Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

Factors associated with mental health outcomes among family caregivers to adults with COVID: a scoping review

PURPOSE

Family caregivers (FCGs) are essential to the health and wellbeing of people affected by COVID. Protecting mental health of FCGs is essential to sustaining their caregiving role. The objective of this scoping review was to synthesise identified risks factors and protective factors for mental health of FCGs to adults with COVID.

MATERIALS AND METHODS

Using the Joanna Briggs Institute (JBI) methodology, the search was conducted across Medline, CINAHL, and PsycINFO. Original studies conducted since the pandemic began were included. The population was adult FCGs to adults with COVID, and studies reported mental health outcomes and related factors.

RESULTS

Of 3474 identified articles, 22 met inclusion criteria (14 quantitative, seven qualitative, one mixed-methods, 18/22 conducted in Iran). Across all study designs, risk factors included limited support, financial burden, family challenges, unpredictable nature of COVID, inexperience, isolation, and unpleasant experiences. Protective factors included accessing support services, self-reinforcement, coping strategies, professional help, and online intervention.

CONCLUSIONS

Quantitative and qualitative research identified common mental health risk factors and protective factors for FCGs to adults with COVID. These factors may inform development of supports and services for FCGs to people with COVID, such as online interventions. Studies did not distinguish acute versus long COVID.

Caregiver experiences and needs in pediatric rheumatic disease: a mixed-methods systematic review protocol

INTRODUCTION

Understanding the genuine experiences and requirements of caregivers and implementing targeted interventions can have a positive impact on the physical and mental well-being of caregivers with children diagnosed with rheumatic diseases, ultimately reducing their burden and enhancing their quality of life. While there has been a gradual increase in research in this area in recent years, there remains a gap in the evidence that comprehensively and systematically reflects the actual experiences and needs of caregivers. We will employ a mixed-methods approach to evaluate the real-life experiences and requirements of caregivers for children diagnosed with rheumatic diseases to provide insights for both research and clinical interventions. METHODS AND ANALYSIS: All types of studies (quantitative, qualitative, and mixed-methods) involving caregivers of children aged 0 to 18 with rheumatic diseases will be included. We will conduct a comprehensive search across multiple databases, including MEDLINE (PubMed), Embase (Ovid), PsycINFO (Ovid), CINAHL (EBSCO), Cochrane Central Register of Controlled Trials (CENTRAL), CNKI, WanFang, and VIP, as well as the grey literature, to identify primary studies published in either English or Chinese since 2000. Two independent reviewers will conduct the selection process and cross-check the data extraction. The focus of interest will be on understanding the experiences and needs of caregivers for pediatric rheumatic disease patients. In our systematic review, we will employ the 2018 version of the Mixed Methods Assessment Tool (MMAT) to evaluate study quality, and we will apply a convergent integration approach to synthesize the data.

ETHICS AND DISSEMINATION

Ethical approval is not needed, as no primary data will be collected. The results will be made available through a peer-reviewed publication.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 42023465302.

Nurse Telephone Support for Caregivers of Older Adults at Hospital Discharge: A Randomized Clinical Trial

Importance

Informal caregivers who provide home-based care frequently experience stress and burden that adversely affect their health-related quality of life (HRQOL).

Objective

To evaluate the efficacy of the Further Enabling Care at Home (FECH+) program for the HRQOL of caregivers of older adults discharged home from the hospital.

Design, Setting, and Participants

This multicenter, parallel, 2-group randomized clinical trial, with blinded baseline and outcome measurements, was conducted at 3 hospitals in 2 states in Australia. Recruitment took place between August 2020 and July 2022, and follow-up was performed for 12 months after hospital discharge. Participants were dyads of caregivers and patients. Eligible caregivers were aged 18 years or older who provided informal home-based care at least weekly for a patient aged 70 years or older. Caregivers were enrolled when their patient was discharged from the hospital. Dyads were randomly assigned to either the intervention or control group. Data analysis followed an intention-to-treat approach.

Intervention

Caregivers in the intervention group received the FECH+ program, structured nurse support of 6 telephone calls over 6 months after the patient's discharge plus usual discharge care. Caregivers in the control group received usual care alone.

