Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 18, 2025
Date Accepted: Aug 13, 2025
Supporting informal dementia caregivers in China: A hybrid effectiveness–implementation trial of an iSupport web–based primary healthcare intervention
ABSTRACT
Background:
Informal caregivers of home–dwelling people with dementia (PWD) experience significant unmet needs. Yet family doctor teams, as primary healthcare gatekeepers for aging populations in China, remain an underutilized resource for structured caregiver support.
Objective:
This hybrid effectiveness–implementation study aims to evaluate a policy–aligned integration of WHO’s iSupport web-based program with China’s family doctor contract services for informal dementia caregivers, while systematically assessing implementation determinants using the Consolidated Framework for Implementation Research (CFIR).
Methods:
A cluster randomized controlled trial enrolled 120 informal caregivers of PWD in Beijing, randomly assigned to either the intervention group (family doctor contract services: 20–week iSupport training, enhanced health management, and usual care; n=60) or the control group (usual care only; n=60). Caregiver burden (primary outcome), quality of life, social support, and learning behaviors (secondary outcomes) were assessed at baseline and post–intervention. Intention–to–treat analysis was applied. The quantitative data were analyzed using Linear Mixed Models (LMM) and Generalized Linear Mixed Models (GLMM). Implementation barriers/facilitators were explored through CFIR–guided thematic analysis of semi–structured interviews with 34 stakeholders.
Results:
The intervention revealed no significant between–group differences in caregiver burden (β= ̶ 0.58, 95%CI: ̶ 7.40, 6.24), quality of life (β= ̶ 0.23, 95%CI: –3.79, 3.33), or social support (β= ̶ 0.08, 95%CI: ̶ 2.71, 2.54). But it demonstrated significantly improved learning behaviors in the intervention group (β=2.35, 95%CI: 1.03, 3.67, P<.001). CFIR analysis identified multi–level barriers: (1) policy–finance misalignment excluding dementia care from essential services; (2) digital adaptation gaps for older users; (3) lack of performance incentives in primary healthcare; (4) caregivers’ technological/time constraints; and (5) conflicts between standardized content and personalized needs.
Conclusions:
This iSupport–based primary healthcare intervention presents a policy–aligned support model for dementia caregivers in China. While core outcomes showed no significant improvement, enhanced learning behaviors suggest potential for caregiver empowerment. Key implementation insights reveal optimizing digital platforms, strengthening policy incentives, and personalizing support. These findings offer a scalable, policy–aligned model for dementia care management by leveraging primary healthcare networks, particularly in LMICs. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2400084788; https://www.chictr.org.cn/showproj.html?proj=223091
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