Abstract
Objective
Chronic diseases are the leading causes of death and disability in the U.S., and disease management largely falls onto patients’ family caregivers. The long-term burden and stress of caregiving negatively impact caregivers’ well-being and ability to provide care. Digital health interventions have the potential to support caregivers. This article aims to provide an updated review of interventions using digital health tools to support family caregivers and the scope of the Human-Centered Design (HCD) approaches.
Methods
We conducted a systematic search on July 2019 and January 2021 in PubMed, CINAHL, Embase, Cochrane Library, PsycINFO, ERIC, and ACM Digital Library, limiting to 2014–2021 to identify family caregiver interventions assisted by modern technologies. The Mixed Methods Appraisal Tool and the Grading of Recommendations Assessment, Development and Evaluation were used to evaluate the articles. Data were abstracted and evaluated using Rayyan and Research Electronic Data Capture.
Results
We identified and reviewed 40 studies from 34 journals, 10 fields, and 19 countries. Findings included patients’ conditions and relationships with family caregivers, how the technology is used to deliver the intervention, HCD methods, theoretical frameworks, components of the interventions, and family caregiver health outcomes.
Conclusion
This updated and expanded review revealed that digitally enhanced health interventions were robust at providing high-quality assistance and support to caregivers by improving caregiver psychological health, self-efficacy, caregiving skills, quality of life, social support, and problem-coping abilities. Health professionals need to include informal caregivers as an essential component when providing care to patients. Future research should include more marginalized caregivers from diverse backgrounds, improve the accessibility and usability of the technology tools, and tailor the intervention to be more culturally and linguistically sensitive.
Introduction
Chronic diseases such as diabetes and cancer are the leading causes of disability and death, accounting for more than three-quarters of U.S. healthcare spending. 1 Chronic disease management largely falls on patients and their families. Over 50 million family caregivers provide an estimated $470 billion in unpaid care in the U.S. 2 Long-term burden and stress of caregiving negatively impact caregivers’ physical and mental health and ability to provide care. Caregiving support is highly fragmented and scarce, exacerbating health impacts associated with caregiving, especially for families residing in marginalized communities. 3 Cost-effective tools such as digital health allow caregivers to defer and mitigate public budgets such as hospitalization and long-term services and support. 4 With the rapid development of new technologies in the past decade, such as ubiquitous smart devices and advances in artificial intelligence, it is essential to review the current evidence of how these tools affect caregivers. Digital health refers to “the use of information and communications technologies in medicine and other health professions to manage illnesses and health risks and to promote wellness.” 5 It compasses mobile health, telehealth, wearable devices, health information system, and telemedicine. 5 So far, several existing systematic literature reviews have mainly focused on caregivers of adults or older adults with dementia, cancer, or late-life diseases.5,9 Two systematic reviews focused only on web-based interventions.6,7 All these systematic reviews found evidence that digital health tools had an overall positive effect on supporting caregivers and their well-being. The existing reviews also indicated that the accessibility, acceptability, and sustainability of digital health interventions for end-users need to be explored further, and more studies about integrating different health tool interventions need to be conducted. To develop digital health interventions, many intervention developers use Human-Centered Design (HCD) with a focus on designing technologies to serve the stakeholder (e.g., end-user).8,9 The stakeholder's needs dominate the interface of the technology, which then impacts the design of the rest of the system. In HCD, designers consult with representative stakeholders from project inception to completion. The goal is to engage and enable stakeholders to understand and manage the technology in multiple situations and contexts. 10
In 2014, Chi and Demiris 11 conducted a systematic review of the effectiveness of telehealth interventions to support family and informal caregivers. They reviewed technologies including video, web-based, telephone-based, and telemetry and they also categorized interventions as education, consultation, psychosocial behavioral therapy, social support, data collection, and care delivery. They found that more than 95% of the studies reported significant improvements in the caregivers’ outcomes and that caregivers were satisfied and comfortable with telehealth. Building on Chi and Demiris's work, we aimed to update their systematic review by expanding the search terms, broadening the search databases, and repositioning the categories of digital health tools to include more updated digital health interventions from 2014 to 2021. In addition, we also described the breadth and scope of the HCD design approaches used with these digital health interventions.
