Digital health interventions to support family caregivers: An updated systematic review

Caregiver experiences managing information prior to hematopoietic stem cell transplantation and after transition to home: a qualitative study

PURPOSE

Caregivers of adults undergoing hematopoietic stem cell transplantation (HSCT) manage extensive transplant-related information, including medications, support services, lifestyle changes, treatment risks, and potential complications. The overwhelming volume of information can cause uncertainty and stress. While prior studies highlight caregivers' unmet information needs, little is known about their responses to pre-transplant and post-discharge education. This study explores caregivers' experiences and elicits their recommendations for managing transplant-related information during these critical periods.

METHODS

This qualitative study included demographic data from 14 caregivers of adults who underwent autologous or allogeneic HSCT between July 2020 and June 2021. Due to follow-up loss, 12 caregivers completed semi-structured interviews. Recorded interviews were transcribed and analyzed for key themes and caregiver recommendations regarding pre-transplant and post-discharge information needs.

RESULTS

Caregivers' experiences varied across two critical periods. Three themes emerged: (1) feeling overwhelmed by the breadth of information they receive pre-transplant; (2) before transplant, gathering information to gain a sense of control and understanding; and (3) facing unanticipated challenges post-discharge despite receiving education during hospitalization. Recommendations included the following: (1) identifying sources of support when feeling overwhelmed with information; (2) seeking information that matches caregiver learning needs; and (3) learning from others who understand the transplant experience.

CONCLUSION

Tailored education is crucial to addressing caregivers' informational, emotional, and practical needs as they navigate transplant-related information before HSCT and after discharge.

Family-centered care in neonatal and pediatric critical care units: a scoping review of interventions, barriers, and facilitators

INTRODUCTION

The Family-Centered Care (FCC) model has been linked to improved clinical outcomes and family satisfaction. However, implementing this model can be challenging, especially in neonatal and pediatric critical care units. This review aims to map the literature on FCC in neonatal and pediatric critical care units, identify barriers and facilitators of effective interventions, and suggest a practical step-by-step approach for implementing FCC interventions.

METHODS

This scoping review was guided by the PRISMA-ScR guidelines and followed the Arksey and O'Malley 5-step scoping review framework. We accessed the databases on the 28 th of April, 2024, and included all prospective and randomized controlled trials (RCT) implementing FCC interventions from PubMed and Web of Science databases. Data were organized, tabulated, and described narratively.

RESULTS

Out of 1,577 potentially relevant citations after duplicate removal, 17 articles met our eligibility criteria (4 RCTs and 13 prospective studies). Nine of these studies were conducted in neonatal intensive care units (NICU) and eight in pediatric intensive care units (PICU). Three NICU interventions were single-type interventions, while six were part of comprehensive programs; in the PICU, seven were single-type interventions and one was part of a comprehensive program. All interventions incorporated elements of FCC principles (respect, information sharing, collaboration, and participation). Barriers included institutional factors, provider attitudes, cultural issues, communication challenges, environmental constraints, training needs, and emotional stress. FCC facilitators included enhanced environment, empowerment and training, supportive Infrastructure, collaborative communication, parental Involvement, adaptive interventions, and continuous feedback.

CONCLUSION

Effective implementation of FCC interventions requires careful planning and needs assessment. It ensures management support, regular staff training, family orientation, and a continuous feedback loop. Incorporating FCC principles and delivering culturally acceptable interventions is key while acknowledging possible barriers and utilizing available facilitators. FCC interventions can help foster a healthcare culture that values partnerships with families and can transform the neonatal and pediatric critical care experience for patients, families, and providers alike.

Online interventions for the mental health and well-being of parents of children with additional needs: Systematic review and meta-analysis

INTRODUCTION

Parents of children with additional needs experience compromised physical and mental health and higher stress, and their ability to engage in meaningful occupations is impacted by their additional caregiving tasks. Online interventions targeting mental health, stress, and well-being for parents of children with additional needs have potential to increase supports alongside occupational therapy direct services. The aims of this review are to systematically identify and synthesise evidence of effectiveness of online interventions aimed at improving mental health, stress, and well-being of parents of children with additional needs.

METHOD

Eight databases were searched up to July 2024 to identify online interventions for parents of children with additional needs. Studies were appraised for methodological quality. Standardised effect sizes were calculated, and meta-analyses of randomised control trials (RCTs) were conducted on outcomes of mental health, well-being, and stress.

CONSUMER AND COMMUNITY INVOLVEMENT

There was no consumer or community involvement.

RESULTS

Systematic screening identified 30 papers that met inclusion criteria. Most were RCTs or controlled clinical trials (CCTs) with 'moderate' quality ratings: Three were designed by occupational therapists. There was substantial variation in intervention types, methods of delivery, outcomes, and outcome measures used. The pooled standardised effect size estimates (ES) and the lower and upper confidence intervals (CI) of online interventions from RCTs post-interventions were significant for mental health ES = 0.47, 95% CI (0.18, 0.77), p = 0.002; stress ES = 1.27, 95% CI (0.56, 1.98), p = 0.000; and well-being ES = 0.65, 95% CI (1.2, 0.06), p = 0.03, respectively.

