Exploring the influence of Internet-based caregiver support on experiences of isolation for older spouse caregivers in rural areas: a qualitative interview study

Mapping of technological strategies for reducing social isolation in homebound older adults: A scoping review

BACKGROUND

Homebound older adults (HOAs) are particularly vulnerable to social isolation and loneliness, which engender a poorer physical and mental health, and greater cognitive decline. The purpose of this review is to map the literature to identify potential technological strategies that reduce social isolation in HOAs, and to understand facilitators and barriers for adoption and implementation.

METHODS

Six databases including PubMed (MEDLINE), Google Scholar, Cochrane Database, EBSCOHost, National Library ProQuest, Web of Science, and the Journal of Medical Internet Research were searched for relevant articles. Peer-reviewed literature published in English from Jan 2014 to Feb 2024 that employed technological strategies applicable to HOAs and assessed social isolation or connectedness as an outcome measure were included.

RESULTS

107 studies were reviewed and classified into different technological categories based on their functions and features. A social technology framework encompassing delivery, hardware, software, content, training, and support was conceptualized with core characteristics identified from the reviewed technological strategies. Cost and complexity of technology, and resource commitment were identified as barriers while user-friendliness, content curation and a supportive ecosystem may facilitate the adoption of a technological strategy to address social isolation in HOAs.

CONCLUSION

There is a need for early and concerted effort to identify HOAs, provide technology training, and empower them to tap on the digital world to complement and/or supplement social interactions. Development of cost-effective and rapid-to-implement technology is vital for HOAs who are at highest risk to social isolation.

Place-based, intersectional variation in caregiving patterns and health outcomes among informal caregivers in the United States

Introduction

Informal caregiving is a critical component of the healthcare system despite numerous impacts on informal caregivers' health and well-being. Racial and gender disparities in caregiving duties and health outcomes are well documented. Place-based factors, such as neighborhood conditions and rural-urban status, are increasingly being recognized as promoting and moderating health disparities. However, the potential for place-based factors to interact with racial and gender disparities as they relate to caregiving attributes jointly and differentially is not well established. Therefore, the primary objective of this study was to jointly assess the variability in caregiver health and aspects of the caregiving experience by race/ethnicity, sex, and rural-urban status.

Methods

The study is a secondary analysis of data from the 2021 and 2022 Behavioral Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention. Multivariable logistic regression or Poisson regression models assessed differences in caregiver attributes and health measures by demographic group categorized by race/ethnicity, sex, and rural-urban status.

Results

Respondents from rural counties were significantly more likely to report poor or fair health (23.2% vs. 18.5%), have obesity (41.5% vs. 37.1%), and have a higher average number of comorbidities than urban caregivers. Overall, rural Black male caregivers were 43% more likely to report poor or fair health than White male caregivers (OR 1.43, 95% CI 1.21, 1.69). Urban female caregivers across all racial groups had a significantly higher likelihood of providing care to someone with Alzheimer's disease than rural White males (p < 0.001). Additionally, there were nuanced patterns of caregiving attributes across race/ethnicity*sex*rural-urban status subgroups, particularly concerning caregiving intensity and length of caregiving.

Discussion

Study findings emphasize the need to develop and implement tailored approaches to mitigate caregiver burden and address the nuanced needs of a diverse population of caregivers.

Assessing the Comprehensive Training Needs of Informal Caregivers of Cancer Patients: A Qualitative Study

Introduction: The increasing demand for cancer services is projected to overwhelm the cancer care system, leading to a potential shortfall in human resource capacity. Informal caregivers (unpaid family/friend caregivers of cancer patients) provide a significant amount of care to patients and the cancer care system could not cope without them. The aim of this study was to analyze the needs of informal caregivers (CGs) through interviews with cancer patients and CGs, and to assess the content and utility of a comprehensive caregiver training course. Methods: Cancer patients and CGs were recruited from an academic cancer centre to elicit their thoughts and perceptions of cancer CG education needs through a qualitative, phenomenological design using semi-structured interviews and a curriculum review activity. Results: Six patients and seven CGs were interviewed. Patients averaged 53.8 years of age and CGs averaged 53.1 years. Caregiver participants reported that they were unprepared for their caregiving role. Depending on the severity of the disease, CGs reported significant emotional strain. Most participants wanted more practical information, and all expressed the desire for greater social support for CGs. While there were differences in terms of desired modality (e.g., online, in-person), support for greater CG education was strong. Discussion: CGs experience a significant learning curve and receive little to no direct training or education to help them acquire the knowledge and skills they need to support a cancer patient. This is especially challenging for new CGs, for whom emotional and informational needs are particularly acute. Participants shared a great deal of endorsement for a comprehensive training course for new CGs. Given the multiple demands on their time, some participants suggested that consideration be made to establish synchronous classes. Participants held that having the course take place (online or in-person) at a specific time, on a specific date could help CGs prioritize their learning. Participants also endorsed the idea of “required” learning because even though CGs may recognize that a course could be beneficial, some may lack the motivation to participate unless it was “prescribed” to them by a healthcare provider.

