A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial Web-Based Training in Family Advocacy The effect of a Web-based stroke intervention on carers' well-being and survivors' use of healthcare services A Web-Based Program for Informal Caregivers of Persons With Alzheimer’s Disease: An Iterative User-Centered Design Exploring the effectiveness of an Internet-based program for reducing caregiver distress using the iCare Stress Management e-Training Program Effectiveness of online cognitive behavioral therapy on family caregivers of people with dementia A Randomized Trial of Mobile Health Support for Heart Failure Patients and Their Informal Caregivers: Impacts on Caregiver-reported Outcomes Usability of online psychoeducation for siblings of people with psychosis. The effect of web based depression interventions on self reported help seeking: randomised controlled trial [ISRCTN77824516] Effectiveness of an Internet Intervention for Family Caregivers of People with Dementia: Results of a Randomized Controlled Trial Logging On: Evaluating an Online Support Group for Parents of Children with Autism Spectrum Disorders A Clinical Trial to Test the Feasibility of a Telehealth Psychoeducational Intervention for Persons With Schizophrenia and Their Families: Intervention and 3-Month Findings. Long-Term Caregiver Mental Health Outcomes Following a Predominately Online Intervention for Adolescents With Complicated Mild to Severe Traumatic Brain Injury. Online Support for Employed Informal Caregivers: Psychosocial Outcomes Creating a Bond Between Caregivers Online: Effect on Caregivers’ Coping Strategies E-care: a telecommunications technology intervention for family caregivers of dementia patients. Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes. Effects of an automated telephone support system on caregiver burden and anxiety: findings from the REACH for TLC intervention study. Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores A randomized trial of teen online problem solving: efficacy in improving caregiver outcomes after brain injury. A randomized controlled trial of an Internet-based cognitive-behavioural skills package for carers of people with anorexia nervosa. What factors influence successful recruitment of siblings of individuals with first episode psychosis to e‐health interventions? A qualitative study Reducing depression in stroke survivors and their informal caregivers: a randomized clinical trial of a Web-based intervention. Evaluation of a web-based skills intervention for carers of people with anorexia nervosa: a randomized controlled trial. The effect of a family therapy and technology-based intervention on caregiver depression. Caring for others: Internet video-conferencing group intervention for family caregivers of older adults with neurodegenerative disease. Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs What is your research question? An introduction to the PICOT format for clinicians. A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. A novel Interactive Health Communication Application (IHCA) for parents of children with long-term conditions: Development, implementation and feasibility assessment A Tailored Web-Based Psychoeducational Intervention for Cancer Patients and Their Family Caregivers CHESS improves cancer caregivers' burden and mood: results of an eHealth RCT. Innovative tools for quality assessment: integrated quality criteria for review of multiple study designs (ICROMS). The use of Internet technology for psychoeducation and support with dementia caregivers.
Background Although several face-to-face programs are dedicated to informal caregivers of persons with dementia , they are not always accessible to overburdened or isolated caregivers . Based on a face-to-face intervention program , we adapted and design ed a Web-based fully automated psychoeducational program ( called Diapason ) inspired by a cognitive approach . Objective This study aim ed to evaluate through a pilot unblinded r and omized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer ’s disease ( PWAD ) based on a mixed methods research design . Methods We recruited and r and omized offline 49 informal caregivers of a PWAD in a day care center in Paris , France . They either received the Web-based intervention and usual care for 3 months ( experimental group , n=25 ) or only usual care ( control group , n=24 ) . Caregivers ’ perceived stress ( PSS-14 , primary outcome ) , self-efficacy , burden , perceived health status , and depression ( secondary outcomes ) were measured during 3 face-to-face on-site visits : at baseline , at the end of the program ( month 3 ) , and after follow-up ( month 6 ) . Additionally , semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis . Results Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups ( P=.98 ) . The experimental group significantly improved their knowledge of the illness ( d=.79 , P=.008 ) from baseline to month 3 . Of the 25 participants allocated to the experimental group , 17 ( 71 % ) finished the protocol and entirely viewed at least 10 of 12 online sessions . On average , participants used the website 19.72 times ( SD 12.88 ) and were connected for 262.20 minutes ( SD 270.74 ) . The results of the satisfaction question naire showed that most participants considered the program to be useful ( 95 % , 19/20 ) , clear ( 100 % , 20/20 ) , and comprehensive ( 85 % , 17/20 ) . Significant correlations were found between relationship and caregivers ’ program opinion ( P=.01 ) . Thus , positive opinions were provided by husb and s and sons ( 3/3 ) , whereas qualified opinions were primarily reported by daughters ( 8/11 ) . Female spouses expressed negative ( 2/3 ) or neutral opinions ( 1/3 ) . Caregivers expected more dynamic content and further interaction with staff and peers . Conclusions In this study , quantitative results were inconclusive owing to small sample size . Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers . Caregivers did not rule out their interest in this kind of intervention provided that it met their needs . More dynamic , personalized , and social interventions are desirable . Our recruitment issues pointed out the necessity of in-depth studies about caregivers ’ help-seeking behaviors and readiness factors . Trial Registration Clinical trials.gov NCT01430286 ; http:// clinical trials.gov/ct2/show/NCT01430286 ( Archived by WebCite at http://www.webcitation/6KxHaRspL ) Objective : To examine the efficacy of an interactive multimedia intervention that teaches advocacy skills to people caring for a family member with traumatic brain injury . Participants : A total of 201 individuals ( control , n = 97 ; treatment , n = 104 ) providing support to a family member with traumatic brain injury . Design : R and omized controlled study . Main Measures : Caregiver knowledge , skill application , behavioral intention , and overall life satisfaction . Intervention : The Brain Injury Partners program , a Web site focused on advocacy , communication skills , and re sources for families affected by brain injury . Results : Univariate analyses revealed that compared with the control group , the Brain Injury Partners group reported statistically significant higher adjusted means for application , knowledge , and attitudes scales immediately postintervention and at follow-up . Satisfaction with life , assessed at follow-up but not posttest , was not significant . Discussion : This study demonstrated the effectiveness of a Web-based intervention to teach effective skills to caregivers advocating for a family member with traumatic brain injury Purpose . We hypothesised that carers of stroke survivors who participate in the Web-based intervention , Caring∼Web © , would have higher well-being than non-Web users . We also