CONCLUSION

The online interventions that aimed to improve mental health, stress, and well-being included in this meta-analysis were effective. Occupational therapists supporting families play an important role in guiding parents of children with additional needs to evidence-based interventions to support them with addressing their own mental health and well-being needs.

The Impact of Digital Tool Use on Older Caregivers' Burden, Depression and Quality of Life: A Systematic Review and Meta-Analysis

BACKGROUND

Assumption of an informal caregiving role is often circumstantial and unexpected. Older informal caregivers (OICGs), those aged 60 years and above, exhibit impaired coping and considerably poorer psychological and physical health outcomes due to the demanding nature of the caregiving role. Digital caregiving tools were found to be effective in enhancing caregivers' mental health.

AIMS

To synthesize randomized controlled trials related to digital caregiving tools and aids available for OICGs and to study their impact on OICG's key outcomes, including burden, depression, and quality of life (QoL).

METHODS

Literature from 7 electronic databases from January 1, 2006 to April 1, 2024 was reviewed: Medline, PsycINFO, Embase, Cochrane, Scopus, CINAHL, and Web of Science. The protocol for this review is registered in PROSPERO (CRD42023493282).

RESULTS

Eight randomized controlled trials were included for analysis. None of the included trials purposefully recruited or catered to OICGs. There was low quality evidence suggesting that the use of digital tools may slightly reduce caregiver burden (SMD -0.42, CI [-0.66, -0.18]) and depression (MD -2.5, 4.19 lower to 0.82 lower). For QoL, moderate quality evidence suggests that digital tool use will likely result in a slight improvement in QoL (SMD 0.21, CI [-0.18, 0.6]). Within the retrieved literature, complex digital interventions were associated with higher dropout rates in OICGs. There is also a trend of OICGs caring for dependents with neurodegenerative diseases.

LINKING EVIDENCE TO ACTION

This systematic review highlighted the increased uptake and benefits of digital tool use by the OICG population. Nursing research on technology-enabled caregiving innovations should include an in-depth consideration of their target audience's demography, offering simplified, age-friendly features as necessary.

Feasibility and Acceptability of Engaging Care Partners of Persons Living With Dementia With Electronic Outreach for Deprescribing

BACKGROUND AND OBJECTIVES

Care partners are critical for making treatment decisions in persons living with dementia. However, identifying them is challenging, hindering the broader use of interventions, such as those using digital technologies. We aimed to (i) assess the feasibility of identifying and contacting care partners using electronic health record (EHR) systems, and (ii) elicit their perspectives on electronic interventions for deprescribing.

RESEARCH DESIGN AND METHODS

We systematically identified care partners of persons living with dementia ≥65 years of age via structured EHR data in a large health care system. Eligible care partners were contacted by patient portal (if they were an established proxy), mail, and phone to complete a survey.

RESULTS

Of 4,138 eligible persons living with dementia identified, 1,084 (26%) had a care partner name recorded in the EHR. Out of 259 (6%) with sufficient care partner contact information for outreach, 74 (29%) completed the survey. Among care partners, 62 (84%) reported being confident in managing dementia medications, 59 (80%) were willing to stop ≥1 medications, and 43 (58%) were very/extremely interested in using digital tools for decision-making.

DISCUSSION AND IMPLICATIONS

Despite the low percentage of care partners with sufficient contact information, reach rates were high for contacted care partners, suggesting feasibility for pragmatic system-level interventions. Most care partners showed great interest in using digital health tools for decision-making and managing medications. Therefore, electronic tools could help with identifying care partners and engaging them. However, scaling up interventions requires better care partner documentation or extracting information from free text.

Relationship between problem solving dimensions and psychological distress among cancer caregivers

BACKGROUND

Family caregivers of patients with cancer face numerous challenges, leading to a heightened risk of psychological distress. Problem-solving abilities of cancer caregivers may influence coping and be relevant in anticipating the level of support needed from palliative care.

OBJECTIVE

Researchers sought to evaluate the relationship between problem-solving dimensions and psychological distress, specifically symptoms of anxiety and depression, among family caregivers of cancer patients receiving outpatient palliative care.

METHODS

Researchers conducted a cross-sectional exploratory study using data from an ongoing multisite clinical trial. Using block-wise linear regression models, they examined the relationship between psychological distress and problem-solving dimensions.

RESULTS

Results identified positive significant associations between negative problem orientation and symptoms of anxiety and depression, and between avoidance problem-solving style and symptoms of depression.

CONCLUSION

Study results shed light on maladaptive problem-solving as influential in cancer caregiver coping, especially as it relates to risk of psychological distress.

The potential of single session intervention approaches to enhance the mental health and resilience of older adults, care partners, and healthcare systems

Single-session interventions (SSIs) are mental health (MH) interventions that intentionally involve a single encounter. In this commentary, we outline issues with existing models of MH care for older adults & their care partners, how SSIs can address barriers, and considerations for research. We encourage the development of SSIs to increase accessibility, scalability, participation, and cost-effectiveness of mental health interventions.