Methods
Design
Following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) for Systematic Reviews guidelines, 12 we conducted a systematic literature search in bibliographic databases to identify caregiver interventions supported by various digital health tools. For the population of interest caregivers, we searched for “unpaid care provided by family, close relatives, friends, and neighbors.” 13
Inclusion and exclusion
We included modern technologies such as interactive web resources, web resources with nonexpert intervention, learning management system (LMS), telemonitoring system, online support group, videoconference, telehealth, mobile health, text message, and wearable technology (Table 1). Eligible studies had at least one caregiver-specific outcome or finding related to caregivers’ well-being and quality of life (QoL), such as their mental and physical health, skill, and self-care ability. We also limited the studies to Clinical Trials to avoid non-intervention studies. The study design of randomized controlled trials (RCTs), quasi-experimental, and mix-methods were included. Studies focused on paid professionals, professionally trained caregivers, and targeted care receivers were excluded. Studies were excluded if the intervention was not published in English, contained no human subjects, was only about HCD, had no caregiver self-care outcomes, were telephone-only interventions, were pilot studies with a sample size less than 30, or were protocol only.
Characteristics of included studies.
1a. Randomized Controlled Trial (RCT)
* Technology Intervention Delivery Evaluation Outcomes: 1, effectiveness (The accuracy and completeness with which users achieve specified goals); 2, efficiency (Once users have learned the design, how quickly can they perform tasks?); 3, satisfaction (After using the technology does the user have a good feeling about the technology?); 4, feasibility (How users perceive the ability to integrate the technology into their lives?); 5, acceptability (How willing are the users to use this technology?); 6, learnability (How easy is it for users to accomplish basic tasks the first time they encounter the design?); 7, memorability (Can a returning user remember how to effectively use technology?); 8, error frequency (How many errors do users make, how severe are these errors, and how easily can they recover from the errors?); and 9, understandability of content (How well users understands the content?).
Search strategy
The librarian in our team (FC) performed the comprehensive searches in July 2019 and repeated in January 2021. The search was conducted in PubMed, CINAHL, Embase, Cochrane Library, PsycINFO, ERIC, and ACM Digital Library databases with date limits of 2014–2021. A combination of controlled vocabularies and keywords was used in the search strategy. A full search strategy with filters and limits for each database can be seen in the supplementary files.
Study selection
Two authors (SZ and FC) followed two steps of data extraction. In the first step, each author independently assessed the titles and abstracts of the references identified in the search and determined whether they followed the study's objective and met the inclusion criteria. The results (include, exclude, and not sure) were compared and discussed by two reviewers until a consensus was reached, and then they read the full-text articles. In the second step, full-text articles were reviewed and assessed individually, compared, and discussed among two reviewers, and the potential articles were categorized in a list The search identified 2350 records after de-duplication with Endnote 14 and Rayyan. 15 Using Rayyan, two researchers (SZ and FC) reviewed 2350 records and excluded 2177 records. A total number of 173 full-text articles were reviewed for data abstraction.
Methodological quality appraisal
The researchers used the Mixed Methods Appraisal Tool (MMAT) 14 to screen the articles and ensure the study was of the desired quality. MMAT is a tool used as a checklist for appraising the methodological quality of various empirical research methods, including qualitative, RCTs, quantitative nonrandomized, quantitative descriptive, and mixed methods. We used MMAT to include randomized controlled and nonrandomized trials that could be prescreened by different evaluation items. Two raters (SZ and FC) independently assessed the methodological quality of the included studies through the MMAT checklist. Discrepancies were resolved through discussion until an agreement was reached. We used MMAT to evaluate the study designs, the quality of the data collection, and analytic methods.
Certainty of evidence
We applied Grading of Recommendations, Assessment, Development and Evaluations (GRADE) to assess the quality of the body of evidence separately for the prespecified outcome.16,17 As defined by the GRADE working group, high certainty refers to the authors being very confident that the true effect lies close to that of the estimate of the effect; moderate certainty means that the authors are moderately confident and the effects are likely to be close to not only estimating of the impact but also possible that it is different; low certainty means the confidence in the effect estimate is limited; and very low certainty refers to the authors have least confidence in the effect estimate.