An evaluation of registered nurses' experiences of person-centered care and competence after participating in a course in digital competence in care

BACKGROUND

Health care's rapid transition from in-person visits to more digital care meetings has challenged nurses to find new, sustainable ways of using digital technology.

METHODS

The aim was to describe registered nurses'(RN) experiences with person-centred care (PCC) and competence after participating in a course in Digital Competence in Care (DCC). In this study, a qualitative descriptive design was used, and 16 individual interviews were carried out with RNs. Data were analysed using qualitative content analysis. The COREQ checklist was used in this study.

RESULTS

The results were presented in four categories: being open to change and new ways of working with patients; struggling to handle requirements; developing new ways of working and focusing on patients despite the distance.

CONCLUSIONS

The DCC course helped develop RNs' skills and practice of PCC in digital care meetings. Training in digital care theory increased RNs' competence and facilitated the creation of new knowledge. The RNs' professional role was strengthened by participating in the changing of work routines. Digital care meetings were shown to be distance bridging and complementary to physical care meetings contributing to PCC. The increased availability of health care via digital means has affected the consumption of care and tailored education needs for RNs must be met by nursing education programs. Digital care is accessible, efficient and enables care regardless of geographical conditions, its innovative development needs to be based on science and experience and RNs are key personnel in this process.

TRIAL REGISTRATION

Not applicable.

What are we doing to support informal caregivers? A scoping review of caregiver education programs in cancer care

OBJECTIVES

The cancer system is experiencing a rise in cancer prevalence, a workforce shortage, and is resource-stretched. In this environment, informal caregivers (unpaid family caregivers of cancer patients) are required to take on expanded care roles and experience the debilitating effects of caregiver burden. Education programs are increasingly being developed to support caregivers. The aim of this review is to summarize what is known about these programs.

METHODS

A scoping review was conducted from May 2019 to January 2020. The literature search yielded 34,906 articles.

RESULTS

119 articles were included, and ninety-two (77%) were focused on in-person psychoeducational programs.

CONCLUSION

Most caregiver programs have a unidimensional focus on psychoeducational training, demonstrating a need for more comprehensive programming to address the full spectrum of caregiver needs.

PRACTICE IMPLICATIONS

Clinicians and educators must collaborate to create accessible, equitable education programs that comprehensibly address the needs of unpaid family caregivers beyond addressing psychological aspects of cancer care. This will ensure that a broader range of patients and caregivers are equipped with the knowledge and skills needed to cope with a cancer diagnosis, navigate the health system and to maintain their quality of life.

Experiences of Being Significant Others to Older Adults with Frailty Living Alone in Rural Arctic Norway: A Qualitative Study

Purpose

Our aim in this study was to explore how significant others experience being “significant” to older adults living alone with frailty in rural Arctic areas in northern Norway. The proportion of older adults in the population is larger and growing faster in rural- than in urban areas. Due to out-migration of the younger generations, many significant others live far from the older adults.

Methods

Our results are based on a thematic analysis of semistructured interviews with ten persons identified as significant others by older adults in rural Arctic Norway.

Results

The analysis resulted in two main themes and five subthemes: 1. Restoring and maintaining balance in the older adult’s life with the following three subthemes: 1.1. balancing between the older adult’s capacity and the physical environment; 1.2. emotional support; and 1.3. balancing between the older adult’s need for help and the services offered; and 2. Maintaining balance in one’s own life with the following two subthemes: 2.1. family and working life; and 2.2. tensions between family members. The rural Arctic context in which the older adult lived was relevant to varying degrees in all themes.

Conclusion

Our results showed that experiences of being the significant other involve a continuous balancing act affected by the older adult’s life situation, the significant other’s own life and the rural Arctic context in which the older adult lives. Our study adds to previous conceptualizations of frailty as both a bodily and a relational phenomenon framed by materialities, the understanding of frailty as also a situated phenomenon.

Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review

Background

Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults’ needs for eHealth services, and thus, these health solutions require further exploration.

Objective

The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults’ (aged ≥60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context.

Methods

A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas.

Results

In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults’ learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults’ own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services.

Conclusions

The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use.

Strengthening positive social pathways via digital social applications in individuals with social skills deficits: A scoping review

BACKGROUND

Effective digital social capital interventions have great potential to establish trusted social pathways to access supportive services and to enable talking about issues contributing to distress.

AIM

This review explores the digital social capital interventions used in individuals with social skills deficits, and the best social health outcomes achieved.

METHOD

Four databases (PubMed, CINAHL, PsychINFO, and Web of Science) were used with no time limitation, and 33 papers were included.

RESULTS

A diverse range of digital social programs was used for social capital improvement based on individuals' characteristics (e.g. age range and illnesses). Programs ranged from digitally-enhanced self-help or self-guided treatment (to enhance the self-efficacy of individuals), to group treatments and/or web-based caregiver support services. They comprised mobile social apps, video blogging, video-communication system/video-conferencing, and online social communication, to more advanced techniques such as virtual reality. All of these modalities were shown to be beneficial for improving the social health of individuals. Interventions targeted two aspects of social capital: (1) cognitive social capital, focusing on enhancing trust and control, self-efficacy on life. Some examples were cognitive behavioural therapy, and increasing the received and more importantly perceived social support. (2) structural social capital, focusing on individuals' relationships with family/carers, friends, peers to other connections at the macro level, such as health care providers and their community as a whole. The two interconnected aspects of social capital play a role in decreasing fears of being judged by others, general fears in social interactions and interpersonal problems.

CONCLUSION

Guided digital social support interventions result in open and flexible access to various resources through supportive social networks, for patients and their family members/carers.

Older people and rural eHealth: perceptions of caring relations and their effects on engagement in digital primary health care

Background

The aim of this article is to describe older people’s perceptions of caring relations in the context of rural eHealth, as well as to explore how such relations can facilitate engagement in digital primary health care. There is an ongoing implementation of eHealth in Western health care, and rural areas and older people are specifically targeted. eHealth is said to be a solution to emergent problems and a technology that will facilitate people’s opportunities to achieve good and equal health. From this perspective, it is crucial that older people engage in eHealth services, but there are barriers for use, and care providers need to adapt to the preferences of older people.

Methods

Semi‐structured interviews with 19 individuals aged 61‐85 were conducted. The participants were using digital services at two primary healthcare centres located in northern Sweden. Qualitative content analysis was used. An important theoretical tenet was that older people’s perceptions of and engagements in eHealth are affected by the specific rural conditions. Ethical approval for the study has been obtained.

Results

The analysis rendered a total of three themes: in‐person interaction was central to people’s perceptions of good caring relations; patient–nurse relations were particularly emphasised; and caring relations in rural eHealth appeared to be multi‐directional and fuelled by a shared sense of rural community. Altogether, this facilitated participants’ engagement in local eHealth initiatives.

Conclusions

eHealth is an opportunity for primary health care and for rural communities. However, the results provide insight into matters that can affect the quality, access, and equality of rural primary health care. Participants’ engagement in eHealth was almost always facilitated by close caring relations with local Registered Nurses. Digital care needs to be approached as a combination of digital and in‐person presence. Separating digital and physical task assignments among different personnel could make older people refrain from seeking health care.

Predictors of Depressive Symptoms in Heart Failure Caregivers

Heart failure is a serious and complex chronic illness and family caregivers often assist these individuals in performing self-care. Unsurprisingly, caregivers often are overwhelmed by daily activities associated with heart failure management and frequently have depressive symptoms. This study examined predictors (i.e., sociodemographic and clinical characteristics, social support, social problem-solving, family functioning, and objective and subjective burden) of depressive symptoms in 530 informal caregivers of individuals with heart failure in a large cross-sectional, descriptive study in the community. Younger caregivers who provided care for longer periods of time, lived in rural areas, and had less social support and lower problem-solving skills were more likely to have depressive symptoms. These findings emphasize the need for further studies to develop dynamic and innovative approaches that incorporate multiple components to lessen caregiving challenges. Social support and problem-solving skills training may be useful components to lessen depressive symptoms in these younger, rural caregivers.

The role of internet-based digital tools in reducing social isolation and addressing support needs among informal caregivers: a scoping review

Background

In Canada, 8.1 million people informally provide care without payment, primarily to family members; 6.1 million of them are employed at a full-time or part-time job. Digital technologies, such as internet-based tools, can provide informal caregivers’ access to information and support. This scoping review aimed to explore the role of internet-based digital tools in reducing social isolation and addressing support needs among informal caregivers.