postulated that those survivors whose carers participated in Caring∼Web would use fewer healthcare services . Method . A r and omised , two-group , repeated measures design was used . Subjects were recruited from four rehabilitation centres from which first-time stroke survivors were discharged to home in two Midwestern states . Of 144 carers screened , 103 carers of these survivors who were novice Internet users were assigned to a Web or non-Web user group . Seventy-three subjects completed the study . Intervention . Caring∼Web was a Web-based intervention of education and support provided to the Web user group for 1 year . A bi-monthly telephone survey collected data on all carers well-being ( perceived depression , life satisfaction ) and survivors healthcare service use ( self-reported provider and emergency department visits , hospital re-admissions , nursing home placement ) . Results . No statistical differences were found between the groups in carers well-being or in the number of provider visits for survivors . There were significant differences in emergency department visits ( p = 0.001 ) and hospital re-admissions ( p = 0.0005 ) related to the health of survivors . Conclusions . This Web-based intervention helped new carers make informed decisions about healthcare needs of stroke survivors , thus reducing service use Background Web-based programs have been developed for informal caregivers of people with Alzheimer ’s disease ( PWAD ) . However , these programs can prove difficult to adopt , especially for older people , who are less familiar with the Internet than other population s. Despite the fundamental role of usability testing in promoting caregivers ’ correct use and adoption of these programs , to our knowledge , this is the first study describing this process before evaluating a program for caregivers of PWAD in a r and omized clinical trial . Objective The objective of the study was to describe the development process of a fully automated Web-based program for caregivers of PWAD , aim ing to reduce caregivers ’ stress , and based on the user-centered design approach . Methods There were 49 participants ( 12 health care professionals , 6 caregivers , and 31 healthy older adults ) that were involved in a double iterative design allowing for the adaptation of program content and for the enhancement of website usability . This process included three component parts : ( 1 ) project team workshops , ( 2 ) a proof of concept , and ( 3 ) two usability tests . The usability tests were based on a mixed methodology using behavioral analysis , semistructured interviews , and a usability question naire . Results The user-centered design approach provided valuable guidelines to adapt the content and design of the program , and to improve website usability . The professionals , caregivers ( mainly spouses ) , and older adults considered that our project met the needs of isolated caregivers . Participants underlined that contact between caregivers would be desirable . During usability observations , the mistakes of users were also due to ergonomics issues from Internet browsers and computer interfaces . Moreover , negative self-stereotyping was evidence d , when comparing interviews and results of behavioral analysis . Conclusions Face-to-face psycho-educational programs may be used as a basis for Web-based programs . Nevertheless , a user-centered design approach involving targeted users ( or their representatives ) remains crucial for their correct use and adoption . For future user-centered design studies , we recommend to involve end-users from preconception stages , using a mixed research method in usability evaluations , and implementing pilot studies to evaluate acceptability and feasibility of programs Objective : Determine if the online iCare Stress Management e-Training Program reduces stress , bother , depression , and poor life quality for dementia family caregivers ( CGs ) . Method : CGs ( N = 150 ) were r and omly assigned to the iCare Condition ( ICC ) or to the Education/Information-Only Condition ( EOC ) for a 3-month period . Change in self-report measures of stress ( PSS ) ( primary outcome ) , caregiver bother(RMBPC ) , depression ( CES-D ) , and quality of life ( PQOL ) ( secondary outcomes ) was determined , along with usage of new information in one 's own caregiving . Results : A mixed ANOVA revealed that change in perceived stress was significant for the ICC but not the EOC ( p = .017 ) . Changes in the other measures were not significant . More caregivers in the ICC used the material s in their own caregiving situation than those in the EOC . Roughly one-third of the caregivers enrolled in the study dropped prior to completion . Conclusion : Results are promising , but the high dropout is a concern . Future efforts to improve dropout rate and increase participant engagement are warranted . To our knowledge , this is the first attempt to present an evidence -based intervention for CGs via the Internet Purpose Family caregivers of persons with dementia ( PWD ) may receive caregiver training because of logistical constraints and privacy concerns . This study evaluated the effectiveness of an online intervention for family caregivers of PWD in improving their self-efficacy in managing behavioral and psychological symptoms of dementia ( BPSD ) , and their emotion well-being . Subjects and methods A total of 36 family caregivers of people with dementia participated in a 9-week online intervention based on the cognitive behavioral therapy model . Outcomes of the intervention were measured by the Chinese version of the Neuropsychiatric Inventory Question naire and two domains of the Revised Scale for Caregiving Self-Efficacy . Wilcoxon signed rank tests were used to compare the change in outcome variables . Results The severity of BPSD of PWD and BPSD-related distress in family caregivers showed a statistically significant reduction after the intervention . Subgroup analysis showed self-efficacy in controlling up setting thoughts significantly improved in caregivers of PWD at moderate to severe stages . Conclusion Online cognitive behavioral therapy for family caregivers reduced BPSD of PWD and the related distress in their caregivers Background : Mobile health services may improve chronic illness care , but interventions rarely support informal caregivers ’ efforts . Objectives : To determine whether automated feedback to caregivers of chronic heart failure patients impacts caregiving burden and assistance with self-management . Research Design : R and omized comparative effectiveness trial . Subjects : A total of 369 heart failure patients were recruited from a Veterans Health Administration health care system . All patients participated with a “ CarePartner ” or informal caregiver outside their household . Intervention : Patients r and omized to “ st and ard mHealth ”  received weekly automated self-care support calls for 12 months with notifications about problems sent to clinicians . “ mobile health+CarePartner ” ( mHealth+CP ) patients received identical services , plus email summaries and suggestions for self-care assistance automatically sent to their CarePartners . Measures : At baseline , 6 , and 12 months , CarePartners completed assessment s of caregiving strain , depressive symptoms , and participation in self-care support . Results : mHealth+CP CarePartners reported less caregiving strain than controls at both 6 and 12 months ( both P⩽0.03 ) . That effect as well as improvements in depressive symptoms were seen primarily among CarePartners reporting greater burden at baseline ( P⩽0.03 for interactions between arm and baseline strain/depression at both endpoints ) . Although most mHealth+CP CarePartners increased the amount of time spent in self-care support , those