User feedback and usability testing of an online training and support program for dementia carers

BACKGROUND

eHealth interventions have been explored to provide convenient support and training to informal dementia carers. Design and usability issues may however hinder user acceptance of Web-based interventions. iSupport is an online program developed by World Health Organization (WHO) to support informal dementia carers.

PURPOSE

This study gathers user-feedback and evaluates the usability of the European-Portuguese version of iSupport.

METHODS

A mixed-methods study was conducted. Two focus groups discussions (n = 15) and 15 usability test sessions were conducted with carers and health/social support professionals to collect data on user satisfaction and requirements on the program's contents and Web interface. The usability testing protocol comprised pre/post-test surveys, a structured interview and observation of task performance in the Web platform. Content analysis of text data was performed by two independent coders.

RESULTS

Success rates were superior to 80% for most tasks. An average score of 89.5 on the System Usability Scale demonstrated an excellent perception of the program's usability. The program was perceived as trustworthy, and participants were globally satisfied with its aesthetics and easiness of use. Feedback and personalization were valued functional requirements, while no consensus was found for mood self-assessment or professional/peer interaction features. Lessons were considered culturally fit, thematically pertinent, and comprehensive. Suggestions for improvement were wide-ranging from program's layout to accessibility, usability, functional requirements, content format and lessons' themes.

CONCLUSIONS

This study derives user requirements for an evidence-based program for dementia carers. Both the study findings and usability assessment methodology can be imported to the development of similar programs worldwide.

Online training and support program (iSupport) for informal dementia caregivers: protocol for an intervention study in Portugal

BACKGROUND

Informal caregivers (IC) of people with dementia (PwD) are at greater risk of developing physical and mental health problems when compared to the general population and to IC of people with other chronic diseases. Internet-based interventions have been explored for their potential to minimize the negative effects of caring, accounting for their ubiquitous nature, convenient delivery, potential scalability and presumed (cost) effectiveness. iSupport is a self-help online program developed by the World Health Organization (WHO) to provide education, skills training and support to IC of PwD. This paper describes the design of an intervention study aimed at determining the effectiveness of a Portuguese culturally adapted version of iSupport on mental health and other well-being outcomes.

METHODS

The study follows an experimental parallel between-group design with two arms: access to the five modules and twenty-three lessons of "iSupport" for three months (intervention group); or access to an education-only e-book (comparison group). One hundred and eighty four participants will be recruited by referral from national associations. Inclusion criteria are: being 18 years or older and provide e-consent; being a self-reported non-paid caregiver for at least six months; of a person with a formal diagnosis of dementia; being skilled to use internet; and experience a clinically relevant level of burden (≥ 21 on Zarit Burden Interview) or depression or anxiety symptoms (≥ 8 on Hospital Anxiety and Depression Scale). Data is collected online, resorting to self-administered instruments, at baseline, 3 and 6 months after baseline. The primary outcome is caregiver burden, measured by the Zarit Burden Interview. Symptoms of depression and anxiety, quality of life, positive aspects of caregiving and general self-efficacy are secondary study outcomes. The data analysis will follow an Intention-to-treat (ITT) protocol.

DISCUSSION

This protocol is an important resource for the many organizations in several countries aiming to replicate iSupport. Findings from this intervention study will offer evidence to bolster an informed decision making on scaling up iSupport as a new intervention program with minimal costs aimed at minimizing the psychological distress of IC of PwD in Portugal and elsewhere.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04104568. Registered 26 September 2019.