Methods

A systematic search for relevant peer-reviewed literature was conducted of four electronic databases, guided by Arksey and O’Malley’s framework. An extensive search for relevant grey literature was also conducted.

Results

The screening process yielded twenty-three papers. The following themes were generated from the reviewed studies: searching for and receiving support; gaining a sense of social inclusion and belonging; and benefits and challenges of web-based support. The studies noted that, to connect with peers and obtain social support, informal caregivers often turn to online platforms. By engaging with peers in online communities, these caregivers reported regaining a sense of social inclusion and belonging.

Conclusions

The findings suggest that internet-based digital tools can be a cost-effective and convenient way to develop programs that help unpaid caregivers form communities, gain support, and access resources. Service providers can leverage digital tools to deliver support to caregivers within online communities.

Supporting family caregiver engagement in the care of old persons living in hard to reach communities: A scoping review

Today, 8.5% of the world's population is 65 and over, and this statistic will reach 17% by 2050 (He et al., U.S. Census Bureau, international population reports, P95/16-1, An ageing world: 2015, U.S., 2016). They are the people who, with increasing age, will find themselves more closely interfacing with the national health system, which in many countries shows strong imbalances between rural and urban areas. In this context, a fundamental role is played by the relatives who find themselves becoming informal caregivers to compensate for lack of services. To date, however, little has been done to help these people. In this article, we want to identify the nature and extent of research evidence that had its objective to help informal caregivers in rural, hard to reach areas (Grant & Booth, Health Information & Libraries Journal, 2009, 26, 91). Following the approach set out by Arksey and O'Malley (International Journal of Social Research Methodology, 2005, 8, 19), we conducted a scoping review in May 2018 and closed the review with an update in September 2018. We identified 14 studies published from 2012, the European Year of Active Ageing, promoted by the European Commission, which had three domains of implementation: emotional support to decrease the emotional burden of caregivers, educational support to increase their skills, and organisational support to improve the mobility of caregivers and carereceivers. Although informal caregivers play a fundamental role in many countries, the studies that have been involved in alleviating their caring burden are few; nevertheless, they provide interesting indications. This lack of attention confirms how this portion of the population is still neglected by scientific research and risks having unequal access to health and social care. Future research is needed, not only to create and improve services to caregivers in rural, hard to reach areas, but also to evaluate and focus on the participation and the engagement of caregivers in the co-design of these services.

Perceptions of Information and Communication Technology as Support for Family Members of Persons With Heart Failure: Qualitative Study

Background

Heart failure (HF) affects not only the person diagnosed with the syndrome but also family members, who often have the role of informal carers. The needs of these carers are not always met, and information and communications technology (ICT) could have the potential to support them in their everyday life. However, knowledge is lacking about how family members perceive ICT and see opportunities for this technology to support them.

Objective

The aim of this study was to explore the perceptions of ICT solutions as supportive aids among family members of persons with HF.

Methods

A qualitative design was applied. A total of 8 focus groups, comprising 23 family members of persons affected by HF, were conducted between March 2015 and January 2017. Participants were recruited from 1 hospital in Sweden. A purposeful sampling strategy was used to find family members of persons with symptomatic HF from diverse backgrounds. Data were analyzed using qualitative content analysis.

Results

The analysis revealed 4 categories and 9 subcategories. The first category, about how ICT could provide relevant support, included descriptions of how ICT could be used for communication with health care personnel, for information and communication retrieval, plus opportunities to interact with persons in similar life situations and to share support with peers and extended family. The second category, about how ICT could provide access, entailed how ICT could offer solutions not bound by time or place and how it could be both timely and adaptable to different life situations. ICT could also provide an arena for family members to which they might not otherwise have had access. The third category concerned how ICT could be too impersonal and how it could entail limited personal interaction and individualization, which could lead to concerns about usability. It was emphasized that ICT could not replace physical meetings. The fourth category considered how ICT could be out of scope, reflecting the fact that some family members were generally uninterested in ICT and had difficulties envisioning how it could be used for support. It was also discussed as more of a solution for the future.

Conclusions

Family members described multiple uses for ICT and agreed that ICT could provide access to relevant sources of information from which family members could potentially exchange support. ICT was also considered to have its limitations and was out of scope for some but with expected use in the future. Even though some family members seemed hesitant about ICT solutions in general, this might not mean they are unreceptive to suggestions about their usage in, for example, health care. Thus, a variety of factors should be considered to facilitate future implementations of ICT tools in clinical practice.