with the highest time commitment at baseline reported decreases at both follow-ups ( all P<0.05 ) . mHealth+CP CarePartners reported more frequently attending patients ’ medical visits at 6 months ( P=0.049 ) and greater involvement in medication adherence at both endpoints ( both P⩽0.032 ) . Conclusions : When CarePartners experienced significant caregiving strain and depression , systematic feedback about their patient-partner decreased those symptoms . Feedback also increased most CarePartners ’ engagement in self-care OBJECTIVES The E Sibling Project aims to address the needs of siblings of individuals affected by psychosis through provision of a comprehensive online intervention . The online intervention comprises four core elements , including : information on psychosis ; various coping and promoting well-being strategies ; siblings ' blogs and discussion forum with peers ; and an " Ask the Experts " function . After the intervention-prototype was developed , we tested its feasibility , usability and acceptability by siblings . METHODS We evaluated the usability of the intervention-prototype using a non-r and omised usability study with siblings of individuals diagnosed with psychosis . The usability study adapted Poulson et al 's framework to collect subjective feedback from participants on ease of use , perceived usefulness and acceptability , together with objective usage data on the intervention . RESULTS Twenty siblings were recruited to the usability test ; 19 tried out the re source -prototype over a 4-week period and 17 completed the online evaluation after using the intervention . In total , 906 page-views were made by the participants and each spent about two hours using the re source . Participants evaluated the intervention as helpful , relevant and useful in terms of content , design and usability . Developments are needed to improve the navigation and intuitiveness of the re source . CONCLUSIONS Using an internet-based information-giving and peer support intervention to promote wellbeing and coping is feasible and acceptable to siblings of people with psychosis Background To date , there has been very little work investigating behaviour changes induced by interventions that are design ed to increase help seeking . The present paper examines the effects of two Internet depression websites on help seeking . Methods 414 individuals with elevated scores on a depression assessment scale were r and omly allocated to a depression information website , a cognitive-behavioural skills training website ( CBT ) or an attention control condition . Reports of help seeking for specific treatments , from specific sources and for categories of treatments were assessed . Results Relative to the control , the depression information site was associated with decreases in seeking support from friends and family , the use of music and of everyday treatments and no increase in seeking evidence based interventions . The CBT site was associated with the report of help seeking for CBT , massage and exercise . Conclusion Methods to encourage the use of evidence -based treatments need further research to determine whether the assistance sought is evidence based and whether there are unintended effects Background The World Health Organization stresses the importance of accessible and (cost)effective caregiver support , given the expected increase in the number of people with dementia and the detrimental impact on the mental health of family caregivers . Methods This study assessed the effectiveness of the Internet intervention ‘ Mastery over Dementia ’ . In a RCT , 251 caregivers , of whom six were lost at baseline , were r and omly assigned to two groups . Caregivers in the experimental group ( N = 149 ) were compared to caregivers who received a minimal intervention consisting of e-bulletins ( N = 96 ) . Outcomes were symptoms of depression ( Center for Epidemiologic Studies Depression Scale : CES-D ) and anxiety ( Hospital Anxiety and Depression Scale : HADS-A ) . All data were collected via the Internet , and an intention-to-treat analysis was carried out . Results Almost all caregivers were spouses or children ( in-law ) . They were predominantly female and lived with the care recipient in the same household . Age of the caregivers varied from 26 to 87 years . Level of education varied from primary school to university , with almost half of them holding a bachelor ’s degree or higher . Regression analyses showed that caregivers in the experimental group showed significantly lower symptoms of depression ( p = .034 ) and anxiety ( p = .007 ) post intervention after adjustment for baseline differences in the primary outcome scores and the functional status of the patients with dementia . Effect sizes were moderate for symptoms of anxiety ( .48 ) and small for depressive symptoms ( .26 ) . Conclusions The Internet course ‘ Mastery over Dementia ’ offers an effective treatment for family caregivers of people with dementia reducing symptoms of depression and anxiety . The results of this study justify further development of Internet interventions for family caregivers of people with dementia and suggest that such interventions are promising for keeping support for family caregivers accessible and affordable . The findings are even more promising because future generations of family caregivers will be more familiar with the Internet . Trial Registration Dutch Trial Register NTR-2051 www.trialregister.nl/trialreg/admin/ rct Twenty mothers participated in an online support group for parents of children with autism spectrum disorders . Twenty-five unrelated parents participated in a no-treatment control group . The participants completed online question naires prior to and following the 4-month support group , to evaluate changes in mood , anxiety , parenting stress , and positive perceptions . No significant differences between the groups or across time were found . However , parents who participated in the group reported being satisfied with the support they received and finding the group helpful . Issues related to participant recruitment and retention are discussed . Further research is required to investigate the efficacy of online support groups for parents of children with ASD OBJECTIVE To evaluate the feasibility of a telehealth psychoeducation intervention for persons with schizophrenia and their family members . STUDY DESIGN R and omized controlled trial . PARTICIPANTS 30 persons with schizophrenia and 21 family members or other informal support persons . INTERVENTIONS Web-based psychoeducation program that provided online group therapy and education . MAIN OUTCOME MEASURES Measures for persons with schizophrenia included perceived stress and perceived social support ; for family members , they included disease-related distress and perceived social support . RESULTS At 3 months , participants with schizophrenia in the intervention group reported lower perceived stress ( p = .04 ) and showed a trend for a higher perceived level of social support ( p = .06 ) . CONCLUSIONS The findings demonstrate the feasibility and impact of providing telehealth-based psychosocial treatments , including online therapy groups , to persons with schizophrenia and their families OBJECTIVE To examine the efficacy of counselor-assisted problem solving ( CAPS ) in improving  long-term caregiver psychological functioning following traumatic brain injury ( TBI ) in adolescents . METHODS This r and omized clinical trial compared  CAPS ( n = 65 ) , a predominantly online problem-solving intervention , with an  Internet re source comparison ( n = 67 ) program . Families of adolescents with TBI completed a baseline assessment and follow-up assessment s 6 , 12 , and 18 months later . General linear mixed models were used to examine