Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul 7;24(7):e38595.
doi: 10.2196/38595.

Behavioral Change Factors and Retention in Web-Based Interventions for Informal Caregivers of People Living With Dementia: Scoping Review

Kuan-Ching Wu  1 , Yan Su  1 , Frances Chu  1 , Annie T Chen  2 , Oleg Zaslavsky  3
Affiliations

Behavioral Change Factors and Retention in Web-Based Interventions for Informal Caregivers of People Living With Dementia: Scoping Review

Kuan-Ching Wu et al. J Med Internet Res. .

Abstract

Background: Web-based interventions aimed at supporting informal caregivers of people living with dementia have the potential to improve caregivers' well-being and psychological health. However, few interventions are widely implemented for this population, and none of the prior reviews have systematically examined the use of behavior change techniques (BCTs), theories, and agents in web-based interventions for informal caregivers of people living with dementia. To better understand this implementation gap, we reviewed the literature to map behavioral factors (BCTs, theories, and agents) deployed in the studies. Furthermore, because there is an emerging consensus that retention could be shaped by participant characteristics and behavioral factors, we explored relationships between these features and retention rates across studies.

Objective: We pursued 3 objectives: to map behavioral factors involved in the web-based interventions for informal caregivers of people living with dementia; to examine the relationship between behavioral change elements and retention in the studies; and to examine the relationship between participant characteristics (gender, age, and spouse or adult children caregiver proportion) and study retention.

Methods: We conducted a literature review using the following keywords and their corresponding Medical Subject Headings terms: dementia, caregivers, and web-based intervention. The time limits were January 1998 to March 2022. Using the BCTv1 taxonomy, which specifies active behavioral components in interventions, 2 coders collected, summarized, and analyzed the frequency distributions of BCTs. Similarly, they abstracted and analyzed participant characteristics, behavior change theories, behavior change agents, and retention rates in the studies.

Results: The average age was 61.5 (SD 7.4) years, and the average proportion of spousal informal caregivers, adult children informal caregivers, and retention rates were 51.2% (SD 24.8%), 44.8% (SD 22%), and 70.4% (SD 17%), respectively. Only 53% (17/32) of the studies used behavior change theories, but 81% (26/32) included behavior change agents. The most common BCTv1 clusters were shaping knowledge and social support. The median number of BCTv1 clusters was 5 (IQR 3). We observed a negative correlation between the proportion of spousal informal caregivers and the retention rate (r=-0.45; P=.02) and between the number of BCTv1 clusters and retention rates (r=-0.47; P=.01). We also found that the proportion of adult children informal caregivers in the study was significantly and positively correlated with the retention rate (r=0.5; P=.03). No other participant characteristics or behavioral factors were associated with retention rates.

Conclusions: We found that almost half of the studies were not informed by behavior change theories. In addition, spousal involvement and a higher number of BCTs were each associated with lower retention rates, while the involvement of adult children caregivers in the study was associated with higher retention. In planning future studies, researchers should consider matching participant characteristics with their intended intervention as the alignment might improve their retention rates.

Keywords: BCT; aging; behavior; behavior change technique; caregiver; caregiving; change technique; cognition; dementia; digital health; gerontology; health intervention; informal care; informal caregivers; internet; intervention; neurological disorder; older adult population; peer support; psychological health; retention; review; scoping; taxonomy; web-based; web-based intervention.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flow diagram showing the study selection process.
Figure 2
Figure 2
Behavior change agent (BCA) domains used in high vs low retention studies.
Figure 3
Figure 3
Relationships of retention rate to behavior change technique (BCT) clusters and behavior change agent (BCA) domains.
Figure 4
Figure 4
Relationships of retention rate to age, gender, spouse, and adult children proportion. *: P<.05.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Monica MM, Díaz-Santos M, Vossel K. Alzheimer’s Association 2021 Facts and Figures Report. David Geffen School of Medicine. [2022-03-01]. https://www.eastonad.ucla.edu/images/E-Newsletter/Summer_2021/ucla-easto... .
    1. Allen AP, Curran EA, Duggan A, Cryan JF, Chorcoráin AN, Dinan TG, Molloy DW, Kearney PM, Clarke G. A systematic review of the psychobiological burden of informal caregiving for patients with dementia: focus on cognitive and biological markers of chronic stress. Neurosci Biobehav Rev. 2017 Feb;73:123–64. doi: 10.1016/j.neubiorev.2016.12.006.S0149-7634(16)30279-2 - DOI - PubMed
    1. Cross AJ, Garip G, Sheffield D. The psychosocial impact of caregiving in dementia and quality of life: a systematic review and meta-synthesis of qualitative research. Psychol Health. 2018 Nov 27;33(11):1321–42. doi: 10.1080/08870446.2018.1496250. - DOI - PubMed
    1. Mausbach BT, Romero-Moreno R, Bos T, von Känel R, Ziegler MG, Allison MA, Mills PJ, Dimsdale JE, Ancoli-Israel S, Losada A, Márquez-González M, Patterson TL, Grant I. Engagement in pleasant leisure activities and blood pressure: a 5-year longitudinal study in alzheimer caregivers. Psychosom Med. 2017;79(7):735–41. doi: 10.1097/psy.0000000000000497. - DOI - PMC - PubMed
    1. Kwon O, Ahn HS, Kim HJ, Park K. Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. J Clin Neurol. 2017 Oct;13(4):394–404. doi: 10.3988/jcn.2017.13.4.394. https://thejcn.com/DOIx.php?id=10.3988/jcn.2017.13.4.394 13.394 - DOI - PMC - PubMed

Publication types