Implementation of e–Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis

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 to informal caregivers. However, e–mental health interventions are seldom implemented in real-world practice. Objective This mixed methods systematic review aimed 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: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e–mental health interventions for informal caregivers were explored using thematic synthesis. Methods We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies 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. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation. Results Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored. Conclusions e–Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of 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 to and facilitators of implementing e–mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-035406

“Systems seem to get in the way”: a qualitative study exploring experiences of accessing and receiving support among informal caregivers of people living with chronic kidney disease

“…Interventions can also be designed to provide caregivers with empathy and understanding by tailoring interventions to caregiver characteristics (e.g., cultural background) and caring situations (e.g., stage of care recipient’s CKD, treatment modality) to develop content that reflects caregivers’ lived experiences [ 57 ]. Tailoring has been found to enhance the relevance and acceptability of interventions for caregivers of people living with CKD and caregivers of people living with other health conditions [ 1 , 77 – 81 ]. Additionally, tailoring interventions based on caregiver’s cultural background may enhance intervention effectiveness [ 82 , 83 ], and has been found to improve the acceptability of interventions for caregivers in other settings [ 84 ].…”

Potential Implementers’ Perspectives on the Development and Implementation of an e–Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study

“…This study identified several implementation factors within all domains of the CFIR that require consideration during the design and implementation of an e–mental health intervention for caregivers of people living with CKD. Some identified factors align with existing caregiving literature that has similarly identified the relative advantage of e–mental health interventions (eg, flexible access), the barriers caregivers may experience if accessing an e–mental health intervention (eg, low digital literacy and low motivation), the presence of both positive (eg, beneficial for caregivers) and negative (eg, impersonal) views of e–mental health interventions, and the importance of designing e–mental health interventions that are easy to use and contain tailored content [ 10 , 39 , 40 ].…”

“…An evaluation of 12 eHealth and e–mental health interventions developed for caregivers of people with dementia indicated interventions were generally not implementation ready , with little information available concerning important factors required for implementation, such as staffing and training resources [ 9 ]. A recent systematic review of the implementation of e–mental health interventions for caregivers of adults with chronic diseases identified that factors related to the implementation setting and wider context (eg, available resources, relative priority of the intervention, and external policies) have been largely neglected [ 10 ]. In addition, professionals (eg, potential implementers) were seldom engaged in understanding how interventions would fit within the current health care practice [ 10 ].…”

“…A recent systematic review of the implementation of e–mental health interventions for caregivers of adults with chronic diseases identified that factors related to the implementation setting and wider context (eg, available resources, relative priority of the intervention, and external policies) have been largely neglected [ 10 ]. In addition, professionals (eg, potential implementers) were seldom engaged in understanding how interventions would fit within the current health care practice [ 10 ]. Therefore, research suggests that existing e–mental health interventions have low implementation potential, limiting intervention adoption and long-term sustainability [ 11 ].…”

“…Despite depression and anxiety being commonly reported [ 18 , 19 ], few mental health interventions have been tailored for this population [ 17 ]. Tailoring interventions can enhance acceptability [ 20 , 21 ] and ensure intervention content meets the needs and preferences of caregivers of people living with CKD [ 10 ]. Given the current lack of tailored support, we aimed to develop an e–mental health intervention, optimized for future implementation, for caregivers of people living with CKD by using the new MRC framework [ 11 ] and intervention development framework [ 12 ].…”