longitudinal changes in caregiver global psychological distress , depressive symptoms , and caregiving self-efficacy . Family income and injury severity were examined as moderators of treatment efficacy . RESULTS Family income moderated long-term changes in  caregiver psychological distress . For lower-income caregivers , the CAPS intervention was associated with lower levels of psychological distress at 6 , 12 , and 18 months post baseline . CONCLUSIONS These findings support the utility of Web-based interventions in improving long-term caregiver psychological distress  , particularly for lower-income families The overall objectives of this project were to evaluate whether psychosocial outcomes in employed family caregivers of people with chronic disease , who participate in online support  , differ from nonactive participants and whether psychosocial outcomes differ based on the format of online group support . A r and omized longitudinal design comparing two types of online support groups and nonactive participants , on the basis of three principal measures , was utilized . Eighty-six self-reported family caregivers of people with chronic disease , who spoke English and had Internet access , took part in the study . Subjects were r and omly assigned to professionally facilitated/psychoeducational or moderated/peer-directed online support groups for a period of 12 weeks . The setting was a password-protected Web page housed on a university server . Independent variables were type of online support groups and level of participation ; the dependent variables were depressive symptoms , caregiver burden , and caregiver quality of life . There were significant differences in depressive symptoms and quality of life among nonactive participants and either of the two intervention groups , but not between the two intervention groups . Results suggest that professionally facilitated/psychoeducational and moderated/peer-directed online support groups help reduce depressive symptoms and improve quality of life for those who actively participate and that both types of online support groups provided similar benefits . Men and minorities should be targeted in future caregiver research Numerous studies have investigated the effect of Interactive Cancer Communication Systems ( ICCSs ) on system users ' improvements in psychosocial status . Research in this area , however , has focused mostly on cancer patients , rather than on caregivers , and on the direct effects of ICCSs on improved outcomes , rather than on the psychological mechanisms of ICCS effects . To underst and the underlying mechanisms , this study examines the mediating role of perceived caregiver bonding in the relation between one ICCS ( the Comprehensive Health Enhancement Support System [ CHESS ] ) use and caregivers ’ coping strategies . To test the hypotheses , a secondary analysis of data was conducted on 246 caregivers of lung cancer patients . These caregivers were r and omly assigned to ( a ) the Internet , with links to high- quality lung cancer websites , or ( b ) access to CHESS , which integrated information , communication , and interactive coaching tools . Findings suggest that perceived bonding has positive effects on caregivers ’ appraisal and problem-focused coping strategies , and it mediates the effect of  ICCS  on the coping strategies 6 months after the intervention has begun OBJECTIVE This study evaluated the effectiveness of a  technology-based psychoeducational intervention for family caregivers of dementia patients . An additional objective was to determine if the intervention could be implemented by a community-based social service agency . METHODS Forty-six caregivers were r and omly assigned to either a technology-based intervention or an information-only control condition . RESULTS Caregivers assigned to the intervention condition reported a significant decrease in burden postintervention and those who evidence d high depression at baseline experienced a significant decline in depression . CONCLUSION This study provides evidence that technology offers a cost-effective and practical method for delivering interventions to caregivers OBJECTIVE This study examined the use of a uniquely design ed Web site and home computers to deliver online multifamily psychoeducational therapy to persons with schizophrenia and their informal supports ( family and friends ) . Web site usage and outcome benefits are reported . METHODS Thirty-one persons with schizophrenia or schizoaffective disorder and 24 support persons were r and omly assigned to the online intervention ( telehealth ) or treatment as usual ( usual care ) condition . At three , six , and 12 months , interviewer-administered assessment s were conducted with participants . Intention-to-treat analyses compared persons with schizophrenia in the two study conditions on severity of positive symptoms and knowledge of schizophrenia . Support persons in the two study conditions were compared on knowledge of schizophrenia . Each participant 's usage of the Web site was logged . RESULTS Persons with schizophrenia in the telehealth condition had a large and significant reduction in positive symptoms ( p=.042 , d=-.88 ) and a large and significant increase in knowledge of schizophrenia compared with their counterparts in the usual care condition . Support persons in the telehealth condition showed a large and significant increase in knowledge about prognosis compared with those in the usual care condition ( p=.036 , d=1.94 ) . Persons with schizophrenia used the Web site to a much greater extent ( pages viewed and time spent ) than support persons . CONCLUSIONS These findings suggest that online delivery of psychotherapeutic treatment and educational re sources to consumers ' homes has considerable potential to improve consumer well-being and offers several advantages over st and ard clinic-based delivery models PURPOSE We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response ( IVR ) intervention design ed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer 's disease ( AD ) . DESIGN AND METHODS We conducted a r and omized controlled study of 100 caregivers , 51 in the usual care control group and 49 in the technology intervention group , who received yearlong access to an IVR-mediated system .  The system provided caregiver stress monitoring and counseling information , personal voice-mail linkage to AD experts , a voice-mail telephone support group , and a distraction call for care recipients . We conducted analyses by using a repeated measures approach for longitudinal data and an intention-to-treat analytic approach . Outcomes included the caregiver 's appraisal of the bothersome nature of caregiving , anxiety , depression , and mastery at baseline , 6 , 12 , and 18 months . RESULTS There was a significant intervention effect as hypothesized for participants with lower mastery at baseline on all three outcomes : bother ( p = .04 ) , anxiety ( p = .01 ) , and depression ( p = .007 ) . Additionally , wives exhibited a significant intervention effect in the reduction of the bothersome nature of caregiving ( p = .02 ) . IMPLICATION S Wives who exhibited low mastery and high anxiety benefited the most from the automated telecare intervention . Findings suggest that , to optimize outcome effects , similar interventions should be tailored to match the users ' characteristics and preferences Background Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face , via self-help books ( bibliotherapy ) , and through computer administration . The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners . We have developed a free Internet-based cognitive behavior therapy intervention ( MoodGYM , http://moodgym.anu.edu.au ) design ed to treat and prevent depression in young people , available to all Internet users , and targeted to those who may have no formal contact with professional help services . Objective To document site usage , visitor characteristics , and changes in depression and anxiety symptoms among users of MoodGYM , a Web site delivering a cognitive-behavioral-based preventive intervention to the general public . Methods All visitors to the MoodGYM site over about 6 months were investigated , including 2909 registrants of whom 1503 had completed at least one online assessment . Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately . The main outcome measures were ( 1 ) site-usage measures including number of sessions , hits and average time on the server , and number of page views ; ( 2 ) visitor characteristics including age , gender , and initial Goldberg self-report anxiety and depression scores ; and ( 3 ) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions . Results Over the first almost-6-month period of operation , the server recorded 817284 hits and 17646 separate sessions . Approximately 20 % of sessions lasted more than 16 minutes . Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population -based surveys and those characterizing a sample of University students . For the Web-based population , both anxiety and depression scores decreased significantly as individuals progressed through the modules . Conclusions Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public . However , r and omized controlled trials are required to establish the effectiveness of these interventions OBJECTIVE To examine the results of a r and omized clinical trial ( RCT ) of Teen Online Problem Solving ( TOPS ) , an online problem solving therapy model , in increasing problem-solving skills and decreasing depressive symptoms and global distress for caregivers of adolescents with traumatic brain injury ( TBI ) . METHOD Families of adolescents aged 11 - 18 who sustained a moderate to severe TBI between 3 and 19 months earlier were recruited from hospital trauma registries . Participants were assigned to receive a web-based , problem-solving intervention ( TOPS , n = 20 ) , or access to online re sources pertaining to TBI ( Internet Re source Comparison ; IRC ; n = 21 ) . Parent report of problem solving skills , depressive symptoms , global distress , utilization , and satisfaction were assessed pre- and posttreatment . Groups were compared on follow-up scores after controlling for pretreatment levels . Family income was examined as a potential moderator of treatment efficacy . Improvement in problem solving was examined as a mediator of reductions in depression and distress . RESULTS Forty-one participants provided consent and completed baseline assessment s , with follow-up assessment s completed on 35 participants ( 16 TOPS and 19 IRC ) . Parents in both groups reported a high level of satisfaction with both interventions . Improvements in problem solving skills and depression were moderated by family income , with caregivers of lower income in TOPS reporting greater improvements . Increases in problem solving partially mediated reductions in global distress . CONCLUSIONS Findings suggest that TOPS may be effective in improving problem solving skills and reducing depressive symptoms for certain subsets of caregivers in families of adolescents with TBI BACKGROUND Anorexia nervosa ( AN ) poses a major burden on families . Carers ( e.g. parents or partners ) of people with AN are often highly distressed and may inadvertently respond in ways that can contribute to the maintenance of the disorder , e.g. through high levels of over-involvement and criticism [ also known as expressed emotion ( EE ) ] . This study aim ed to evaluate the efficacy of a novel web-based systemic cognitive-behavioural ( CBT ) intervention for carers of people with AN , design ed to reduce carer distress and teach skills in how to offer effective support . METHOD Carers of people with AN ( n=64 ) were r and omly allocated to either the web-intervention , overcoming anorexia online , with limited clinician supportive guidance ( by email or phone ) , or to ad-hoc usual support from the UK patient and carer organization Beat . Carer outcomes were assessed at post-treatment ( 4 months ) and follow-up ( 6 months ) . RESULTS Compared with the control intervention , web-based treatment significantly reduced carers ' anxiety and depression ( primary outcome ) at post-treatment , with a similar trend in carers ' EE . Other secondary outcomes did not favour the online intervention . Gains were maintained at follow-up . CONCLUSIONS This is the first ever study to use an online CBT program to successfully reduce carer distress and improve  carers ' ability to support the person with AN Abstract Background Recruitment to clinical research studies can prove complex . This is particularly true of mental health research , given factors such as confidentiality , capacity and consent , or when attempting to recruit family members as opposed to service users themselves . Aim This study investigated the challenges experienced and strategies employed in the recruitment of siblings of people with first episode psychosis using Early Intervention in Psychosis Services ( EIPS ) in Engl and . Methods As part of a r and omized controlled trial ( RCT ) of an e‐health intervention for siblings , we conducted a process evaluation study whereby semistructured interview was undertaken with clinical and research staff involved in recruitment of siblings . Data were analysed thematically . Results Twelve participants from six EIPS were interviewed . Data analysis revealed seven key themes : ( i ) limited comprehensive family data available ; ( ii ) data governance and consent issues ; ( iii ) organizational factors ; ( iv ) convoluted recruitment methods ; ( v ) concerns about service users ' opinions ; ( vi ) fluidity in siblings ' needs and expectations ; and ( vii ) strategies to enhance recruitment . Conclusions Recruitment challenges identified in this study concerned administrative , organizational , process and attitudinal issues . These are similar to other studies recruiting mental health service users as well as family members . Failure to recruit to target implies that studies are underpowered to detect potential statistically or clinical ly meaningful changes . Future studies should establish how best to enhance family inclusiveness in clinical practice and research PURPOSE / OBJECTIVES To develop and test the efficacy of a Web-based intervention for alleviating depression in male stroke survivors ( SSs ) and their spousal caregivers ( CGs ) that blends both peer and professional support . DESIGN AND METHODS The research consisted of an intervention protocol evaluated by a focus group of rehabilitation professionals , a " think aloud " session conducted with female stroke CGs , and a usability test of the intervention 's online features with 7 female stroke CGs . Efficacy of the final protocol was tested in a 2-group r and omized clinical trial with a sample of 32 CG-SS dyads . The CGs in the intervention condition received an online group intervention . Intervention components were based on the Stress Process Model . Those CGs in a control condition received minimal support with individualized access to relevant online information . Measures of depression , as well as the secondary outcomes of mastery , self-esteem , and social support , were obtained from SSs and CGs at pretest , posttest , and 1-month later . RESULTS At posttest and 1 month later , CGs in the intervention condition reported significantly lower depression than CGs in the control condition with baseline depression controlled . There was no significant effect on depression among SSs . Although no significant treatment effects for either SSs or CGs were