Main Outcomes and Measures

Primary outcome was caregivers' HRQOL 6 months after discharge, which was measured using the Assessment of Quality of Life 8-Dimension (AQOL-8D). Secondary outcomes were caregivers' HRQOL 12 months after discharge as well as preparedness to care (measured using the Preparedness for Caregiving Scale), self-efficacy (measured using the Caregiver Inventory), and levels of strain and distress (measured using the Family Appraisal of Caregiving Questionnaire) at 6 and 12 months after discharge. Baseline and outcome measurements were administered by telephone at 3, 6, and 12 months after discharge.

Results

A total of 547 dyads (caregivers: 405 females [74.0%], mean [SD] age, 64.50 [12.82] years; patients: 296 females [54.1%], mean [SD] age, 83.16 [7.04] years for the intervention group and 83.45 [7.20] years for the control group) were included in the intention-to-treat analysis. There was no significant difference in caregivers' HRQOL between the 2 groups at the primary time point of 6 months (difference in AQOL-8D score, 0.01; 95% CI, -0.02 to 0.03; P = .62) after hospital discharge.

Conclusions and Relevance

In this randomized clinical trial, the FECH+ program-a nurse telephone support intervention for caregivers of older adults after hospital discharge-did not significantly improve caregivers' HRQOL at 6 months after discharge compared with usual care. Additional examination is warranted into improving caregivers' HRQOL at the time of their patient's hospital discharge.

Trial Registration

Australian New Zealand Clinical Trials Registry Identifier: ACTRN12620000060943.

Caring for yourself while you care for someone else: a qualitative study exploring the mental and cardiovascular health behaviours of female carers of stroke survivors

PURPOSE

Female carers of stroke survivors may experience increased risk of developing chronic health issues, such as cardiovascular disease. This study aims to understand: (i) how female carers of stroke survivors manage their mental and cardiovascular health and (ii) the characteristics they would find helpful in an intervention to support their ability to manage their health and wellbeing.

MATERIALS AND METHODS

A qualitative descriptive design was used with data collected via semi-structured interviews and analysed using inductive thematic analysis.

RESULTS

Eighteen female carers of stroke survivors participated in the study. Three key themes were identified: (i) struggling to prioritise own health and wellbeing; (ii) new roles and responsibilities impact on self-care; and (iii) peer-support improves mental health and well-being. Carers described preferences for group interventions to include peer support and have flexible delivery to allow easy access to information. One-to-one sessions with different health professionals may also be useful at times through the caregiving journey.

CONCLUSIONS

These findings suggest that current interventions do not address cardiovascular risk self-management for female carers and provide insight into characteristics of interventions that may increase acceptability and feasibility of interventions to support long-term cardiovascular and mental health-promoting behaviours.

Post-abortion needs-based education via the WeChat platform to lessen fear and encourage effective contraception: a post-abortion care service intervention-controlled trial

OBJECTIVE

Our study aims to investigate post-abortion needs-based education via the WeChat platform for women who had intended abortion in the first trimester, whether they are using effective contraception or becoming pregnant again.

DESIGN

This single hospital intervention-controlled trial used a nearly 1:1 allocation ratio. Women who had intended abortions were randomly assigned to a Wechat group (needs-based education) and a control group (Traditional education). The women's ability to use effective contraception was the main result. Whether they unknowingly became pregnant again was the second result. Another result was patient anxiousness. Before and after education, women filled out questionnaires to assess their contraception methods and anxiety.

METHODS

Based on the theoretical framework of contraceptions of IBL (inquiry-based learning), post-abortion women were included in WeChat groups. We use WeChat Group Announcement, regularly sending health education information, one-on-one answers to questions, and consultation methods to explore the possibilities and advantages of WeChat health education for women after abortion. A knowledge paradigm for post-abortion health education was established: From November 2021 until December 2021, 180 women who had an unintended pregnancy and undergone an induced or medical abortion were recruited, their progress was tracked for four months, and the PAC service team monitored the women's speech, discussed and classified the speech entries and summarized the common post-abortion needs in 8 aspects. At least 2 research group members routinely extracted records and categorized the outcomes.

RESULTS

Before education, there were no appreciable variations between the two groups regarding sociodemographic characteristics, obstetrical conditions, abortion rates, or methods of contraception (P > 0.05). Following education, the WeChat group had a greater rate of effective contraception (63.0%) than the control group (28.6%), and their SAS score dropped statistically more than that of the control group (P < 0.05). Following the education, there were no unwanted pregnancies in the WeChat group, whereas there were 2 in the traditional PAC group. Only 5 participants in the WeChat group and 32 in the conventional PAC group reported mild anxiety after the education.