Disease-Related Knowledge, Stress, and Quality of Life of Parental Caregivers of Children with Cleft Lip and Palate in a Selected Hospital in Ho Chi Minh City, Vietnam

INTRODUCTION

Cleft lip and palate (CLP) is one of the most common congenital anomalies worldwide, affecting approximately 2,000 children annually in Vietnam. Parental caregivers, particularly mothers, face considerable challenges in managing complex treatment pathways and addressing their children's multifaceted needs. This often leads to increased stress and decline in the quality of life (QoL). This study aimed to explore the relationship between disease-related knowledge, stress, and QoL among caregivers of children with CLP in Ho Chi Minh City.

MATERIALS AND METHODS

A descriptive-correlational design was used with a purposive sample of 235 parental caregivers from an Odonto-Stomatology Hospital in Ho Chi Minh City, Vietnam. Data were collected using three validated instruments: the Disease-Related Knowledge Scale, Stress Scale for Parents of Children with CLP, and WHOQOL-BREF. Descriptive statistics were used to summarize the data; Pearson's correlation coefficient and multiple linear regression were used to examine the relationships between knowledge, stress, and QoL.

RESULTS

Caregivers had moderately good disease-related knowledge (M=3.66, SD=0.39), with the highest scores in information provision (M=3.90, SD=0.43). Stress levels were moderately low (M=3.46, SD=0.44), with resource deficiencies being the most significant stressor. Although the caregivers reported good overall QoL (M=3.97, SD=0.47), psychological health scored lower (M=3.45, SD=0.84). A significant positive correlation was found between knowledge and stress (r=0.421, p<0.001), but no significant correlation was observed between knowledge and QoL (r=-0.033, p=0.619).

CONCLUSION

Greater disease-related knowledge correlated with increased stress, yet it did not directly improve QoL. These findings emphasize the need for comprehensive support, including education and psychosocial interventions, to reduce stress and enhance the well-being of parental caregivers.

Digital Health Interventions Supporting Recovery for Intensive Care Patients and Their Family Members: A Scoping Review

Digital innovation in interventions to promote recovery for intensive care unit (ICU) patients and their family members holds promise for enhancing accessibility and improving physical, psychological, and cognitive outcomes. This scoping review provides a comprehensive overview of digital health interventions designed to support the recovery of ICU patients and their family members described in peer-reviewed publications. We searched 6 databases (inception to September 2023); 2 reviewers independently screened citations against predefined eligibility criteria and extracted data. We screened 3485 records and identified 18 original studies and 8 study protocols with a range of study designs published between 2016 and 2023. Most (n=15) completed studies recruited patients only. Digital interventions were delivered through applications, virtual reality, videoconferencing, and smartwatches. In the completed studies, outcomes are described as feasibility, intervention efficacy, or both. Digital interventions supplemented with professional support and personalized feedback were more feasible than self-directed interventions. Further research is essential to ascertain the efficacy and cost-effectiveness of digital interventions in improving outcomes for ICU survivors and their family members.

Family caregivers' perception of pressure ulcer prevention devices and equipment for patients with cerebrovascular and spinal disease

BACKGROUND

Family caregivers play a crucial role in preventing pressure ulcers in patients with cerebrovascular and spinal diseases. Despite the availability of advanced devices, including Internet of Things(IoT) based smart mattresses, the adoption and effectiveness of these technologies are influenced by caregivers' experiences and perceptions.

OBJECTIVE

To investigate the experiences and perceptions of family caregivers regarding pressure ulcer prevention devices and equipment, with a focus on the factors influencing the intention to adopt IoT-based smart mattresses.

DESIGN

A cross-sectional survey study.

SETTING(S) AND PARTICIPANTS

159 family caregivers of patients with cerebrovascular and spinal diseases, who had experiences with pressure ulcer prevention devices.

METHODS

Data for this study were collected through survey questionnaires. Descriptive statistics, frequency analysis and multiple regression analysis were conducted.

RESULTS

Caregivers reported using an average of 1.69 types of pressure ulcer prevention equipment, with cushions (37.7 %) and mattresses (44.0 %) being the most commonly used. Ease of use and comfort were identified as key factors contributing to their satisfaction. The multiple regression model (R2 = 0.54, p < .001) revealed that ease of use (p < .01), perceived usefulness (p < .01), and perceived necessity (p < .01) were significant predictors of participants' intention to adopt smart mattresses. In addition, the number of digital devices owned by caregivers was positively associated with the intention to adopt smart mattress (p < .001).

CONCLUSIONS

The findings of this study show the importance of usability and digital inclusion in the adoption of smart health technologies by caregivers. A user-centered approach to device development is recommended to better meet the practical needs of family caregivers.

Systematic review and meta-analysis of family-based interventions for early psychosis: Carer and patient outcomes

BACKGROUND

Previous reviews have indicated that family interventions in early psychosis are beneficial for patients and family caregivers. Given recent developments in research and service provision an updated review is warranted.

METHODS

We conducted a systematic review and meta-analysis of family intervention trials in the first 5 years after psychosis onset. We identified randomized controlled trials that reported outcomes for family members and extracted available outcomes in relation to identified patients.