Data synthesis
Data were abstracted and evaluated using Research Electronic Data Capture, a secure web application for designing clinical/translational research and collecting research data.18,19 Similar to Chi and Demiris's work, we extracted information on the relationship between the caregiver, care receiver, age group of the care recipient, patient condition, technology intervention categories, specific caregiver outcomes, and study limitations reported in this paper. Moreover, we expanded and deepened our review of detailed information about each study, including sample size, content, duration, follow-up timeline, the effectiveness of each intervention, and description of measurement tools for each outcome (Table 1). The researchers also abstracted whether the studies described the study design, evaluated their technology intervention, and assessed for HCD concepts of effectiveness, efficiency, satisfaction, feasibility, acceptability, learnability, memorability, error frequency, and understandability of content. 20
Results
Following PRISMA guidelines, the search and review process identified 2551 records in 2021 and 2350 records after de-duplication with Endnote and Rayyan. Using Rayyan, two researchers (SZ and FC) reviewed all 2350 records and excluded 2177 records. Of the 173 full-text articles, 133 studies were excluded, and 40 full-text articles were included for review and quality assessment (Figure 1). The studies were published in 34 different journals from 10 fields (Figure 2). The most common field was medicine. The papers were from 19 countries, and the U.S. was the most common country (Figure 3).
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 flow diagram for new systematic reviews which included searches of databases and registers only.
Journal fields.
Country of studies conducted.
Study settings and design
Thirty (75%) studies were conducted online at participants’ homes or community settings, nine (23%) were conducted at a hospital or clinic, and one study (2%) in an academic center. Thirty-two (80%) studies are RCTs, and eight (20%) are quasi-experimental designs.
Sample and sample size
For the care recipients’ ages, 21 studies (53%) focused only on adults and older people, 18 articles (44%) focused on children and adolescents, and one study (3%) focused on care recipients of all ages. The care recipients had various conditions. For adults and older people, conditions included mental illness,21,22 dementia,7,23,31 Alzheimer's disease, 32 cancer,31,33,35 critically ill or late-life disability,36,38 and heart disease.31,39,40 For children and adolescents, conditions included Anorexia Nervosa, 41 Attention-Deficit Hyperactivity Disorder,42,44 Autism Spectrum Disorder,45,46 life-threatening illness or injury,47,48 disruptive behavior disorders,49,50 undergoing repair or surgery,51,53 depression and anxiety, 54 and traumatic brain injury.48,55,56 Caregivers’ relationships with the patients included relatives and nonrelatives. Specifically, 20 studies included spouses or intimate partner caregivers. Parents as caregivers were in 26 studies. Children or children-in-law as a caregiver were included in 13 studies, while nine studies had siblings as caregivers. Three studies had grandparents as caregivers, and seven studies included friends or volunteers.
Study quality appraisal and effects of interventions
Table 2 reported the quality appraisal for each included study, including screening questions for both quantitative RCT and non-RCT. Table 3 shows the results of the certainty of evidence. SPSS was used to calculate the inter-rater reliability score of 0.9 (IBM SPSS Statistics Version 27). For the screening questions, all included studies presented clear research questions and collected appropriate data to address the questions. Among the 32 studies that used RCT, most addressed randomization (n = 28, 88%), ensured intervention adherence (n = 27, 84%), and completed more than 90% of outcome collection compared to groups at baseline (n = 27, 84%). Fewer studies reported blinded assessors for the outcomes (n = 17, 53%). For eight that had a nonrandomized study component, the majority had a good completion rate (80%), administrated intervention as intended (n = 8, 100%), and used appropriate sampling methods and measures (n = 8, 100%). Seven studies considered confounders in design and analysis (n = 7, 87%).
Risk of bias (RoB) in individual study.
• Screening Questions
S1. Are there clear research questions?
S2. Do the collected data allow to address the research questions?
• Quantitative randomized controlled trials
D1: Is randomization appropriately performed?
D2: Are the groups comparable at baseline?
D3: Are there complete outcome data?
D4: Are outcome assessors blinded to the intervention provided?
D5: Did the participants adhere to the assigned intervention?
• Quantitative nonrandomized study
D6: Are the participants representative of the target population?
D7: Are measurements appropriate regarding both the outcome and intervention (or exposure)?
D8: Are there complete outcome data?
D9: Are the confounders accounted for in the design and analysis?
D10: During the study period, is the intervention administered (or exposure occurred) as intended?
*Judgement: 
Low risk; 
High risk; 
Unclear risk
GRADE evidence profile (EP) for included studies.
We have presented the GRADE evidence profile for included studies in Table 3. Among 40 included interventions, 37.5% (n = 15) were rated high, 42.5% (n = 17) were rated moderate, 15% (n = 6) were rated low, and 5% (n = 2) were rated very low.