[Telephone assistance for neurological diseases: a systematic review]

INTRODUCTION AND OBJECTIVE

While part of the care for neurological patients is done by telephone, it is not well known what neurological diseases and which part of that care is provided by telephone. Our goal is to find it out through a bibliographic review.

MATERIALS AND METHODS

References on telephone care for neurological diseases accessible through the PubMed, Embase, and Cochrane platforms have been systematically reviewed, with an unspecified start date and up to March 2022. We found 618 references, and as 219 did not pass the exclusion criteria, 399 were finally included in the review.

RESULTS

Dementia is the area of neurology with more publications about its telephone assistance. It is followed by stroke, head trauma, multiple sclerosis, Parkinson's disease and movement disorders, epilepsy, neuromuscular disorders, and others.

DISCUSSION AND CONCLUSIONS

Dementias are the diseases with more bibliographic references on their telephone assistance despite not being the most prevalent. The telephone is frequently used to administer diagnostic scales or support caregivers and is particularly useful in diseases that limit mobility and attending a medical practice.

Recruitment, retention, and adherence of family caregivers: Lessons from a multisite trial

Objective

To describe the recruitment, retention of family caregivers, and adherence to a telephone based intervention evaluated in a multi-site trial and provide recommendations for the design of future studies.

Methods

A descriptive study based on a secondary analysis of a multi-site clinical development in Colombia and Brazil. Recruitment was measured by the number of participants eligible and consented. Retention was assessed by the percentage of participants with outcomes data at two follow-ups. The intervention adherence was measured by the percentage of the caregiver who received the intervention.

Results

Of the family caregivers assessed, 63% were eligible, and 32.9% declined to be in the study for time restriction or no interest. In Colombia, the total retention rate of caregivers was 63.4% at the first follow-up and 48% at the second follow-up, while in Brazil was de 52.8% and 46.2%, respectively. At the end of the study, the sample comprised 28 and 70 caregivers in the intervention and control groups, respectively, for a retention rate of 47%. Of 104 family caregivers allocated to the intervention group, 42 (40.3%) received five sessions. Most reported not completing the Caregiver's Activity Diary.

Conclusion

The recruitment of family caregivers, participant retention, and adherence to the telephone intervention was unsuccessful. Future studies should apply an assessment tool during the recruitment of family caregivers and replace the term "caregiver" with "care provider" in the material involved in the research; define a retention protocol before starting the study and involve family caregivers in the design of the interventions.

Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: an umbrella review of systematic reviews and meta-analyses

OBJECTIVES

This umbrella review aimed to evaluate whether certain interventions can mitigate the negative health consequences of caregiving, which interventions are more effective than others depending on the circumstances, and how these interventions are experienced by caregivers themselves.

DESIGN

An umbrella review of systematic reviews was conducted.

DATA SOURCES

Quantitative (with or without meta-analyses), qualitative and mixed-methods systematic reviews were included.

ELIGIBILITY CRITERIA

Reviews were considered eligible if they met the following criteria: included primary studies targeting informal (ie, unpaid) caregivers of older people or persons presenting with ageing-related diseases; focused on support interventions and assessed their effectiveness (quantitative reviews) or their implementation and/or lived experience of the target population (qualitative reviews); included physical or mental health-related outcomes of informal caregivers.

DATA EXTRACTION AND SYNTHESIS

A total of 47 reviews were included, covering 619 distinct primary studies. Each potentially eligible review underwent critical appraisal and citation overlap assessment. Data were extracted independently by two reviewers and cross-checked. Quantitative review results were synthesised narratively and presented in tabular format, while qualitative findings were compiled using the mega-aggregation framework synthesis method.

RESULTS

The evidence regarding the effectiveness of interventions on physical and mental health outcomes was inconclusive. Quantitative reviews were highly discordant, whereas qualitative reviews only reported practical, emotional and relational benefits. Multicomponent and person-centred interventions seemed to yield highest effectiveness and acceptability. Heterogeneity among caregivers, care receivers and care contexts was often overlooked. Important issues related to the low quality of evidence and futile overproduction of similar reviews were identified.

CONCLUSIONS

Lack of robust evidence calls for better intervention research and evaluation practices. It may be warranted to avoid one-size-fits-all approaches to intervention design. Primary care and other existing resources should be leveraged to support interventions, possibly with increasing contributions from the non-profit sector.