Technology implementation in delivery of healthcare to older people: how can the least voiced in society be heard?

Purpose

The purpose of this paper is to focus on ethical and judicial themes related to technology and the older adults.

Design/methodology/approach

Different consecutive phases in technology design and allocation will be discussed from a range of perspectives.

Findings

Longevity is one of the greatest achievements of contemporary science and a result of development of social relations. Currently, various non-communicable diseases affect older adults and impose the greatest burden on global health. There is a great emphasis across Europe on caring for the older person in their own homes. Technology has a mediating role in determining the possibilities for good quality of life (QOL). The concept of assisting the older adult through the use of technology so as to access healthcare services has enormous potential. Although the potential of technology in healthcare is widely recognised, technology use can have its downsides. Professionals need to be aware of the risks, namely, those related to the privacy of the older person, which may accompany technology use.

Research limitations/implications

By 2050, there will be more people aged over 65 than there are children. This phenomenon of global ageing constitutes a massive challenge in the area of health protection.

Practical implications

Professionals need to be aware of the risks, for example, related to the privacy of the older person, that may accompany technology use.

Social implications

There is a great emphasis across Europe on caring for the older person in their own homes. Technology has a mediating role in determining the possibilities for QOL.

Originality/value

The concept of assisting the older adult through the use of technology to avail of healthcare has enormous potential. Assistive technology, social media use and augmentative and alternative communication can have a positive effect on the QOL of older people, as long as they are supported enough in use of these technologies. However, ethical and juridical considerations are at stake as well.

Perceived Social Determinants of Health Among Older, Rural-Dwelling Adults with Early-Stage Cognitive Impairment

Limited access to resources and delayed detection of subtle cognitive changes may negatively impact the long-term cognitive health of rural-dwelling adults. This study explored perceived social determinants of health among older, rural-dwelling adults with early-stage cognitive impairment. Semi-structured interviews were conducted with older, rural-dwelling adults with early-stage cognitive impairment and their care partners. Thematic content analysis was performed. Participants ( n = 9) were 73.7 ± 6.0 years of age with 14.2 ± 3.1 years of education; care partners ( n = 10) were 70.9 ± 7.4 years of age with 15.6 ± 2.3 years of education. Data analysis revealed six themes: Staying active, Eating well, Living with cognitive changes, Living rural, Connecting with neighbors and community, and Relying on children. Dyads' depictions of perceived social determinants of health focused on the adoption of a healthy lifestyle, description of relationships, and advantages of living in a rural area. Emergent themes may be used to promote adoption of self-management and prevention behaviors, particularly lifestyle changes.

A Web-Based Psychosocial Intervention for Family Caregivers of Older People: Results from a Mixed-Methods Study in Three European Countries

BACKGROUND

Informal caregiving is the main source of care for older people in Europe. An enormous amount of responsibility and care activity is on the shoulders of family caregivers, who might experience problems in their psychological well-being and in reconciling caregiving and their personal sphere. In order to alleviate such burden, there is increasing interest and growing research in Europe on Web-based support addressing family caregivers and their needs. However, the level of development and penetration of innovative Web-based services for caregivers is still quite low and the access to traditional face-to-face services can be problematic for logistic, availability, and quality reasons.

OBJECTIVE

As part of the European project INNOVAGE, a pilot study was conducted for developing and testing a Web-based psychosocial intervention aimed at empowering family caregivers of older people in Italy, Sweden, and Germany. The program offered information resources and interactive services to enable both professional and peer support.

METHODS

A mixed-methods, sequential explanatory design was adopted. Caregivers' psychological well-being, perceived negative and positive aspects of caregiving, and social support received were assessed before and after the 3-month intervention. Poststudy, a subsample of users participated in focus groups to assist in the interpretation of the quantitative results.

RESULTS

A total of 94 out of 118 family caregivers (79.7%) from the three countries used the Web platform at least once. The information resources were used to different extents in each country, with Italian users having the lowest median number of visits (5, interquartile range [IQR] 2-8), whereas German users had the highest number (17, IQR 7-66) (P<.001). The interactive services most frequently accessed (more than 12 times) in all countries were the social network (29/73, 40%) and private messages (27/73, 37%). The pretest-posttest analysis revealed some changes, particularly the slight worsening of perceived positive values of caregiving (Carers of Older People in Europe [COPE] positive value subscale: P=.02) and social support received (COPE quality-of-support subscale: P=.02; Multidimensional Scale of Perceived Social Support subscale: P=.04), in all cases with small effect size (r range -.15 to -.18). Focus groups were conducted with 20 family caregivers and the content analysis of discussions identified five main themes: online social support, role awareness, caregiving activities, psychological well-being, and technical concerns. The analysis suggested the intervention was useful and appropriate, also stimulating a better self-efficacy and reappraisal of the caregivers' role.