Theoretical frameworks informing intervention content
Thirty studies (75%) had a theoretical underpinning or guiding framework for the intervention's design. For example,adult learning theory principles,40,45 social learning theory and self-regulation theory,25,39,49,57 cognitive behavioral therapy (CBT) framework,28,42 acceptance and commitment theory,22,58 transition theory,7,34 stress and coping theory,25,33 and information provision model. 52
Technology used to deliver intervention
Three main domains of digital health technologies emerged from our review: telehealth, telemedicine, and mHealth. 59 The following sections will describe each type of digital health tool.
Telehealth refers to delivering and facilitating medical care, provider and patient education, health information services, and self-care via remote and digital communication technologies. 60 Telehealth includes four types of resources: (1) Static web resource: a web page delivered to the user's browser exactly as it is stored, which means all users receive the same information. The static web page was used in nine studies22,24,25,27,39,40,50,55,61; (2) Interactive Web Resources, which refer to the webpage that requires interaction/engagement from users to understand, execute, or experience by themselves. Fifteen studies used interactive web resources7,21,25,27,30,33,36,41,45,48,51,52,62; (3) Web resources with expert human interaction mainly refer to the LMS, which is a software application for the administration and delivery of educational programs. 63 LMS was used in 11 articles24,25,27,28,30,31,33,37,45,58,62; (4) Web resource with non-expert interaction, defined as “any virtual social space where people come together to get and give information or support, to learn, or to find the company,” such as an online support group. 64 Communication with nonexpert interaction was often through bulletin/discussion boards or specific software for live interaction with other group members.21,25,27,31,33,45,61 The second domain that emerged from our review was telemedicine. Telemedicine refers to two-way, real-time interactive communication between educator/counselor/doctor/nurses and client/patient. 65 Telemedicine was used in 11 studies.25,27,31,33,37,46,48,49,58 The third domain was mHealth or Mobile health, referred to as conducting health services, information, and data collection through mobile phones, tablet computers, or personal digital assistants (PDA). 66 mHealth was employed in six studies.7,23,24,36,39,42 Text messaging was used in two studies.53,54 Additionally, wearable technology, which detects, analyzes, and transmits information worn by the wearer via their mobile devices,67,68 was used in one study. 50
Digital health delivered interventions
Based on the five categories that Chi and Demiris 11 developed, we summarized the purpose of the intervention and what digital health tools supported the intervention delivery (Table 1). Table 4 also summarizes the intervention purposes for each study.
Intervention categories.
Education. One of the primary purposes of intervention is education. Educational interventions focused on improving self-help strategies and practice, gaining knowledge of patients’ diseases, getting familiar with medical/hospital procedures, and fostering a positive relationship between caregivers and patients. The delivery formats included interactive web-based programs, multimedia applications, LMS, and videoconferencing. This category accounted for 78% of the interventions.
Real-time Communication. The interventions compassed real-time communication as the main component. Caregivers asked questions, obtained information for decision-making, and consulted on better self-care through real-time communication with the coach/therapist/coordinator. The digital health tools for real-time communication included videoconferencing, instant messaging, discussion boards, and robotic telepresence. Studies using online support groups usually adopted a real-time communication approach. For example, Hattink et al. used Facebook® and LinkedIn® communities to provide opportunities to contact other dementia care professionals and peers.
Data Collection and Monitoring. This type of intervention aims for continuous data collection, analysis, and monitoring. The most popular system is Assistive Technology and Telecare (ATT). ATT offers innovative methods of supporting people by reducing potential harmful risks, increasing independence, and improving communication and QoL. The system has sensors that detect falls, gas leaking, and movement, and alerting devices to transfer data/information to the support center.68,69 This approach is often used among older adults with dementia who want to live independently. Davies et al. used the full version of ATT, which involves installing equipment to continuously, automatically, and remotely monitor real-time emergencies and lifestyle changes among older adults with dementia living at home. 26
Psychotherapy. Psychotherapy is embodied in CBT, and aims to support caregivers in reducing stress, gaining coping strategies, and improving problem-solving skills. Coach feedback or support groups were often combined with CBT to better help caregivers.27,28,33,55 Researchers often employ static or interactive web resources integrated with nonexpert interaction or mobile health web resources to deliver psychotherapy.