found on the secondary outcomes , posttreatment changes on some constructs were significantly correlated with change in depression . CONCLUSIONS / IMPLICATION S CGs benefit from Web-based programs that help them better underst and both their emotional needs and those of the SS OBJECTIVE To investigate the feasibility and usefulness of an online information and skills development intervention for carers of individuals with anorexia nervosa ( AN ) and individuals with AN . METHOD Thirty-seven carers and seventeen individuals with AN were recruited ; carers completed the intervention Overcoming Anorexia Online ( OAO ) , with r and om allocation to receiving additional clinician guidance ( OAO-G ) or no guidance ( OAO-NoG ) . Level of expressed emotion , distress , depressive symptoms , experience of caregiving , and impact of eating disorder symptoms were assessed in carers and perceptions of changes in their carers ' expressed emotion were assessed in individuals with AN . Participants completed question naires at pre-intervention , post-intervention and 3-month follow-up . RESULTS Significant reductions were found for carer intrusiveness , negative experiences of caregiving , and the impact of starvation and guilt . Within group effect sizes suggested mixed findings with respect to whether greater benefits were conferred for carers receiving clinician guidance . Decreases in perceived intrusiveness of the carer by the individual with AN were associated with a large effect size . DISCUSSION Results demonstrate the feasibility and usefulness of an online intervention for carers . Further examination of the efficacy of the intervention for both carers and individuals with AN is warranted PURPOSE The majority of persons with Alzheimer 's disease ( AD ) are cared for at home by a family member such as a spouse or daughter . Caregiving places enormous dem and s on these caregivers , and the negative consequences associated with caregiving are well documented . This paper reports results from the Miami site of the REACH ( Re sources for Enhancing Alzheimer 's Caregiver Health ) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms ( according to the Center for Epidemiological Studies Depression scale ) among family caregivers of AD patients at 6 months and 18 months follow-up . DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were r and omized into a structural ecosystems therapy , structural ecosystems therapy + computer-telephone integrated system , or minimal support control condition .  RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months . The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husb and and daughter caregivers . IMPLICATION S The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers . The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship PURPOSE The aim of this pilot feasibility study was to evaluate the effects of an innovative , Internet-based psychosocial intervention for family caregivers of older adults with neurodegenerative disease . DESIGN AND METHODS After receiving signed informed consent from each participant , we r and omly assigned 66 caregivers to an Internet-based intervention or to a no-intervention control group .  The intervention group received computers and training in order to access a password-protected Web site with links to information , e-mail , and threaded discussion . Unique to the Web site was a video-conferencing link that supported caregivers ' participation in a 10-session , manual-guided psychosocial support group , followed by 12 additional online sessions facilitated by a group member . Participants completed health-status and stress-response measures at baseline and 6-month follow-up . RESULTS Content analysis of archived video sessions showed ( a ) reliable adherence to the manual-guided support-group intervention and ( b ) online group discussion themes similar to those in face-to-face caregiver support groups . Analyses of stress-response outcome data showed significant between-group differences , with the intervention group experiencing a decline in stress compared with an escalation in stress for the control group . IMPLICATION S Despite the limitations of this pilot study in terms of limited sample size and 54 % dropout of control participants at 6-month follow-up , the results provide preliminary supportive evidence for a technology-based psychosocial intervention for family caregivers of individuals with neurodegenerative disease Purpose : The aim of this study was to examine the impact on dementia caregivers ’ experienced stress and health status of 2 Internet-based intervention programs . Design and methods : Ninety-one dementia caregivers were given the choice of being involved in either an Internet-based chat support group or an Internet-based video conferencing support group . Pre-post outcome measures focused on distress , health status , social support , and service utilization . Results : In contrast to the Chat Group , the Video Group showed significantly greater improvement in mental health status . Also , for the Video Group , improvements in self-efficacy , neuroticism , and social support were associated with lower stress response to coping with the care recipient ’s cognitive impairment and decline in function . Implication s : The results show that , of 2 Internet-based intervention programs for dementia caregivers , the video conferencing intervention program was more effective in improving mental health status and improvement in personal characteristics were associated with lower caregiver stress response Clinicians often witness impressive treatment results in practice and may wish to pursue research to formally explore their anecdotal experiences . The potential to further new knowledge both within the profession and to the greater healthcare system is compelling . An obvious next step for a practitioner considering research is to connect with experienced research ers to convey their idea for a study , who may in turn ask , “ What is your research question ? ” With limited underst and ing of how to respond , this interaction may result in the first and last experience these clinicians will have with the research community . It has been estimated that between 1 % and 7 % of the chiropractic profession in Canada is engaged in research . 1,2 Arguably , this low engagement could be the result of practitioners ’ perceived importance of research and levels of research literacy and capacity . However , increasing dem and s for evidence -based approaches across the health system puts pressure on all clinicians to base their decisions on the best available scientific evidence . Lack of clinician representation in research has the probable effect of limiting growth and new developments for the profession . Furthermore , lack of clinician involvement in research complicates the transfer of study findings into practical setting s. The Canadian Institutes of Health Research describes integrated knowledge translation as a process that involves collaboration between research ers and knowledge users at all stages of a research project.3 This necessitates involvement of clinicians to help in forming a research question , interpreting the results , and moving research findings into practice . This shared effort between clinicians and research ers increases the likelihood that research initiatives will be relevant to practice .3 Conversely , it has been reported that there is a growing communication gap between clinicians and academics in chiropractic . 