PROSPERO REGISTRATION NUMBER

CRD42021252841; BMJ Open: doi:10.1136/bmjopen-2021-053117.

Effectiveness of the Online "Dialogue Circles" Nursing Intervention to Increase Positive Mental Health and Reduce the Burden of Caregivers of Patients with Complex Chronic Conditions. Randomized Clinical Trial

The personal demands involved in caring for a chronically ill person can lead to emotional and physical exhaustion in caregivers. The aim of this study was to evaluate the effectiveness of an online nursing intervention called "dialogue circles" designed to reduce caregiver overload and enhance positive mental health (PMH) in family caregivers. We used a pre-post design. The sample consisted of 86 family caregivers of patients with complex chronic conditions, randomly assigned to the intervention group (n = 43) or the control group (n = 43). All participants completed the Zarit scale and the Positive Mental Health Questionnaire 15 days before starting the intervention and 30 days after its completion. Comparison of the post-test changes revealed statistically significant differences between the two groups in PMH and overload, with the intervention group showing greater positive changes in all dimensions of PMH after the intervention and lower scores on overload. In conclusion, the results suggest that incorporating dialogue circles as an online nursing intervention in the caregivers of patients with complex chronic conditions can enhance PMH and decrease caregiver overload, especially in settings where face-to-face encounters are not possible.

Perceived mental health and emotional trajectories of long-term family caregivers of persons with mental conditions: A mixed-methods study

AIMS AND OBJECTIVES

To explore the emotional experience and the perceived mental health of experienced family caregivers of people with mental disorders.

BACKGROUND

Family caregiving for individuals with mental disorders differs from other health conditions, as it implies a burden, deterioration in physical and mental health, stigma and a perceived lack of support from mental health services.

METHODS

A mixed-method study was undertaken with family caregivers of people diagnosed with mental disorders.

RESULTS

A total of 13 experienced family caregivers were included in the study. The qualitative data were classified into two major themes: emotions and perceived mental health. Emotions included five categories: irritability, painful emotions, pressure, emotions orientated towards coping, and positive emotions. The perceived mental health status embraced five categories: anxiety, burden and exhaustion, needing psychological or psychiatric treatment, insomnia and suicidal thoughts. An emotional path could be constructed from their discourses, starting with lack of control or irritation that evolved towards resignation, peace or satisfaction. The quantitative analysis partially replicated the qualitatively reported anxiety, depressive symptoms and insomnia.

CONCLUSION

Past and present emotions related to caregiving described by experienced family caregivers were identified. Their emotional trajectories converged in that negative emotions gave way to emotions towards coping, which in turn were followed by positive emotions. The participants' descriptions about their mental status were partially reflected through objective mental health measurements.

RELEVANCE TO CLINICAL PRACTICE

More support from mental health services could help caregivers to progress in their emotional trajectory towards coping, and improve their caregiving knowledge and skills. Mental health nurses have a role in patients and caregivers education and in the promotion of caregivers' psychological wellbeing.

Validation of Content for an App for Caregivers of Stroke Patients through the Delphi Method

The aim of this study was to reach a consensus among experts (using the Delphi technique) to validate the informative content that should be included in an App to be used by informal caregivers of stroke patients in order to improve their quality of life, facilitating access to the health care system and involving them in their own health. This technique was developed between June and December 2021. The group of experts was selected on the basis of previously established criteria, and the coefficient of variation (v) was used as a measure of consensus. In addition, the concordance index was calculated to determine the stability of the different rounds. In the first round, the preliminary content, previously elaborated by the research group, was evaluated as very appropriate for the objectives set (N-P < 1.07). In addition, averages of 4.5 out of five and a coefficient of variation of less than 0.5 were obtained, confirming the consensus. In the second round, suggestions were made by the experts on how to improve the content of the information, obtaining 100% agreement with the results obtained in the first round. The results obtained allow a positive evaluation of the use of the Delphi method for the elaboration of the information to be housed in an App.

Risk Factors for Depression in Tuberculosis Patients: A Meta-Analysis

Purpose

Tuberculosis (TB) is a life threatening global infection. However, not only does TB have a high global prevalence, but it is also associated with several comorbidities. Depression is one of the most common and lethal comorbidities of TB patients. Therefore, in order to prevent depression in TB patients more effectively, it is necessary to investigate the factors associated with depression in TB patients by studying the pooled effect of each factor statistically. By concluding the associated factors through statistical analysis, it not only offers accurate guidance for further studies about programs targeted at preventing depression in TB patients, but provides health-care workers useful suggestions and warnings when treating TB patients.

