JMIR Publications

ABSTRACT

Background:

Informal caregivers commonly experience mental health difficulties related to their caregiving role. E-mental health interventions provide mental health support in a format that may be more accessible for informal caregivers. However, e-mental health interventions are seldom implemented into real-world practice.

Objective:

The overall aim of this mixed-methods systematic review was to examine factors associated with the effectiveness and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: (1) combinations of implementation and/or intervention characteristics sufficient for intervention effectiveness were explored using a qualitative comparative analysis; and (2) barriers and facilitators to the implementation of e-mental health interventions for informal caregivers were explored using a thematic synthesis.

Methods:

Relevant studies published from January 1, 2007 to July 6, 2022 were identified by systematically searching six electronic databases, clinical trial registries, and various secondary search strategies. Studies were included if they reported on the effectiveness or implementation of e-mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers’ mental health outcomes were included in a crisp-set qualitative comparative analysis. Randomized controlled trials were assessed for bias using the Risk of Bias 2.0 tool, and for how pragmatic or explanatory their trial design was using the PRagmatic Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation.

Results:

53 reports, representing 29 interventions, were included in the review. The majority (93%) of interventions focused on informal cancer or dementia caregivers. 14 reports were included in the qualitative comparative analysis with conditions including the presence of peer or professional support, and key persuasive design features explored. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. 44 reports were included in the thematic synthesis. 152 barriers and facilitators were identified, with the majority related to the intervention and individual (informal caregiver) characteristic domains of the CFIR. Implementation barriers and facilitators at the inner (e.g. organizational culture) and outer setting (e.g. external policies and resources) domains are largely unexplored.

Conclusions:

E-mental health interventions for informal caregivers tend to be well-designed and easy to use, with a number of barriers and facilitators to implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers or facilitators to implementing e-mental health interventions for informal caregivers, taking into consideration inner and outer setting barriers and facilitators. Clinical Trial: PROSPERO CRD42020155727