Connection and Support. Social support is an approach to exchanging information, connecting with caregivers with a similar situation, and obtaining support from a peer or an expert to increase the sense of hope, mastery, self-efficacy, and compassion. Social support mainly occurred on social media sites, and password-protected web page discussion forums could significantly connect and encourage caregivers. For example, McKechnie et al. used Talking Point (the UK Alzheimer's Society's online platform) for informal caregivers of people with dementia. This forum acted as a place for anyone affected by dementia to ask for advice, share information, and join the discussion to feel supported. 32
HCD/UCD methods and outcomes
Of the 40 studies, 18 (45%) included some HCD methods. All 18 studies evaluated the usability and satisfaction of the technology delivering the intervention,7,22,27,30,33,35,42,45,51,55,62,70,75 while two studies included design and evaluation methods for their intervention.30,62 Van Mierlo et al. 30 utilized potential users for information with no direct input from these users about the design of the intervention. In contrast, Phipps et al. 63 specifically stated that they used a user-centered design process that included focus groups for formative development of the intervention and representative users to review the intervention. 62
In the 18 studies that included an evaluative component for their intervention, the usability concepts ranked from most frequent to least frequent were: Satisfaction (9), Feasibility (8), acceptability (6), effectiveness (6), Learnability (6), Efficiency (3), Error Frequency (2), Understandability (1), and Memorability (0). Some researchers explicitly called out concepts of Usefulness, Usability, Ease of Use, Engagement, Functionality, Aesthetics, and Content which overlap with the previously stated ideas. The specific questionnaires utilized for evaluating the technology in the intervention were satisfaction questionnaires (3), usability questionnaires (4), and two questionnaires/questions developed for the study (Table 5). Three studies measured technology use, examining time spent engaged on the website,33,55 number of logins, 33 number of page views, 33 or attendance. 43 One study used interviews to evaluate the intervention (7), while one used interviews and a questionnaire. 30
Study instruments.
Caring/Parenting
All 18 studies that included HCD evaluation components in their research described positive results for satisfaction, usage, high scores on usability questionnaires, or other HCD evaluation concepts. Fuller-Tyszkiewicz et al. 42 did find low engagement scores on the Mobile Application Rating Scale. They noted “interventions that are personalized and flexible in their design, with advances in technology offering the potential for ubiquitous, tailored support.” Only four studies provided limitations for their HCD evaluation.34,35,42,51 The limitations could be technology-related, or they could be studied as design-related.
Caregiver outcomes
Based on our previous work, 11 we categorized the caregiver outcomes into the following categories: (1) Psychological health: less anxiety, depression, stress, burden, irritation, and isolation; (2) Self-Efficacy and Hope: self-efficacy/hope/resiliency/comfort; (3) Knowledge/Skills/Communication/Management of Patient; (4) QoL; (5) Social support: social support, social functioning, and needs to be met; and (6) Problem Coping Skills: ability and skills in coping and solving problems, identifying strategies for attaining goals, and getting information or support to make decisions. More specifically, thirty-four studies (85%) reported that caregivers significantly improved caregiver outcomes. Eleven had statistically significant decreased depression and anxiety symptoms,23,24,29,31,36,39,42,51,53,55 six had significantly improved self-efficacy, positive attitudes, and sense of control, 13 had significantly reduced stress, strain, and distress,21,23,27,35,44,45,50,51,56,58,61,63 10 had significantly increased resiliency, competence, compassion, and coping skills,22,23,28,40,41,45,46,53,54,62 four had significantly decreased sense of burden,22,37,41,49 one study had reduced substantially social isolation, 38 and six had significantly increased well-being and QoL.21,28,29,31,35,37 Seven studies (18%) reported that the caregiver did not statistically significantly improve post-intervention compared to the control group.26,30,32,34,43,47 A summary of all instruments used to measure is in Table 5.
Discussion
This systematic review identified 40 studies employing different digital health tools to deliver interventions to caregivers of people with various conditions globally published in English. More than 85% of the studies in the review showed significant improvements in the caregivers’ outcomes. Our updated and expanded review found that digitally enhanced health interventions improved caregiver outcomes in the following aspects: psychological health (reduced anxiety, depression, stress, strain, burden, irritation, and isolation), self-efficacy (increased confidence, hope, resiliency, and comfort), caregiving skills (improved communication with the patient, patient symptom management), QoL, social support (enhanced social connection and functioning), and problem coping skill (strengthened problem coping and solving skills, goal attainment, and decision-making). In the 18 studies that included HCD methods, the results were generally positive for the technology delivering the intervention.
