Background
Aim
Methods
Design
Caregiver support theory
Output | Input | |||
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Target of the intervention | Intervention components (topics and sections) | Qualitative data | Key theoretical themes | Systematic review |
Feeling prepared and equipped | What can I expect towards the end of life? (Fig. 3) | Caregivers reported a lack of information particularly about end of life care. Caregivers discussed a desire and need to feel prepared. There was a need to feel more confident and knowledgeable about how to manage the medical decline. | • Ensure timely availability of key external resources | Individualised information was considered more beneficial by caregivers and thought to be one of the most useful components of interventions. The section was developed to be engaging through the use of a video from a caregiver which families could relate to and creating a sense of peer support which was highlighted as important in the systematic review. |
Day to day caring (Fig. 4) | ||||
Planning (Fig. 5) | ||||
Feeling connected and supported | Chat to a caregiver (Fig. 6) | Participants described caring as a lonely experience in which they often felt socially isolated, and wanted to feel both connected and supported by other caregivers and professionals. | • Extending social assets | Support was able to be provided online though peer interaction and contact with professionals. Opportunities to engage with other caregivers in the same situation as them and in a group situation appeared more beneficial. Interaction with professionals was a positive experience for caregivers, however views were mixed on receiving this online. |
Talk to a professional (Fig. 7) | ||||
Communicating with the person with dementia (Fig. 8) | ||||
Valuing themselves as a caregiver and an individual | Chat to a caregiver (Fig. 6) | In the interviews participants appeared to describe an internal conflict about caring for themselves and maintaining their own life, whilst caring. They needed mechanisms to cope with their emotions including; anger, grief and guilt. | • Strengthen key psychological resources available to caregiver; • Maintaining caregiver’s physical health status; • Safeguard caregiver’s quality of life | Several previous interventions included measures around the health and wellbeing of caregivers. Many interventions used psychological support, which demonstrated the most positive effect. Many used self-guided psychological support, most often consisting of educational modules. Randomised controlled trials (RCTs) found significantly greater improvements in stress, self-efficacy, intention to get support, strain, depression, and anxiety. |
Looking after yourself (Fig. 9) | ||||
Preparing for death (Fig. 10) | ||||
Maintaining control of the caring situation being the co-ordinator care | Financial information (Fig. 11) | Caregivers felt they needed to take control and manage the care. Interspersed among these discussions was a lack of support from other family members and a lack of understanding from existing friends. | • Ensuring timely availability of key resources • Extending social networks | Several interventions identified provided local and tailored support or signposting of services, which was well received by caregivers. The internet resources may be a method of preparation for discussions, but decisions should be made face to face. |
Local support (Fig. 12) | ||||
Family relationships and social networks (Fig. 13) |
Research development group
User testing recruitment
Procedure
Stage 1 – synthesis of data
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Feeling prepared and equipped
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feeling connected and supported
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valuing themselves as a caregiver and an individual
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maintaining control of the caring situation and being the co-ordinator of care
Stage 2 – identifying intervention targets and components
Stage 3 – developing the intervention prototype
Stage 4 - user testing
Ethics
Results
Participant characteristics
Feeling prepared and equipped
Feeling connected and supported
Valuing themselves as a caregiver and an individual
Maintaining control of the caring situation and being the coordinator of care
Discussion
Strengths and weaknesses
Lessons learnt for development
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Allowing time for iterations is vital in the development of all complex interventions; however the development of online interventions such as websites requires much more time and emphasis needs to be placed on the earlier phases of development.
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We suggest that due to time pressures and the iterative nature required for the development of online interventions a pragmatic approach to co-production may be needed for populations such as caregivers. Individual meetings with caregivers appears to be a valuable method for co-production and researchers should not assume that co-production panels and group meetings are required for robust methods. Individual meetings reduce the burden on caregivers and allows for fast paced intervention development, minimising delays to the overall research project.
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Synthesis of a variety of data sources is often not well reported in intervention development. The use of tabulation, adopting a matrix approach to display findings allows clear comparison of evidence.