Methods

We searched the published literatures from PubMed, Web of Science, EMBASE, and Cochrane Library to collect studies. The meta-analysis included articles from observational studies, including cross-sectional studies, cohort studies and case control studies that had information about factors associated with depression in tuberculosis patients. When the heterogeneity is defined as significant (I2>50%), a random-effect model with 95% confidence interval (CI) was used to estimate risk factors; otherwise, a fixed-effect model was used to combine the effect. A sensitivity test was conducted to examine which one of the studies may have potential bias that can affect the validity and reliability of the result. The funnel plots and Begg's and Egger's statistical tests were performed to assess the publication bias. Subgroup analysis was performed according to the prespecified variables in each group.

Results

Totally, 25 studies were included in the meta-analysis. The studies were conducted in various countries around the world between 2011 and 2021, representing the situation in the previous ten years. The final associated factors include female gender [OR=1.319, 95% CI=1.132-1.536, p<0.001], poor social support [OR=4.109, 95% CI=1.431-11.799, p<0.01], marriage status [OR=1.362, 95% CI=1.154-1.608, p<0.001], low education level [OR=1.921, 95% CI=1.475-2.503, p<0.001], residence in rural areas [OR=1.408, 95% CI=1.122-1.767, p<0.01], retreatment status [OR=2.515, 95% CI=1.226-5.159, p<0.01], and having perceived stigma[OR=4.131, 95% CI=1.412-12.088, p<0.05].

Conclusion

Depression prevention programs targeted at women TB patients are supposed to be carried out. Patients in retreatment status are supposed to be paid more attention of their psychological health by caring about their mental status. More social support is ought to be given to tuberculosis patients to reduce their chance of getting depressed. It is necessary to provide patients with a lower education level with psychological related courses to help them learn about their mental status. For patients living in rural areas, governments are supposed to offer psychotherapy for treatment as well as enhancing living condition. Suitable psychotherapy programs and plans is ought to be studied to eradicate perceived stigma of TB patients.

Supporting Relatives Prior to Caregiver Burden—Preventive E-Mental Health Short Intervention for Family Members of Individuals with Parkinsonism in an Early Phase of the Disease: Protocol for a Feasibility Study

Research on support for relatives of patients with Parkinsonism has mainly focused on caregivers, while preventive offers for non-caregiving relatives are lacking. Thus, the aim of this multicenter pilot study is to develop and assess the feasibility of a preventive psychosocial support program for relatives of patients with Parkinsonism. It specifically focuses on family members of patients who are in an early phase of the disease, are not currently caregiving, and have not yet developed distress symptoms. It includes a telemedicine-based, 6-week preventive psychological short intervention (PPSI). The main objective of this feasibility mixed-methods study is to specify the demand for an early, low-threshold, and low-cost short intervention and to collect feedback based on qualitative and quantitative data of N = 20 relatives. Secondary objectives are an evaluation of the effects of the intervention and an analysis of the study design. Future directions are to further develop the PPSI using these data. This study can serve as a basis for future randomized controlled studies on this intervention, which might fill an important gap in clinical supply.

Follow-up of severely injured patients can be embedded in routine hospital care: results from a feasibility study

OBJECTIVE

Understanding the longitudinal patient experience outcomes following major trauma can promote successful recovery. A novel, hospital-led telephone follow-up program was implemented by a multi-disciplinary clinical trauma service team at a Level I trauma center. This process evaluation examined what factors promoted or impeded the program's implementation.

METHODS

A prospective convergent mixed methods process evaluation design was used. Quantitative data included patient and injury demographics and program feasibility data such number of telephone calls attempted/completed and call duration. Qualitative data consisted of semi-structured interviews with program participants (staff, patients, caregivers) who had participated in the program. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data respectively. Data were collected concurrently and merged in the results to understand and describe the implementation and sustainability of the program.

RESULTS

274 major trauma patients (ISS ≥ 12) were eligible for follow-up. A response rate of over 75% was achieved, with nurses responsible for most of the calls. Limited time and competing clinical demands were identified as barriers to the timely completion of the calls.