RESULTS

We screened 8737 abstracts and 177 full text papers, resulting in 36 for extraction. We found significant pooled treatment effects for family interventions for carer psychological distress (Hedges g = 0.35), carer burden (Hedges g = -0.68), positive and negative carer appraisals (Hedges g = 0.20, g = -0.21), and components of expressed emotion (critical comments and emotional overinvolement) compared with care as usual (Hedges g = -0.81, -0.92). For patients we found a moderate pooled effect for reduced rates of hospitalization compared with care as usual (Hedges g = -0.52). The effects for carer burden were maintained for studies in China, but not in other settings combined. The effects for hospitalization were maintained for multicomponent interventions but not when psychoeducation was the sole component. There was evidence of significant study heterogeneity. Risk of bias assessment indicated that deviations from intended treatment were most frequently rated as the weakest domain.

CONCLUSIONS

Family interventions for early psychosis benefit both family carers and their relatives diagnosed with psychosis when compared with usual care. Future research should further clarify the effective components and investigate innovations in cultural sensitivity, peer support and digital modes.

It is Time to Address Fear of Cancer Recurrence in Family Caregivers: Feasibility and Acceptability of a Randomized Pilot Study of the Family Caregiver Version of the Fear of Recurrence Therapy (FC-FORT)

OBJECTIVE

Fear of cancer recurrence (FCR) is common, persistent, and associated with lower quality of life, impaired functioning, and psychological distress in family caregivers (FC) of individuals with a cancer diagnosis. Interventions are needed to specifically target FCR in FC. This study aimed to pilot test the adapted Family Caregiver-Fear Of Recurrence Therapy (FC-FORT) to establish its feasibility, acceptability, and clinical significance.

METHODS

This pilot study used a mixed-method, parallel, two-group randomized control trial (FC-FORT vs. waitlist control group) design. Women FC were recruited through Canadian hospitals, community partners, and social media. FC in the intervention group completed 7 weekly sessions of virtual group therapy (FC-FORT) and an exit interview. All participants completed questionnaires at baseline, post-intervention, and 3-month follow-up. Feasibility (e.g., recruitment, allocation, fidelity), acceptability (e.g., dropout, completion, satisfaction) and clinical significance of secondary outcomes were evaluated. Descriptive statistics, mixed ANOVAs, and conventional content analyses were used.

RESULTS

Regarding feasibility, 22 FC were recruited, 18 were randomized and therapist fidelity was 87%. As to acceptability, 67% of participants completed≥ ${\ge} $ 5 sessions (33% dropout). Questionnaire completion rate was 92%. FC satisfaction was 80%. Analyses did not reveal any significant differences on the secondary outcomes between groups. Qualitative analyses revealed high importance, helpfulness, satisfaction, and group cohesion. Suggestions were made by FC for improvements.

CONCLUSIONS

This is one of the first interventions to address FCR in FC. While acceptability of FC-FORT was good, important feasibility issues need to be addressed before moving forward with a larger randomized control trial.

TRIAL REGISTRATION

NCT, NCT05441384. Registered July 1st, 2022, https://classic.

CLINICALTRIALS

gov/ct2/show/NCT05441384.

Stress, perceived competence and guilt as predictors of depression in parents with chronic pain

Introduction

Suffering from chronic pain (CP) and coping with parenthood can be challenging for parental mental health. Pain can hinder the ability to deal with demands related to parenthood, which can negatively affect their psychological well-being because of unmet caregiving expectations.

Methods

Considering the limited amount of research regarding the mental health of parents with CP, the study's main aim was to test a predictive model based on previous scientific literature, using structural equation analysis, in which parental competence and parental guilt partially mediate the relationship between parental stress and depression. To examine the moderating role of CP, the model was tested on a group of parents with CP and a control group of parents without CP. The study included 380 parents from all over Spain, of which 200 formed the group with CP and 180 participants formed the control group. A cross-sectional design was used to collect data through self-report measures.

Results

Higher levels of stress, guilt, and depression were observed in parents with CP. Based on the results, both groups of parents showed a good fit with the predictive model; parental stress was a good predictor of symptoms of depression both in parents with and without CP, parental competence mediated the relationship between parental stress and depression, being the relationship between competence and depression partially mediated by parental guilt.

Discussion

This study is the first to quantitatively examine parental competence and guilt in parents with CP, and to analyze their role as mediators between parental stress and depression in both CP and healthy parents. The results confirm previous qualitative findings and extend them to parents with CP, showing that the tested model aligns with the main theories on stress, self-efficacy, and depression, as well as existing literature on CP. These results suggest the relevance of addressing parental stress levels for reducing and preventing depressive symptoms in parents with CP and the importance of working on guilt reduction and enhancing competence in order to improve the emotional well-being of parents. The need to take into account the mental health of parents with CP to improve their quality of life is discussed.

Research Participants' Engagement and Retention in Digital Health Interventions Research: Protocol for Mixed Methods Systematic Review

BACKGROUND

Digital health interventions have become increasingly popular in recent years, expanding the possibilities for treatment for various patient groups. In clinical research, while the design of the intervention receives close attention, challenges with research participant engagement and retention persist. This may be partially due to the use of digital health platforms, which may lack adequacy for participants.