4 Clinicians have important practice -related questions to ask , but many may lack the ability to map out their research strategy , specifically in communicating their question in a manner required to develop a research protocol . David L. Sackett , Officer of the Order of Canada and the founding Chair of Canada ’s first Department of Clinical Epidemiology & Biostatistics at McMaster University , highlights the importance of mapping one ’s research strategy in exploration of the research question : “ one-third of a trial ’s time between the germ of your idea and its publication in the New Engl and Journal of Medicine should be spent fighting about the research question . ” ( personal communication , November 30 , 2011 ) We describe a r and omized controlled trial ( RCT ) example to highlight how clinicians may use existing literature and the PICOT format to formulate a research question on treatment efficacy Background Mobile health ( mHealth ) interventions may improve heart failure ( HF ) self-care , but st and ard models do not address informal caregivers ’ needs for information about the patient ’s status or how the caregiver can help . Objective We evaluated mHealth support for caregivers of HF patients over and above the impact of a st and ard mHealth approach . Methods We identified 331 HF patients from Department of Veterans Affairs outpatient clinics . All patients identified a “ CarePartner ” outside their household . Patients r and omized to “ st and ard mHealth ” ( n=165 ) received 12 months of weekly interactive voice response ( IVR ) calls including questions about their health and self-management . Based on patients ’ responses , they received tailored self-management advice , and their clinical team received structured fax alerts regarding serious health concerns . Patients r and omized to “ mHealth+CP ” ( n=166 ) received an identical intervention , but with automated emails sent to their CarePartner after each IVR call , including feedback about the patient ’s status and suggestions for how the CarePartner could support disease care . Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate . Self-care and symptom data also were collected through the weekly IVR assessment s. Results Participants were on average 67.8 years of age , 99 % were male ( 329/331 ) , 77 % where white ( 255/331 ) , and 59 % were married ( 195/331 ) . During 15,709 call-weeks of attempted IVR assessment s , patients completed 90 % of their calls with no difference in completion rates between arms . At both endpoints , composite quality of life scores were similar across arms . However , more mHealth+CP patients reported taking medications as prescribed at 6 months ( 8.8 % more , 95 % CI 1.2 - 16.5 , P=.02 ) and 12 months ( 13.8 % more , CI 3.7 - 23.8 , P<.01 ) , and 10.2 % more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up ( P=.048 ) . mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints ( both P<.05 ) , were consistently more likely to report taking medications as prescribed during weekly IVR assessment s , and also were less likely to report breathing problems or weight gains ( all P<.05 ) . Among patients with more depressive symptoms at enrollment , those r and omized to mHealth+CP were more likely than st and ard mHealth patients to report excellent or very good general health during weekly IVR calls . Conclusions Compared to a relatively intensive model of IVR monitoring , self-management assistance , and clinician alerts , a model including automated feedback to an informal caregiver outside the household improved HF patients ’ medication adherence and caregiver communication . mHealth+CP may also decrease patients ’ risk of HF exacerbations related to shortness of breath and sudden weight gains .  mHealth+CP may improve quality of life among patients with greater depressive symptoms . Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical , infrequent retrospective surveys . Trial Registration Clinical Trials.gov NCT00555360 ; https:// clinical trials.gov/ct2/show/NCT00555360 ( Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B ) BACKGROUND Two-thirds of people with dementia live at home supported mainly by family carers . These carers frequently develop clinical depression or anxiety , which predicts care breakdown . We aim ed to assess the clinical effectiveness ( long-term reduction of depression and anxiety symptoms in family carers ) and cost-effectiveness of a psychological intervention called START ( STrAtegies for RelaTives ) . METHODS We did a r and omised , parallel-group trial with masked outcome assessment s in three UK mental-health services and one neurological-outpatient dementia service . We included self-identified family carers of people with dementia who had been referred in the previous year and gave support at least once per week to the person with dementia . We r and omly assigned these carers , via an online computer-generated r and omisation system from an independent clinical trials unit , to either START , an 8-session , manual-based coping intervention delivered by supervised psychology graduates , or treatment as usual ( TAU ) . The primary long-term outcomes were affective symptoms ( Hospital Anxiety and Depression Scale total score [ HADS-T ] ) 2 years after r and omisation and cost-effectiveness ( health and social care perspectives ) over 24 months . Analysis was by intention to treat , excluding carers with data missing at both 12 and 24 months . This trial is registered ISCTRN70017938 . FINDINGS From November 4 , 2009 , to June 8 , 2011 , we recruited 260 carers . 173 carers were r and omly assigned to START and 87 to TAU .  Of these 260 participants , 209 ( 80 % ) were included in the clinical efficacy analysis ( 140 START , 69 TAU ) . At 24 months , compared with TAU the START group was significantly better for HADS-T ( mean difference -2·58 points , 95 % CI -4·26 to -0·90 ; p=0·003 ) . The intervention is cost effective for both carers and patients ( 67 % probability of cost-effectiveness at the £ 20 000 per QALY willingness-to-pay threshold , and 70 % at the £ 30 000 threshold ) . INTERPRETATION START is clinical ly effective , improving carer mood and anxiety levels for 2 years . Carers in the control TAU group were seven times more likely to have clinical ly significant depression than those receiving START . START is cost effective with respect to carer and patient outcomes , and National Institute for Health and Care Excellence ( NICE ) thresholds . The number of people with dementia is rapidly growing , and policy frameworks assume that their families will remain the frontline providers of ( unpaid ) support . This cost-neutral intervention , which substantially improves family-carers ' mental health and quality of life , should therefore be widely available . FUNDING National Institute for Health Research Health Technology Assessment programme 08/14/06 Background : Few evidence -based , on-line re sources exist to support home-based care of childhood long-term conditions . Methods : In a feasibility study , children with stages 3 , 4 , or 5 chronic kidney disease , parents and professionals collaboratively developed a novel Online Parent Information and Support ( OPIS ) application .  Parents were r and omized to an  intervention arm with access to OPIS or a control arm without access .  