Participants valued the pre-existing trauma service/patient relationship, and this facilitated program implementation. Clinicians were motivated to evaluate their patient's recovery, whilst patients felt 'cared for' and 'not forgotten' post-hospital discharge. Teamwork and leadership were highly valued by the clinical staff throughout the implementation period as ongoing source of motivation and support.

Staff spontaneously developed the program to incorporate clinical follow up processes by providing guidance, advice and referrals to patients who indicated ongoing issues such as pain or emotional problems.

CONCLUSION

Telephone follow-up within a clinical trauma service team is feasible, accepted by staff and valued by patients and families. Despite time constraints, the successful implementation of this program is reliant on existing clinical/patient relationships, staff teamwork and leadership support.

Technological and Digital Interventions for Mental Health and Wellbeing: An Overview of Systematic Reviews

Background: Research increasingly shows how selective and targeted use of technology within care and welfare can have several advantages including improved quality of care and active user involvement.

Purpose: The current overview of reviews aims to summarize the research on the effectiveness of technology for mental health and wellbeing. The goal is to highlight and structure the diverse combinations of technologies and interventions used so far, rather than to summarize the effectiveness of singular approaches.

Methods: The current overview includes reviews published in the past five years with a focus on effectiveness of digital and technological interventions targeting mental health and wellbeing.

Results: A total of 246 reviews could be included. All reviews examined the effectiveness of digital and technological interventions in the context of care and welfare. A combination of two taxonomies was created through qualitative analysis, based on the retrieved interventions and technologies in the reviews. Review classification shows a predominance of reviews on psychotherapeutic interventions using computers and smartphones. It is furthermore shown that when smartphone applications as stand-alone technology are researched, the primary focus is on self-help, and that extended reality is the most researched emerging technology to date.

Conclusion: This overview of reviews shows that a wide range of interventions and technologies, with varying focus and target populations, have been studied in the field of care and wellbeing. The current overview of reviews is a first step to add structure to this rapidly changing field and may guide both researchers and clinicians in further exploring the evidence-base of particular approaches.

Evaluating the provision of Further Enabling Care at Home (FECH+) for informal caregivers of older adults discharged home from hospital: protocol for a multicentre randomised controlled trial

INTRODUCTION

There are personal and societal benefits from caregiving; however, caregiving can jeopardise caregivers' health. The Further Enabling Care at Home (FECH+) programme provides structured nurse support, through telephone outreach, to informal caregivers of older adults following discharge from acute hospital care to home. The trial aims to evaluate the efficacy of the FECH+ programme on caregivers' health-related quality of life (HRQOL) after care recipients' hospital discharge.

METHODS AND ANALYSIS

A multisite, parallel-group, randomised controlled trial with blinded baseline and outcome assessment and intention-to-treat analysis, adhering to Consolidated Standards of Reporting Trials guidelines will be conducted. Participants (N=925 dyads) comprising informal home caregiver (18 years or older) and care recipient (70 years or older) will be recruited when the care recipient is discharged from hospital. Caregivers of patients discharged from wards in three hospitals in Australia (one in Western Australia and two in Queensland) are eligible for inclusion. Participants will be randomly assigned to one of the two groups. The intervention group receive the FECH+ programme, which provides structured support and problem-solving for the caregiver after the care recipient's discharge, in addition to usual care. The control group receives usual care. The programme is delivered by a registered nurse and comprises six 30-45 min telephone support sessions over 6 months. The primary outcome is caregivers' HRQOL measured using the Assessment of Quality of Life-eight dimensions. Secondary outcomes include caregiver preparedness, strain and distress and use of healthcare services. Changes in HRQOL between groups will be compared using a mixed regression model that accounts for the correlation between repeated measurements.

ETHICS AND DISSEMINATION

Participants will provide written informed consent. Ethics approvals have been obtained from Sir Charles Gairdner and Osborne Park Health Care Group, Curtin University, Griffith University, Gold Coast Health Service and government health data linkage services. Findings will be disseminated through presentations, peer-reviewed journals and conferences.

TRIAL REGISTRATION NUMBER

ACTRN12620000060943.

Effectiveness of a home-based nursing support and cognitive restructuring intervention on the quality of life of family caregivers in primary care: A pragmatic cluster-randomized controlled trial

BACKGROUND

Caregivers of patients with chronic conditions or disability experience fatigue, burden and poor health-related quality of life. There is evidence of the effectiveness of support interventions for decreasing this impact. However, little is known about the benefits of home-based nursing intervention in primary health care.

