JMIR Publications

ABSTRACT

Background:

The global rise in ageing populations is expected to significantly increase the demand for informal care. Informal carers are crucial to healthcare systems but often face physical, mental, and emotional challenges due to the demands of caregiving. Open online courses have emerged as potential tools to support informal carers by providing accessible, flexible learning opportunities. However, the landscape of these courses remains underexplored, particularly concerning their design, outcomes, and the barriers and enablers to participation.

Objective:

This systematic review aimed to map the characteristics of open online courses for informal carers, explore learner experiences, and identify barriers and enablers to participation to inform the design of future courses.

Methods:

We systematically searched four electronic databases for studies published from inception to 30 January 2025: (1) APA PsycINFO, (2) CINAHL, (3) EMBASE, and (4) MEDLINE. Two reviewers independently screened titles and abstracts for eligibility. Included studies reported on the development, delivery, or outcomes of open online courses for informal carers, using quantitative, qualitative, or mixed methods designs. Backward and forward citation was conducted on the reference lists of included studies. Data on study methodology, course characteristics, and course evaluations were extracted and synthesised narratively. The quality of quantitative studies was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool, and qualitative studies using the Critical Appraisal Skills Program (CASP) toolkit. Mixed methods studies were appraised using both tools.

Results:

The database search identified 200 studies, with an additional study identified through backward citation. Following screening, 10 studies (6 quantitative, 4 mixed methods) met the eligibility criteria for inclusion. All the open online courses examined were massive open online courses (MOOCs) and varied in length and content. The courses primarily targeted carers of older individuals with dementia and chronic conditions such as multiple sclerosis. Learner benefits included improvements in knowledge, caregiving skills, and the application of learning gains into everyday scenarios. Learners identified course accessibility and flexible learning approaches as key benefits. However, challenges related to course interactivity, peer engagement, and accessibility for learners with varying levels of digital literacy and internet access were emphasised. Nine of ten papers demonstrated moderate to weak methodological quality on the EPHPP tool, and three of four papers on the CASP toolkit, with limitations in participant selection, blinding, and presentation of qualitative data.

Conclusions:

Open online courses can provide flexible and accessible education that improves knowledge and caregiving skills for learners. However, key barriers such as poor digital literacy and limited opportunities for peer interaction will be helpful areas to address in future course designs. The incorporation of synchronous elements including live moderated discussions, along with more technical support options, could enhance the learner experience. Further high-quality research is essential to extend and strengthen the evidence base and guide the development of more effective educational resources for informal carers. Clinical Trial: PROSPERO CRD42024532766; https://www.crd.york.ac.uk/PROSPERO/display_record.php? RecordID=532766