Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study

Abstract

This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial. Key learning aims (1) To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS). (2) To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS. (3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.

Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability

“…In this context, a sense of connection with other participants, and the positive therapeutic relationship with the therapists, appeared central to the acceptability of the intervention. This feeling was also shared by the therapists that took part in the feasibility study (Contreras, Van Hout et al, 2021 ).…”

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

“…Most interventions were designed for informal caregivers of people with dementia (n=16) [ 95 , 96 , 99 - 104 , 112 - 117 , 126 - 134 , 136 , 141 , 143 - 147 ] and cancer (n=11) [ 65 , 98 , 105 - 111 , 119 - 125 , 135 , 137 - 140 , 142 ], with 2 interventions focused on informal caregivers of stroke survivors [ 97 , 118 ]. Interventions were commonly based on cognitive behavioral therapy (n=10) [ 98 - 100 , 102 , 104 , 107 , 115 , 124 ,​ 125 , 134 , 135 , 137 , 141 - 144 ], stress and coping theory (n=9) [ 65 , 95 - 97 , 101 , 103 , 109 , 110 , 113 , 114 , 121 - 123 , 126 - 133 ], mindfulness (n=7) [ 106 , 108 , 111 , 116 - 120 ], or acceptance and commitment therapy (ACT; n=3) [ 105 , 112 , 136 , 138 - 140 , 146 ]. Most interventions inc...…”

“…Interventions were commonly based on cognitive behavioral therapy (n=10) [ 98 - 100 , 102 , 104 , 107 , 115 , 124 ,​ 125 , 134 , 135 , 137 , 141 - 144 ], stress and coping theory (n=9) [ 65 , 95 - 97 , 101 , 103 , 109 , 110 , 113 , 114 , 121 - 123 , 126 - 133 ], mindfulness (n=7) [ 106 , 108 , 111 , 116 - 120 ], or acceptance and commitment therapy (ACT; n=3) [ 105 , 112 , 136 , 138 - 140 , 146 ]. Most interventions included support (n=22), providing standardized (n=9) [ 99 , 105 - 108 , 111 , 116 - 118 , 124 , 125 ,​ 138 - 140 , 142 , 144 ], guided (n=7) [ 96 , 97 , 101 , 102 , 113 ,​ 114 , 119 , 126 - 132 , 134 ], or minimal (n=5) [ 98 , 100 , 105 , …”

“…Interventions tended to be well-designed and easy to use [ 98 , 105 , 108 - 110 , 113 , 116 , 117 , 124 - 127 , 131 - 134 , 136 - 138 , 141 , 143 , 146 ]. There were mixed views on whether caregivers preferred dyadic or individual interventions [ 109 , 110 , 125 , 135 , 139 , 140 ]; however, there was generally a need for space to be created to allow caregivers to express themselves without the presence of care recipients [ 119 , 123 ].…”

“…Evidence suggesting interventions remained effective when implemented in real-world settings [ 128 ], and information on outcomes more relevant to health care organizations (eg, number of caregivers receiving support) [ 129 , 130 ] was lacking. Although e–mental health interventions have advantages, both caregivers and stakeholders expressed that communication within e–mental health interventions could be challenging [ 123 , 126 , 128 , 146 ]. Unfamiliar technologies and multistep intervention and implementation activities (eg, recruitment of intervention staff) added complexity to e–mental health interventions [ 113 , 128 ].…”