OPIS usage was assessed using  Google Analytics  . Parents in the intervention arm completed the  Suitability Assessment of Material s ( SAM ) and User Interface Satisfaction ( USE ) question naires and participated in qualitative interviews . Results : Twenty parents  accessed OPIS with a mean of 23.3 ( SD 20.8 , range 2–64 ) visits per user . Responses from the SAM and USE question naires were positive , most respondents rating OPIS highly and finding it easy to use . Qualitative suggestions include refinement of OPIS components , enabling personalization of OPIS functionalities and proactive endorsements of OPIS by professionals . Conclusions : Implementation of OPIS into st and ard practice is feasible in the centre where it was developed . Suggested developments will augment reported strengths to inform ongoing testing in the wider UK network of units . Our design and methods are transferrable to developing and evaluating web-applications to support home-based clinical care-giving for other long-term conditions Background : Most programs addressing psychosocial concerns of cancer survivors are in-person programs that are expensive to deliver , have limited availability , and seldom deal with caregivers ’ concerns . Objective : This study examined the feasibility of translating an efficacious nurse-delivered program ( FOCUS Program ) for patients and their caregivers to a tailored , dyadic Web-based format . Specific aims were to ( 1 ) test the preliminary effects of the Web-based intervention on patient and caregiver outcomes , ( 2 ) examine participants ’ program satisfaction , and ( 3 ) determine the feasibility of using a Web-based delivery format . Methods : A phase 2 feasibility study was conducted with cancer patients ( lung , breast , colorectal , prostate ) and their family caregivers ( N = 38 dyads ) . The Web-based intervention provided information and support tailored to the unique characteristics of each patient , caregiver , and their dyadic relationship . Primary outcomes were emotional distress and quality of life . Secondary outcomes were benefits of illness/caregiving , communication , support , and self-efficacy . Analyses included descriptive statistics and repeated- measures analysis of variance . Results : Dyads had a significant decrease in emotional distress , increase in quality of life , and perceived more benefits of illness/caregiving . Caregivers also had significant improvement in self-efficacy . There were no changes in communication . Participants were satisfied with program usability , but recommended additional content . Conclusions : It was possible to translate a clinician-delivered program to a Web-based format that was easy to use and had positive effects on dyadic outcomes . Implication s for Practice : The Web-based program is a promising way to provide psychosocial care to more patients and caregivers using fewer personnel . It needs further testing in a larger r and omized clinical trial OBJECTIVE Informal caregivers ( family and friends ) of people with cancer are often unprepared for their caregiving role , leading to increased burden or distress .  Comprehensive Health Enhancement Support System ( CHESS ) is a Web-based lung cancer information , communication , and coaching system for caregivers . This r and omized trial reports the impact on  caregiver burden , disruptiveness , and mood of providing caregivers access to CHESS versus the Internet with a list of recommended lung cancer websites . METHODS A total of 285 informal caregivers of patients with advanced nonsmall cell lung cancer were r and omly assigned to a comparison group that received Internet or a treatment group that received Internet and CHESS . Caregivers were provided a computer and Internet service if needed . Written surveys were completed at pretest and during the intervention period bimonthly for up to 24 months . Analyses of covariance ( ANCOVAs ) compared the intervention 's effect on caregivers ' disruptiveness and burden ( CQOLI-C ) , and negative mood ( combined Anxiety , Depression , and Anger scales of the POMS ) at 6 months , controlling for blocking variables ( site , caregiver 's race , and relationship to patient ) and the given outcome at pretest . RESULTS Caregivers r and omized to CHESS reported lower burden , t(84 ) = 2.36 , p = .021 , d = .39 , and negative mood , t(86 ) = 2.82 , p = .006 , d = .44 , than those in the Internet group . The effect on disruptiveness was not significant . CONCLUSIONS Although caring for someone with a terminal illness will always exact a toll on caregivers , eHealth interventions like CHESS may improve caregivers ' underst and ing and coping skills and , as a result , ease their burden and mood OBJECTIVES With the aim to facilitate a more comprehensive review process in public health including patient safety , we established a tool that we have termed ICROMS ( Integrated quality Criteria for the Review Of Multiple Study design s ) , which unifies , integrates and refines current quality criteria for a large range of study design s including qualitative research . STUDY DESIGN Review , pilot testing and expert consensus . METHODS The tool is the result of an iterative four phase process over two years : 1 ) gathering of established criteria for assessing controlled , non-controlled and qualitative study design s ; 2 ) pilot testing of a first version in two systematic review s on behavioural change in infection prevention and control and in antibiotic prescribing ; 3 ) further refinement and adding of additional study design s in the context of the European Centre for Disease Prevention and Control funded project ' Systematic review and evidence -based guidance on organisation of hospital infection control programmes ' ( SIGHT ) ; 4 ) scrutiny by the pan-European expert panel of the SIGHT project , which had the objective of ensuring robustness of the systematic review . RESULTS ICROMS includes established quality criteria for r and omised studies , controlled before- and -after studies and interrupted time series , and incorporates criteria for non-controlled before- and -after studies , cohort studies and qualitative studies . The tool consists of two parts : 1 ) a list of quality criteria specific for each study design , as well as criteria applicable across all study design s by using a scoring system ; 2 ) a ' decision matrix ' , which specifies the robustness of the study by identifying minimum requirements according to the study type and the relevance of the study to the review question . The decision matrix directly determines inclusion or exclusion of a study in the review . ICROMS was applied to a series of systematic review s to test its feasibility and usefulness in the appraisal of multiple study design s. The tool was applicable across a wide range of study design s and outcome measures . CONCLUSION ICROMS is a comprehensive yet feasible appraisal of a large range of study design s to be included in systematic review s addressing behaviour change studies in patient safety and public health . The tool is sufficiently flexible to be applied to a variety of other domains in health-related research . Beyond its application to systematic review s , we envisage that ICROMS can have a positive effect on research ers to be more rigorous in their study design and more diligent in their reporting A large r and omized trial evaluated the benefits of online education , support , and self-care promotion  for caregivers of persons with dementia . Anecdotal reports from participants indicated enjoyment of the material s , convenient access from home , and support from professionals and other caregivers . A substantial number of screened caregivers experienced obstacles of access , cost , and time regarding use of technology . Telephone options are being explored , and future caregiving generations are expected to have increased exposure and willingness to use computer technology , such as the program described here
Family carers of people who have long term illness often experience physical and mental health morbidities , and burden .
While there is good evidence to suggest that carers benefit from psychosocial interventions , these have primarily been delivered via face-to-face individual or group-formats .
eHealth interventions offer a novel , accessible and self-paced approach to care delivery .
Whether these are effective for carers ' wellbeing has been little explored .
This paper reports the first comprehensive systematic review in this area .