JMIR Publications

ABSTRACT

Background:

Dementia caregiving entails chronic, fluctuating stress with downstream risks to caregiver mental health and care quality. Mindfulness-based interventions can reduce caregiver stress; however, moment-to-moment fluctuations in stress may limit receptivity to practice at any given time. We developed a brief mindfulness just-in-time adaptive intervention (JITAI) that aims to deliver support at the right moment by using machine learning algorithms to optimize notification timing based on receptivity to engage in brief mindfulness practices.

Objective:

To evaluate the feasibility, acceptability, and effectiveness of a brief mindfulness JITAI for dementia caregivers on stress, depressive symptoms, caregiver burden, sleep, quality of life, and trait mindfulness.

Methods:

A single-arm, pre-test post-test design was adopted. 120 community-dwelling dementia caregivers were recruited to participate in the 18-day intervention, which included four days of psychoeducation delivered via videos and phone coaching, alongside an in-app brief, low-dose Mindfulness-based Stress Reduction (MBSR) component. From days 5 to 11, prompts were delivered either by a static machine learning model trained on prior pilot data or at random times, with equal probability. From days 12 to 18, three delivery models were used with equal probability: static, random, and an adaptive model that updated per participant using accumulating receptivity data. Feasibility and acceptability were assessed post-intervention; standardized measures of stress, depressive symptoms, caregiver burden, positive aspects of caregiving, sleep, quality of life, and trait mindfulness were collected via phone interviews at baseline and post-intervention.

Results:

Retention was 100%. Most participants (92.5%) found the app easy to use; 81.7% perceived it as helpful for stress management; and 80.0% would recommend it to other caregivers. Pre–post analyses indicated significant improvements in perceived stress (p < .001), depressive symptoms (p < .001), caregiver burden (p < .01), positive aspects of caregiving (p < .001), and subjective sleep quality (p < .05). Health-related quality of life and trait mindfulness did not change significantly.

Conclusions:

A brief, smartphone-delivered mindfulness JITAI for dementia caregivers was feasible and acceptable, with high retention and positive user evaluations. Pre–post findings suggest improvements in stress, depressive symptoms, caregiving burden, positive aspects of caregiving, and sleep, supporting the potential of adaptive, technology-enabled interventions to provide timely support to caregivers. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2300071361)