JMIR Publications

ABSTRACT

Background:

Informal caregivers play a central role in long-term care but face elevated risks of stress, depressive symptoms, and caregiver burden, alongside barriers to accessing preventive support. Low-threshold digital public health interventions may offer scalable, evidence–based support, however, evidence on feasibility, usability, and contextual fit remains limited, particularly for intersectionally diverse caregiver populations.

Objective:

This study describes the development and implementation of an intersectionality–informed WhatsApp–based chatbot intervention (PflegeBot) and evaluates its feasibility, usability, and acceptability among informal caregivers in Germany.

Methods:

A single-arm, non-randomized feasibility study with pre-post assessments was conducted between December 2023 and October 2024. Informal caregivers aged ≥18 years were recruited via community, institutional, and online channels. PflegeBot, a bilingual (German/Turkish) WhatsApp-based chatbot delivering 84 scheduled messages over 12 weeks, including psychoeducation, self-care, and CBT-informed self-help elements, plus optional FAQ and “ask” functions, was co-designed with caregivers and stakeholders. This paper reports the feasibility evaluation. Outcomes were self-assessed via online survey. Primary outcomes were usability (System Usability Scale, SUS) and user satisfaction; secondary outcomes included perceived stress (PSS-4), caregiver burden (ZBI-4), depressive symptoms (CES-D), and loneliness. Descriptive and exploratory pre-post analyses were conducted, complemented by qualitative feedback from open-ended survey items interpretation workshops. Intersectionality-informed principles guided intervention development and the Conceptual Model for the Relationship of Social Networks and Social Support to Health informed content structure and sequencing.

Results:

Of 140 individuals entering the study dataset, 102 (mean age of 56.2 years (SD 12.2); 82.4% women) met eligibility criteria at baseline and 70 initiated the chatbot. Sixty-seven actively received the intervention; 57 provided at least one follow-up data point and 49 completed the full follow-up survey. Mean usability was good (mean SUS 73.5, SD 13.1). Higher usability scores were descriptively observed among participants with higher educational attainment, with no consistent variation by caregiving language or caregiving characteristics. Satisfaction was high across key features. Exploratory pre-post analyses showed small reductions in perceived stress, depressive symptoms, and loneliness, alongside a modest increase in caregiver burden. Qualitative findings highlighted heterogeneity in perceived relevance and engagement depending on caregiving context and available resources. Message frequency, timing, and content personalization emerged as key aspects of acceptability. Implementation challenges included platform-related verification procedures, changing terms of service, and the introduction of messaging costs.

Conclusions:

A co-designed, intersectionality–informed caregiver intervention delivered via WhatsApp was feasible and acceptable in this sample. While no definitive conclusions about effectiveness can be drawn, findings support further evaluation in controlled trials and highlight important considerations for the sustainable implementation of messenger–based digital public health interventions.