JMIR Publications

ABSTRACT

Background:

Type 1 diabetes mellitus (T1DM) is a common and serious condition primarily diagnosed in childhood. Caregivers often experience a decline in their psychological wellbeing due to the rigorous demands of parenting a child with additional health needs. Whilst interventions to support caregivers are available through services, digitally delivered interventions may offer increased flexibility, accessibility and uptake.

Objective:

This review aimed to summarise the evidence base on the effectiveness of digitally delivered interventions in improving psychological wellbeing outcomes for caregivers of children living with T1DM.

Methods:

PubMed, MEDLINE, Embase, Web of Science and PsycINFO were searched for studies of digitally delivered interventions. The search strategy focused on caregivers of children aged under 18, and included any digitally delivered programme designed to improve psychological wellbeing. Outcomes included a range of psychological wellbeing parameters including parental stress, anxiety, depression, quality of life, self-efficacy and social support.

Results:

Of 3436 records identified, ten studies met the inclusion criteria, including 617 caregivers (15-162 per study); seven were randomised controlled trials. Delivery was by mobile app (n=4), video call (n=4), website (n=2) or telephone (n=2); content was counselling (n=5), peer support (n=4), diabetes education (n=3) or psychosocial education (n=1); 2 studies combined 2 delivery methods. At least one wellbeing outcome improved significantly in 3 of 4 mobile app and 3 of 4 video call studies, against 1 of 2 website and 1 of 2 telephone studies. Diabetes education improved multiple outcomes in 2 of 3 studies, including anxiety and depression (P=.02 and P=.03 in one trial; P<.001 for both in another), and counselling reduced diabetes distress in 3 of 5 (P<.001 to P=.008); peer support and psychosocial education gave inconsistent results. Heterogeneity in design, content and outcomes precluded meta-analysis.

Conclusions:

Evidence for digital interventions supporting caregivers of children with T1DM is limited and inconsistent. Improvement was most often reported where structured diabetes education or counselling was delivered by mobile app or video call; peer support and general psychosocial material showed little effect. The included studies were small and at substantial risk of bias, so these interventions cannot yet be recommended for routine use. The scarcity of research highlights an important gap in evidence-based support for caregivers. Developing interventions that directly address their psychological needs, and evaluating these in larger trials with longer follow-up, should be a research priority.