CONCLUSIONS

The intervention seemed to contribute to the improvement of family caregivers' awareness, efficacy, and empowerment, which in turn may lead to a better self-recognition of their own needs and improved efforts for developing and accessing coping resources. A major implication of the study was the finalization and implementation of the InformCare Web platform in 27 European countries, now publicly accessible (www.eurocarers.org/informcare).

A Facebook Follow-Up Strategy for Rural Drug-Using Women

PURPOSE

Facebook (FB) use has grown exponentially over the past decade, including in rural areas. Despite its popularity, FB has been underutilized as a research follow-up approach to maintain contact with research participants and may have advantages in less densely populated areas and among more hard-to-reach, at-risk groups. The overall goal of this study was to examine FB as a supplemental follow-up approach to other follow-up strategies with rural drug-using women.

METHODS

Face-to-face interviews were conducted with randomly selected women who completed baseline interviews in 3 rural jails in 1 state. Analyses focus on participants who were released from jail and were eligible for 3-month follow-up (n = 284). Bivariate analyses were used to examine differences between FB users and nonusers, and multivariate logistic regression models examined predictors of 3-month follow-up participation and being located for follow-up using FB.

FINDINGS

About two-thirds (64.4%) of participants were regular FB users. Bivariate analyses indicated that FB users were younger, more educated, and more likely to have used alcohol in the 30 days before incarceration but less likely to have a chronic health problem. Regression analyses indicated that rural FB users had more than 5 times the odds of being located for the 3-month follow-up interview, even after controlling for other variables. There were no significant predictors of being followed up using FB.

CONCLUSIONS

Findings suggest that FB is widely used and well accepted among rural drug-using women. Among hard-to-reach populations, including those in rural, geographically isolated regions, FB serves as a method to improve participant follow-up.

Usefulness of a Tailored eHealth Service for Informal Caregivers and Professionals in the Dementia Treatment and Care Setting: The eHealthMonitor Dementia Portal

Background

The European eHealthMonitor project (eHM) developed a user-sensitive and interactive Web portal for the dementia care setting called the eHM Dementia Portal (eHM-DP). It aims to provide targeted support for informal caregivers of persons with dementia and professionals.

Objective

The objective of this study was to assess the usefulness and impact of the eHM-DP service in the dementia care setting from two user perspectives: informal caregivers and professionals.

Methods

The evaluation study was conducted from June to September 2014 and followed a before-after, user-participatory, mixed-method design with questionnaires and interviews. The used intervention was the eHM-DP: an interactive Web portal for informal caregivers and professionals that was tested for a 12-week period. Primary outcomes for caregivers included empowerment, quality of life, caregiver burden, decision aid, as well as perceived usefulness and benefits of the eHM-DP. Primary outcomes for professionals involved decision aid, perceived usefulness, and benefits of the eHM-DP.

Results

A total of 25 informal caregivers and 6 professionals used the eHM-DP over the 12-week study period. Both professionals and informal caregivers indicated perceived benefits and support by the eHM-DP. In total, 65% (16/25) of informal caregivers would use the eHM-DP if they had access to it. Major perceived benefits were individualized information acquisition, improved interaction between informal caregivers and professionals, access to support from home, and empowerment in health-related decisions (PrepDM Score: 67.9). Professionals highlighted the improved treatment and care over the disease course (83%, 5/6) and improved health care access for people living in rural areas (67%, 4/6). However, there was no improvement in caregiver burden (Burden Scale for Family Caregivers) and quality of life (EuroQol-5D-5L) over the study period.

Conclusions

Our study provides insight into the different user perspectives on an eHealth support service in the dementia treatment and care setting. These results are of importance for future developments and the uptake of eHealth solutions in the dementia domain and reinforce the importance of early user involvement. Turning to the primary target of the eHM-DP service, our findings suggest that the eHM-DP service proved to be a valuable post-diagnostic support service, in particular for the home-based care setting. Further research on a larger scale is needed to enhance the implementation in existing health care infrastructures.