OBJECTIVE

This systematic literature review aims to investigate the relationship between digital health platforms and participant engagement and retention in clinical research. It will map and analyze key definitions of engagement and retention, as well as identify design characteristics that influence them.

METHODS

We will carry out a mixed methods systematic literature review, analyzing qualitative and quantitative studies. The search strategy includes the electronic databases PubMed, IEEE Xplore, CINAHL, Scopus, Web of Science, APA PsycINFO, and the ACM Digital Library. The review will encompass studies published between January 2018 and June 2024. Criteria for inclusion will be the presence of digital health care interventions conducted through digital health platforms like websites, web and mobile apps used by patients, and informal caregivers as research participants. The main outcome will be a narrative analysis with key findings on the definitions of participant engagement and retention and critical factors that affect them. Quality assessment and appraisal will be done through the Mixed-Methods Assessment Tool. Data analysis and synthesis will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram. Quantitative data will be qualified and integrated into qualitative data, which will be analyzed using thematic analysis and synthesis.

RESULTS

The study expects to map and summarize critical definitions of participant engagement and retention, and the characteristics of digital health platforms that influence them. The systematic review is expected to be completed in June 2025.

CONCLUSIONS

This systematic review will contribute to the growing discussion on how the design of digital health intervention platforms can promote participant engagement and retention in clinical research.

TRIAL REGISTRATION

PROSPERO CRD42024561650; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=561650.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/65099.

Compassion-Based Intervention Program for Enhancing Coping Patterns Among Family Caregivers of Patients With Bipolar Disorder

Introduction

Bipolar disorder is a long-term, complicated mental illness that affects not only the patient's mental health, but also their family's psychological health and coping strategies.

Objective

This study aimed to evaluate the effects of a compassion-based intervention program on coping patterns among family caregivers of patients with bipolar disorder.

Methods

From June 2023 to March 2024, a study utilizing a one-group pre- and postinterventional design evaluated 50 family caregivers of patients with bipolar disorder. The study was conducted in an outpatient clinic at the Institute of Psychiatry affiliated with Ain Shams University Hospitals, Cairo, Egypt. The program consisted of 16 consecutive sessions, each lasting approximately 45 to 60 min. Researchers used a predesigned questionnaire to collect data pre- and postintervention to assess the sociodemographic data, self-compassion scale, and coping strategies inventory.

Results

Prior to the compassion intervention program, the study found that 62% of the evaluated family caregivers had low self-compassion; however, after the compassion intervention program, a highly significant improvement was observed, with 54% having high self-compassion (p < .01). Likewise, in the compassion intervention program, the study revealed that 60% of the family caregivers had a high use of disengagement coping patterns; however, in the postcompassion intervention program, a highly significant improvement was observed, with 64% having a high use of engagement coping patterns (p < .01).

Conclusion

The Compassion-Based Intervention Program has a positive effect on enhancing coping patterns and self-compassion among family caregivers of patients with bipolar disorder. Therefore, psychiatric nurses and mental health practitioners should collaborate in designing holistic caregiver support strategies that incorporate self-compassion techniques alongside traditional therapeutic approaches.

Digital Health Platform for Improving the Effect of the Active Health Management of Chronic Diseases in the Community: Mixed Methods Exploratory Study

BACKGROUND

China is vigorously promoting the health management of chronic diseases and exploring digital active health management. However, as most medical information systems in China have been built separately, there is poor sharing of medical information. It is difficult to achieve interconnectivity among community residents' self-testing information, community health care information, and hospital health information, and digital chronic disease management has not been widely applied in China.

OBJECTIVE

This study aimed to build a digital health platform and improve the effectiveness of full-cycle management for community chronic diseases through digital active health management.

METHODS

This was a single-arm pre-post intervention study involving the development and use of a digital health platform (2-year intervention; 2020 to 2022). The digital health platform included the "i Active Health" applet for residents and the active health information system (cardio-cerebrovascular disease risk management system) for medical teams. The digital active health management of chronic diseases involved creating health streets, providing internet-assisted full-cycle active health services for residents, implementing internet-based community management for hypertension and diabetes, and performing real-time quantitative assessment and hierarchical management of residents' risks of cardio-cerebrovascular disease. After the 2-year intervention, management effectiveness was evaluated.

RESULTS

We constructed a digital health platform with interconnected health information and implemented a digital active health management model. After the intervention, the 2-way referral between community health care institutions and hospitals increased. Residents' health literacy rate increased from 30.6% (3062/10,000) in 2020 to 49.9% (4992/10,000) in 2022, with improvements in health knowledge, health behavior, and health skills. Moreover, the risk of cardio-cerebrovascular disease decreased after the intervention. The community hypertension and diabetes standardized management rates increased from 59.6% (2124/3566) and 55.8% (670/1200) in 2020 to 75.0% (3212/4285) and 69.4% (1686/2430) in 2022, respectively. The control rates of blood pressure in patients with hypertension and blood sugar in patients with diabetes increased from 51.7% (1081/2091) and 42.0% (373/888) in 2020 to 81.2% (1698/2091) and 73.0% (648/888) in 2022, respectively. The intervention improved patients' BMI, waist circumference, blood uric acid levels, and low-density lipoprotein cholesterol levels. The drug compliance rate of patients with hypertension and diabetes increased from 33.6% (703/2091) and 36.0% (320/888) in 2020 to 73.3% (1532/2091) and 75.8% (673/888) in 2022, respectively. The intervention greatly improved the diet behavior, exercise behavior, and drinking behavior of patients with hypertension and diabetes.