OBJECTIVES

To evaluate the effectiveness of a home-based, nurse-led-intervention (CuidaCare) on the quality of life of caregivers of individuals with disabilities or chronic conditions living in the community, measured at 12-month follow-up.

METHODS

A pragmatic, two-arm, cluster-randomized controlled trial with a 1-year follow-up period was performed between June 2013 and December 2015. Consecutive caregivers aged 65 years or older, all of whom assumed the primary responsibility of caring for people with disabling conditions for at least 6 months a year, were recruited from 22 primary health care centers. Subsequently, 11 centers were randomly assigned to usual care group, and 11 were assigned to the intervention group. The caregivers in the intervention group received the usual care and additional support (cognitive restructuring, health education and emotional support). The primary outcome was quality of life, assessed with the EQ-5D instrument (visual analog scale and utility index score); the secondary outcome variables were perception of burden, anxiety, and depression. Data were collected at baseline, at the end of the intervention, and at the 6- and 12-month follow-up visits. We analyzed the primary outcome as intention-to-treat, and missing data were added using the conditional mean single imputation method.

RESULTS

A total of 224 caregivers were included in the study (102 in the intervention group and 122 in the usual care group). Generalized Estimating Equation models showed that the CuidaCare intervention was associated with a 5.46 point (95% CI: 2.57; 8.35) change in the quality of life, as measured with the visual analog scale adjusted for the rest of the variables at 12 months. It also produced an increase of 0.04 point (95% CI: 0.01; 0.07) in the utilities. No statistically significant differences were found between the two groups at 12 months with respect to the secondary outcomes.

CONCLUSIONS

The findings suggest that incorporating a home-based, nurse-led-intervention for caregivers into primary care can improve the health-related quality of life of caregivers of patients with chronic or disabling conditions.

Rapid systematic review of systematic reviews: what befriending, social support and low intensity psychosocial interventions, delivered remotely, may reduce social isolation and loneliness among older adults and how?

Background: During the COVID-19 pandemic ‘social distancing’ has highlighted the need to minimise loneliness and isolation among older adults (aged 50+). We wanted to know what remotely delivered befriending, social support and low intensity psychosocial interventions may help to alleviate social isolation and loneliness and how they work. Methods: We followed a systematic ‘review of reviews’ approach. Searches of 11 databases from the fields of health, social care, psychology and social science were undertaken during April 2020. Reviews meeting our PICOS criteria were included if they focussed on the evaluation of remote interventions to reduce levels of social isolation or loneliness in adults aged 50+ and were critically appraised using AMSTAR2. Narrative synthesis was used at a review and study level to develop a typology of intervention types and their effectiveness. Intervention Component Analysis (ICA) and Qualitative Comparative Analysis (QCA) were used at a study level to explore the characteristics of successful interventions. Results: We synthesised evidence from five systematic reviews and 18 primary studies. Remote befriending, social support and low intensity psychosocial interventions took the form of: (i) supported video-communication; (ii) online discussion groups and forums; (iii) telephone befriending; (iv) social networking sites; and (v) multi-tool interventions. The majority of studies utilised the first two approaches, and were generally regarded positively by older adults, although with mixed evidence around effectiveness. Focussing on processes and mechanisms, using ICA and QCA, we found that the interventions that were most successful in improving social support: (i) enabled participants to speak freely and to form close relationships; (ii) ensured participants have shared experiences/characteristics; (iii) included some form of pastoral guidance. Conclusions: The findings highlight a set of intervention processes that should be incorporated into interventions, although they do not lead us to recommend specific modes of support, due to the heterogeneity of interventions.

Telephone interventions, delivered by healthcare professionals, for providing education and psychosocial support for informal caregivers of adults with diagnosed illnesses

BACKGROUND

Maintaining care for ill persons in the community is heavily dependent on support from unpaid caregivers. Many caregivers, however, find themselves in a caring role for which they are ill prepared and may require professional support. The telephone is an easily accessible method of providing support irrespective of geographical location.

OBJECTIVES

The objective of this review was to evaluate the effectiveness of telephone support interventions, delivered by healthcare professionals, when compared to usual care or non-telephone-based support interventions for providing education and psychosocial support for informal caregivers of people with acute and chronic diagnosed illnesses, and to evaluate the cost-effectiveness of telephone interventions in this population.

