airway clearance and safe feeding techniques. Traditional education, consisting of one-time verbal instructions and paper brochures, often lacks interactivity and real-time support.
This study introduces "Pneumonia Care Helper," an interactive LINE chatbot designed to provide digital health education. The goal is to evaluate whether this digital tool is more effective than traditional paper-based education in improving the knowledge, attitudes, and caregiving practices of primary caregivers of elderly pneumonia patients. The study will compare the outcomes of caregivers using the chatbot versus those receiving standard paper-based instructions over a 5-day intervention period.
Patients with a primary diagnosis of pneumonia during the current hospitalization.
Patients aged 65 years or older.
Primary caregivers aged 18 years or older.
Primary caregivers who can read and understand Mandarin Chinese.
Primary caregivers who do not live with the patient.
Primary caregivers who have received formal training as professional nursing assistants or caregivers.
Primary caregivers who are currently or were formerly healthcare professionals (e.g., physicians, nurses, therapists).
Primary caregivers who do not possess a mobile device or are unable to use chatbot applications.
Parallel
Chatbot with Educational Videos
BehavioralParticipants will receive access to a dedicated chatbot named "Pneumonia Care Helper." The intervention lasts for 5 days. It includes: (1) Initial orientation on chatbot operation. (2) Unlimited on-demand access to four educational videos: Introduction to Pneumonia, Airway Clearance Techniques, Feeding and Tube Feeding Skills, and Oral Hygiene. (3) An interactive text-based AI response system for real-time Q\&A. Caregivers are encouraged to engage with the chatbot and watch the videos as many times as needed, 24/7, throughout the 5-day study period.
Traditional Paper-based Education
BehavioralParticipants will receive a 20-minute one-on-one verbal health education session conducted by the researcher upon enrollment. A printed pneumonia care brochure will be provided, containing information identical to the content in the chatbot's educational videos (Introduction to Pneumonia, Airway Clearance Techniques, Feeding and Tube Feeding Skills, and Oral Hygiene). The study period lasts for 5 days, during which caregivers have unlimited access to the brochure for review at any time.
Caregiver Knowledge of Elderly Pneumonia Care
Measured using the "Pneumonia Care Knowledge subscale" (13 items). This multiple-choice subscale covers the causes, symptoms, prevention, emergency recognition, chest physiotherapy, feeding safety, and oral hygiene of pneumonia. Each correct answer scores 1 point and incorrect answers score 0. Total scores range from 0 to 15, with higher scores indicating a better level of knowledge regarding elderly pneumonia care. The scale has been validated by experts with an S-CVI/Ave of 0.99.
Caregiver Attitude Toward Elderly Pneumonia Care
Measured using the "Pneumonia Care Attitude subscale" (7 items). This subscale assesses the caregiver's perception of disease severity, learning willingness, and caregiving confidence using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Items 5 and 7 are reverse-scored. Total scores range from 7 to 35, with higher scores indicating a more positive attitude toward pneumonia care. The scale has been validated by experts with an S-CVI/Ave of 0.99.
Caregiver Practice of Elderly Pneumonia Care
Measured using the "Pneumonia Care Practice subscale" (5 items). This subscale evaluates the frequency or intention of practical caregiving behaviors, including chest physiotherapy, oral hygiene, feeding/tube feeding, symptom monitoring, and preventive actions. It uses a 5-point Likert scale (1 = never to 5 = always). Total scores range from 5 to 25, with higher scores indicating more positive or frequent engagement in correct pneumonia care behaviors. The scale has been validated by experts with an S-CVI/Ave of 0.99.
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