CONCLUSIONS

Our digital health platform can effectively achieve the interconnection and exchange of different health information. The digital active health management carried out with the assistance of this platform improved the effectiveness of community chronic disease management. Thus, the platform is worth promoting and applying in practice.

The effect of visual education aimed at the basic needs of individuals with disabilities on the health literacy and life quality of caregivers

The aim of this research is to evaluate the effect of visual education for the basic needs of people with disabilities on the health literacy and life quality of caregivers. The study sample comprised 268 caregivers evaluated in a pretest-posttest pattern. The data were collected using a Personal Information Form, the Health Literacy Scale, and the World Health Organization [WHO] Life Quality Scale-Short Form. Data were evaluated with the Wilcoxon test and Spearman correlation analysis. Following the education given to caregivers, an increase was determined in the Health Literacy Scale sub-dimension of information comprehension and in the WHO Life Quality Scale-Short Form sub-dimension of social relations. Thus it was seen that the visual education increased the health literacy and life quality of the caregivers.

Preparedness for Caregiving Role and Telehealth Use to Provide Informal Palliative Home Care in Portugal: A Qualitative Study

Background/Objectives: Given the increasing occurrence of long-term illnesses, it is imperative to focus on adequately preparing and assisting those who assume the responsibility of caregiving. Our study aims to explore whether caregivers feel prepared to provide informal palliative home care, their experiences, and the usefulness of telehealth in managing daily activities. Methods: Using a descriptive qualitative research design and a purposeful sampling technique, thirteen primary family caregivers who provide informal palliative home care were recruited. Data collection was conducted through face-to-face individual interviews conducted from May 2023 to July 2023. Data were analyzed using Braun and Clarke's reflexive thematic analysis. Results: Caregivers were mainly female (n = 8) with a mean age of 59.5 years (SD = 9.42). Based on our findings, three overarching themes emerged: (1) becoming a caregiver, (2) support-from-home palliative care team, and (3) telehealth in palliative home care. The reasons that influence the preparedness of family caregivers include their own desires, health conditions, their range of responsibilities, and the consequences that arise from the situation's complexity. Telehealth helps fulfill the patient's wishes to be at home in EoL and provides caregivers with access to professional guidance and support. Conclusions: Specialized home-based palliative care teams must be aware of caregivers' self-assurance, knowledge, skills, and aptitudes in carrying out daily responsibilities and in managing emotions to improve preparedness for caregiving, loss, and its aftermath. The provision of professional PC services in the home along with a robust support system for informal caregivers is invaluable.

Physical Activity Mobile App (CareFit) for Informal Carers of People With Dementia: Protocol for a Feasibility and Adaptation Study

BACKGROUND

Physical activity is a critical component of both well-being and preventative health, reducing the risk of both chronic mental and physical conditions and early death. Yet, there are numerous groups in society who are not able to undertake as much physical activity as they would like to. This includes informal (unpaid) carers, with the United Kingdom national survey data suggesting that 81% would like to do more physical activity on a regular basis. There is a clear need to develop innovations, including digital interventions that hold implementation potential to support regular physical activity in groups such as carers.

OBJECTIVE

This study aims to expand and personalize a cross-platform digital health app designed to support regular physical activity in carers of people with dementia for a period of 8 weeks and evaluate the potential for implementation.

METHODS

The CareFit for dementia carers study was a mixed methods co-design, development, and evaluation of a novel motivational smartphone app to support home-based regular physical activity for unpaid dementia carers. The study was planned to take place across 16 months in total (September 1, 2022, to December 31, 2023). The first phase included iterative design sprints to redesign an initial prototype for widespread use, supported through a bespoke content management system. The second phase included the release of the "CareFit" app across Scotland through invitations on the Apple and Google stores where we aimed to recruit 50 carers and up to 20 professionals to support the delivery in total. Partnerships for the work included a range of stakeholders across charities, health and social care partnerships, physical activity groups, and carers' organizations. We explored the implementation of CareFit, guided by both Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Complex Intervention Frameworks.

RESULTS

Project processes and outcomes were evaluated using mixed methods. The barriers and enablers for professional staff to signpost and use CareFit with clients were assessed through interviews or focus groups and round stakeholder meetings. The usability of CareFit was explored through qualitative interviews with carers and a system usability scale. We examined how CareFit could add value to carers by examining "in-app" data, pre-post questionnaire responses, and qualitative work, including interviews and focus groups. We also explored how CareFit could add value to the landscape of other online resources for dementia carers.

CONCLUSIONS

Results from this study will contribute new knowledge including identifying (1) suitable pathways to identify and support carers through digital innovations; (2) future design of definitive studies in carer populations; and (3) an improved understanding of the Reach, Effectiveness, Adoption, Implementation, and Maintenance across a range of key stakeholders.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53727.