SEARCH METHODS

We searched the following databases from inception to 16 November 2018: the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; PsycINFO; ProQuest Dissertations and Theses A&I; and CINAHL Complete. We also searched 11 caregiver-specific websites, three conference links, and two clinical trial registries.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) (including cluster-RCTs) and quasi-RCTs. We excluded cross-over trials because of the high risk of carry-over effects from one intervention to another.

DATA COLLECTION AND ANALYSIS

Two authors independently screened citations against the review's inclusion criteria, extracted data, and assessed the included studies using the Cochrane 'Risk of bias' tool. The review's prespecified primary (quality of life and burden) and secondary outcomes (skill acquisition, psychological health, knowledge, health status and well-being, family functioning, satisfaction, and economic outcomes), where reported, were assessed at the end of intervention delivery and at short-term (≤ 3 months), medium-term (> 3 to ≤ 6 months) and longer-term time points (> 6 to 12 months) following the intervention. Where possible, meta-analyses were conducted, otherwise results were reported narratively.

MAIN RESULTS

We included 21 randomised studies involving 1,690 caregivers; 19 studies compared telephone support interventions and usual care, of which 18 contributed data to the analyses. Two studies compared telephone and non-telephone professional support interventions. Caregiver ages ranged from 19 years to 87 years across studies. The majority of participants were female (> 70.53%), with two trials including females only. Most caregivers were family members, educated beyond secondary or high school level or had the equivalent in years of education. All caregivers were based in the community. Overall risk of bias was high for most studies.The results demonstrated that there is probably little or no difference between telephone support interventions and usual care for the primary outcome of quality of life at the end of intervention (SMD -0.02, 95% CI -0.24 to 0.19, 4 studies, 364 caregivers) (moderate-certainty evidence) or burden at the end of intervention (SMD -0.11, 95% CI -0.30 to 0.07, 9 studies, 788 caregivers) (low-certainty evidence). For one study where quality of life at the end of intervention was reported narratively, the findings indicated that a telephone support intervention may result in slightly higher quality of life, compared with usual care. Two further studies on caregiver burden were reported narratively; one reported that telephone support interventions may decrease burden, the other reported no change in the intervention group, compared with usual care.We are uncertain about the effects of telephone support interventions on caregiver depression at the end of intervention (SMD -0.37, 95% CI -0.70 to -0.05, 9 studies, 792 caregivers) due to very low-certainty evidence for this outcome. Depression was reported narratively for three studies. One reported that the intervention may reduce caregiver depression at the end of intervention, but this effect was not sustained at short-term follow-up. The other two studies reported there may be little or no difference between telephone support and usual care for depression at the end of intervention. Six studies measured satisfaction with the intervention but did not report comparative data. All six reported high satisfaction scores with the intervention. No adverse events, including suicide or suicide ideation, were measured or reported by any of the included studies.Our analysis indicated that caregiver anxiety may be slightly reduced (MD -6.0, 95% CI -11.68 to -0.32, 1 study, 61 caregivers) and preparedness to care slightly improved (SMD 0.37, 95% CI 0.09 to 0.64, 2 studies, 208 caregivers) at the end of intervention, following telephone-only support interventions compared to usual care. Findings indicated there may be little or no difference between telephone support interventions and usual care for all of the following outcomes at the end of intervention: problem-solving, social activity, caregiver competence, coping, stress, knowledge, physical health, self-efficacy, family functioning, and satisfaction with supports (practical or social). There may also be little or no effect of telephone support interventions for quality of life and burden at short-term follow-up or for burden and depression at medium-term follow-up.Litttle or no difference was found between groups for any of the reported outcomes in studies comparing telephone and non-telephone professional support interventions. We are uncertain as to the effects of telephone support interventions compared to non-telephone support interventions for caregiver burden and depression at the end of intervention. No study reported on quality of life or satisfaction with the intervention and no adverse events were reported or noted in the two studies reporting on this comparison.

AUTHORS' CONCLUSIONS

Although our review indicated slight benefit may exist for telephone support interventions on some outcomes (e.g. anxiety and preparedness to care at the end of intervention), for most outcomes, including the primary outcomes, telephone-only interventions may have little or no effect on caregiver outcomes compared to usual care. The findings of the review were mainly based on studies with overall high risk of bias, and few participants. Further high-quality trials, with larger sample sizes are required.