Family caregivers are currently becoming the main source of care for people with dementia [
1]. However, dementia caregivers are at risk for depression, anxiety and other health problems [
2]. Interventions aimed at reducing their burden of care might reduce dementia care costs in the long term if institutionalization can be postponed [
3].
Many face-to-face caregiver support interventions have proven to be effective on caregiver distress (random effect size = 0.3), caregiver knowledge (random effect size = 0.5) [
4], and self-efficacy (effect sizes ranging from 0.3 to 0.9) [
5], but the expected future increase in the number of people with dementia raises concerns about whether care professionals can cope with this demand [
6]. E-health interventions could serve as cost-effective alternatives for dementia caregiver support [
7‐
9], both increasing caregivers’ access to support and extending the reach of such support [
10‐
13]. The benefits of e-health are becoming increasingly recognized, and remote support for dementia caregivers is growing [
14‐
16].
Previous e-health studies on dementia caregivers show positive effects on caregiver confidence, stress, depression, and self-efficacy with effect sizes ranging from 0.2 to 0.3 [
17]. Provision of tailored information, a coach, and the opportunity to interact with other caregivers shows the most promise [
17]. Blending face-to-face guidance with online modules increases caregivers’ connection with the therapist and adherence [
18,
19]. However, research on the effects of e-health on dementia caregivers lacks methodological rigor [
17], and adverse effects of caregiving are often addressed in the later stages of dementia, when caregivers already feel overburdened [
20]. Despite their low levels of life satisfaction and high levels of overload, caregivers do not use services in the early stages because they do not feel the need for such services or because they struggle with acceptance due their experience of stigma [
20‐
22]. Supporting caregivers in the early stages of dementia could prevent high levels of burden and psychological problems in them in the later stages and delay institutionalization [
23‐
26]. However, early-stage dementia caregiver support can be experienced adversely if the care does not suit the caregiver’s personal situation or the stage of the disease. Negative and stigmatizing information can make it difficult for caregivers to identify with and may hamper acceptance [
20]. Learning to positively manage life with dementia, instead of managing the dementia itself in a self-management program, could facilitate caregivers’ adaptation to their new caregiving role. A focus on enhancing positive, intact experiences that are tailored to the individual caregiver’s situation may be more effective in increasing caregiver self-efficacy and reducing the negative consequences of caregiving at the later stages [
20].
Study aim and hypotheses
The current paper presents the design of a randomized waiting-list controlled trial investigating the effects of the blended care self-management program “Partner in Balance.” Alongside the effectiveness study, a process evaluation will be conducted to evaluate internal and external validity. As recommended by the Medical Research Council (MRC) Framework for the design and evaluation of complex intervention [
27], the program was based on existing literature [
17], theory, and user and professional input [
28]. In a pilot evaluation, caregivers reported increased feelings of self-efficacy and goal attainment post intervention. Feedback from the feasibility study was used to adapt the intervention to increase user-friendliness [
28]. The next objective is to evaluate the process characteristics, effectiveness and cost-consequence of “Partner in Balance.” Specifically, we aim to investigate (1) the internal and external validity of the intervention based on sampling quality (recruitment, randomization and reach) and intervention quality (relevance, feasibility, and performance according to protocol) prior to the effect analysis to evaluate credibility and generalizability [
29], (2) whether “Partner in Balance” is superior to the waiting-list control condition in terms of participants’ subjective well-being, as evidenced by improved subjective self-confidence (increased self-efficacy) and goal attainment and lower levels of psychological complaints (depression, anxiety and stress) following the self-management intervention, and (3) whether these effects are maintained after 3, 6 and 12 months, and lastly (4) the cost-consequence of “Partner in Balance” is calculated to estimate the impact of the intervention on resource use, costs, and health outcomes.