Adaptation, testing, and use of the "iSupport for Dementia" program in different countries: a systematic review

The World Health Organization developed the "iSupport for Dementia" program for family caregivers of people with dementia.

Objective

To explore studies on adaptation, randomized clinical trial protocols, and preliminary results of iSupport by unpaid caregivers of people living with dementia in different countries.

Methods

Systematic review.

Results

Ten cultural adaptation studies, eight randomized clinical trial protocols, and two preliminary results were included. Adaptation studies showed adjustments in terminology, design, and additional resources. Clinical trial protocols included burden as the primary outcome, and baseline, three months of intervention, and follow-up after six months. Studies with preliminary results found positive effects on the mental health and well-being of caregivers after using the program.

Conclusion

iSupport is an online program of the World Health Organization in response to dementia in implementation in different countries.

Emotional Regulation, Coping, and Resilience in Informal Caregivers: A Network Analysis Approach

Public health emergencies such as the COVID-19 pandemic can further strain the mental health of informal caregivers who provide unpaid assistance to family members or friends who need support due to illness, disability, or aging. However, there is a lack of research exploring the resources and adaptive strategies that promote resilience in informal caregivers. This cross-sectional study used psychometric network analysis to model the interplay between coping strategies, emotion regulation, trait resilience, and anxiety and depression symptoms in 351 Italian informal caregivers. The results showed that coping through a positive attitude, emotional reappraisal, and trait resilience were the most central and interconnected nodes in the network. These adaptive strategies buffered against the negative impact of anxiety and depression symptoms, providing valuable insights into the mechanisms underlying resilience and well-being in informal caregivers. Clinically, it is crucial to assess and foster these resilience-promoting factors (positive attitude coping, cognitive reappraisal, and trait resilience) to help mitigate the mental health challenges faced by informal caregivers, especially in the context of public health crises such as the COVID-19 pandemic.

Effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy in Port Said City: A pre-post quasi-experimental study

BACKGROUND

Emphasizing the pivotal role of caregivers in the cancer care continuum, a program designed to educate caregivers of cancer patients undergoing chemotherapy underscores their significance. The palliative care education initiative strives to cultivate a compassionate and effective care environment, benefiting both patients and caregivers. By imparting education, fostering positive attitudes, offering support, encouraging appropriate behaviors, and providing essential resources, the program aims to enhance the overall caregiving experience and contribute to the well-being of those navigating the challenges of cancer treatment.

OBJECTIVES

To evaluate the effectiveness of a palliative care education program for caregivers of cancer patients receiving chemotherapy.

METHODS

The research employed a purposive sample comprising 155 caregivers who were actively present with their cancer patients throughout the pre- and post-test phases within a quasi-experimental research design. The study took place at the outpatient oncology center of Al-Shifa Medical Complex in Port Said City, Egypt. To gather comprehensive data, 4 instruments were utilized: a demographic questionnaire, a nurse knowledge questionnaire, a scale measuring attitudes toward palliative care, and an assessment of reported practices in palliative care. This methodological approach allowed for a thorough exploration of caregiver perspectives, knowledge, attitudes, and practices within the context of a palliative care education program.

RESULTS

Before the palliative care education program, only 1.3% of caregivers had a good overall level of knowledge about cancer and palliative care; this increased to 40.6% after the program. Similarly, before the palliative care education program, 32.9% of caregivers had a positive overall attitude, which increased to 72.3% after the program. Similarly, 27.1% of caregivers had an overall appropriate palliative care practice during the pre-test phase, which increased to 93.5% after the palliative care education program.

SIGNIFICANCE OF THE RESULTS

The palliative care education program significantly improved caregivers' knowledge, attitudes, and practice scores. It is strongly recommended that caregivers of cancer patients receive continuing education in palliative care. In addition, it is crucial to conduct further research with a larger sample size in different situations in Egypt.

Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers

BACKGROUND

Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill-equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers.

OBJECTIVE

To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO-pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting.

METHODS

The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including "think-aloud" interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3).

RESULTS

The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small "snackable" sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface.

CONCLUSIONS

The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care.

Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis

Background

Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear.

Objective

This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care.

Methods

A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio.

Results

A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85).

Conclusions

Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.

Impact of an automated, remote monitoring and coaching intervention in reducing hospice cancer family caregiving burden: A multisite randomized controlled trial

BACKGROUND

Care for those with life-limiting cancer heavily involves family caregivers who may experience significant physical and emotional burden. The purpose of this study was to test the impact of Symptom Care at Home (SCH), an automated digital family caregiver coaching intervention, during home hospice, when compared to usual hospice care (UC) on the primary outcome of overall caregiver burden. Secondary outcomes included Caregiver Burden at weeks 1 and 8, Mood and Vitality subscales, overall moderate-to-severe caregiving symptoms, and sixth month spouse/partner bereavement outcomes.

METHODS

Using a randomized, multisite, nonblinded controlled trial, 332 cancer family caregivers were enrolled and analyzed (159 SCH vs. 173 UC). Caregivers were primarily White (92%), female (69%), and spouse caregivers (53%). Caregivers provided daily reports on severity levels (0-10 scale) for their anxiety, depressed mood, fatigue, disturbed sleep, and caregiving interference with normal activities. These scores combined constituted the Caregiver Burden primary outcome. Based on reported symptoms, SCH caregivers received automated, tailored coaching about improving their well-being. Reports of moderate-to-severe caregiving symptoms also triggered hospice nurse notification. Secondary outcomes of Mood and Vitality were subcomponents of the Caregiver Burden score. A combined bereavement adjustment tool captured sixth month bereavement.

RESULTS

The SCH intervention reduced overall Caregiver Burden compared to UC (p < .001), with a 38% reduction at 8 weeks and a medium-to-large effect size (d = .61). SCH caregivers experienced less (p < .001) disruption in both Mood and Vitality. There were higher levels of moderate-to-severe caregiving symptoms overtime in UC (OR, 2.722). All SCH caregivers benefited regardless of caregiver: sex, caregiver relationship, age, patient diagnosis and family income. SCH spouse/partner caregivers achieved better sixth month bereavement adjustment than UC (p < .007).

CONCLUSIONS

The SCH intervention significantly decreased caregiving burden over UC and supports the maintenance of family caregiver mood and vitality throughout caregiving with extended benefit into bereavement.

iCare - a self-directed, interactive online program to improve health and wellbeing for people living with upper gastrointestinal or hepato-pancreato-biliary cancers, and their informal carers: the study protocol for a Phase II randomised controlled trial

BACKGROUND

Up to 70% of people diagnosed with upper gastrointestinal (GI) tract or hepato-pancreato-biliary (HPB) cancers experience substantial reductions in quality of life (QoL), including high distress levels, pain, fatigue, sleep disturbances, weight loss and difficulty swallowing. With few advocacy groups and support systems for adults with upper GI or HPB cancers (i.e. pancreas, liver, stomach, bile duct and oesophageal) and their carers, online supportive care programs may represent an alternate cost-effective mechanism to support this patient group and carers. iCare is a self-directed, interactive, online program that provides information, resources, and psychological packages to patients and their carers from the treatment phase of their condition. The inception and development of iCare has been driven by consumers, advocacy groups, government and health professionals. The aims of this study are to determine the feasibility and acceptability of iCare, examine preliminary efficacy on health-related QoL and carer burden at 3- and 6-months post enrolment, and the potential cost-effectiveness of iCare, from health and societal perspectives, for both patients and carers.

METHODS AND ANALYSIS

A Phase II randomised controlled trial. Overall, 162 people with newly diagnosed upper GI or HPB cancers and 162 carers will be recruited via the Upper GI Cancer Registry, online advertisements, or hospital clinics. Patients and carers will be randomly allocated (1:1) to the iCare program or usual care. Participant assessments will be at enrolment, 3- and 6-months later. The primary outcomes are i) feasibility, measured by eligibility, recruitment, response and attrition rates, and ii) acceptability, measured by engagement with iCare (frequency of logins, time spent using iCare, and use of features over the intervention period). Secondary outcomes are patient changes in QoL and unmet needs, and carer burden, unmet needs and QoL. Linear mixed models will be fitted to obtain preliminary estimates of efficacy and variability for secondary outcomes. The economic analysis will include a cost-consequences analysis where all outcomes will be compared with costs.

DISCUSSION

iCare provides a potential model of supportive care to improve QoL, unmet needs and burden of disease among people living with upper GI or HPB cancers and their carers.

AUSTRALIAN AND NEW ZEALAND CLINICAL TRIALS REGISTRY

ACTRN12623001185651. This protocol reflects Version #1 26 April 2023.

Improving the lives of ethnically diverse family carers and people living with dementia using digital media resources - Protocol for the Draw-Care randomised controlled trial

Objectives

Ethnically diverse family carers of people living with dementia (hereafter carers and people with dementia) experience more psychological distress than other carers. To reduce this inequality, culturally adapted, multilingual, evidence-based practical assistance is needed. This paper details the Draw-Care study protocol including a randomised control trial (RCT) to test the effectiveness of a digital intervention comprising a multilingual website, virtual assistant, animated films, and information, on the lives of carers and people with dementia in Australia.

Methods

The Draw-Care intervention will be evaluated in a 12-week active waitlist parallel design RCT with 194 carers from Arabic, Cantonese, Greek, Hindi, Italian, Mandarin, Spanish, Tamil, and Vietnamese-speaking language groups. Our intervention was based on the World Health Organization's (WHO) iSupport Lite online carer support messages and was co-designed with carers, people with dementia, service providers, and clinicians. Culturally adapted multilingual digital resources were created in nine languages and English.

Results

In Phase I (2022), six co-design workshops with stakeholders and interviews with people with dementia informed the development of the intervention which will be trialled and evaluated in Phases II and III (2023 and 2024).

Conclusions

Digital media content is a novel approach to providing cost-effective access to health care information. This study protocol details the three study phases including the RCT of a co-designed, culturally adapted, multilingual, digital intervention for carers and people with dementia to advance the evidence in dementia and digital healthcare research and help meet the needs of carers and people with dementia in Australia and globally.