The studies in this review came from 34 journals, 10 fields, and 19 countries. In addition, this review covered patients with varying age ranges, from children, adolescents, adults to older people, with a wide range of conditions and symptoms requiring different caregiver skills and workloads. Furthermore, the relationship between caregivers and patients was comprehensive. Most studies included spouses or intimate partners; some were children or children-in-law, and several were siblings, grandparents, or friends/volunteers as caregivers. Using MMAT, we found the quality of the 40 included studies is high (presented clear research questions, collected appropriate data, and the majority addressed randomization, adherence, and sampling methods). The results of this review are likely to be generalizable. With 32 (80%) RCTs and 8 (20%) quasi-experimental designs, evidence strength is high, the included studies’ quality is high, and the findings provide significant directions for future studies. By using GRADE, we assessed the certainty of the evidence for each included study. The results showed that 37.5% were rated with high certainty, 42.5% were rated with moderate certainty, 15% (n = 6) were rated with low certainty, and 5% (n = 2) were rated with very low certainty.
Three-quarters of the interventions were delivered to caregivers at home. Digital health tools enabled robust interventions that provided high-quality assistance to caregivers and saved travel and time, especially during the pandemic or when patients needed intensive monitoring. In addition, the most common digital health tools were interactive web resources (telehealth) and real-time interactive communication (telemedicine). In most studies, the researchers employed multiple intervention components to deliver to caregivers. For example, most studies combined education and data collection components, with or without peer social support, real-time support with professionals, or psychotherapy.
Our review also reveals some limitations across the reviewed studies. Typical constraints include limited generalizability (due to small sample sizes, demographic characteristics of the sample were not broadly representative, care recipients’ symptoms may be more/less severe, Hawthorne effects, self-selection bias, self-report bias), high attrition rate, difficulty to perform intention-to-treat analysis, unknown confounding factors (e.g., disease progression, changes in the family context, caregiving pattern changes), and technology instability (intervention interfaces did not always function correctly, the low usage of the technology intervention). For quasi-experimental studies, the outcomes could not be compared to a group of caregivers who did not have access to the intervention.
Our review found that 75% of studies used a theoretical framework to inform the intervention development. It has been shown that interventions with a theoretical basis are more successful than those without, as theories may focus on determinants that predict or explain outcomes or means of engendering changes in the determinants.76,77
This review was limited to English-language publications and excluded unpublished or ongoing studies, abstracts, editorials, reviews, pilot studies, or dissertations. Other limitations include the issues of publication bias, the search issues of balancing comprehensiveness with precision, and missing studies not published in peer-reviewed journals. Although the researchers attempted to be comprehensive by searching multiple databases, they did not search for gray literature. This updated systematic review was registered at PROSPECO, and the registration ID is CRD42023400030. The review protocol can be found and publicly available. We also listed the search strategies in the supplement to be available for other researchers.
This systematic review and analysis of digital health interventions provide implications for clinical practice. The studies showed that digital health interventions were effective to support informal caregivers, with the majority showing improvements in caregiver outcomes. Because informal caregivers are essential when providing care to patients, health professionals need to ensure informal caregivers also receive the necessary psychosocial assessments and support. The assessment of the caregivers needs to have their capacity (physical condition, mental concerns, and self-efficacy) for caregiving. Lastly, health professionals should also improve their digital health literacy and leverage technologies to better support caregivers.
Future research should include caregivers from diverse backgrounds as participants, especially those from marginalized communities. More efforts should be focused on improving the accessibility and usability of the technology tools and tailoring the intervention content to be more culturally sensitive and linguistically appropriate. Moreover, it is vital to engage end-users in the design process. Without considering input from caregivers and care receivers in the intervention development process, many technologies may have low adoption due to insufficient feasibility and acceptability. A comprehensive HCD approach is essential in intervention design and development.
Conclusion
This review identified 40 studies that investigated the effectiveness of digital health interventions in supporting informal caregivers. Digital health enhanced interventions compensate for the limitations of traditional human interactions and can be tailored to meet both caregivers’ and care recipients’ needs. Digital health interventions also provide a platform that allows interactive communication and provides up-to-date information to users in real time. These interventions may also prevent hospitalizations and unnecessary clinical visits. This updated and expanded review shows the great value of technology in delivering interventions to family caregivers. Technology-delivered intervention could potentially increase access to self-care for caregivers burdened with caring for their care recipient, reduce caregivers’ anxiety and depression, improve their QoL, coping skills, communication strategy, and relationship with care recipients, and eventually increase patients’ and caregivers’ well-being. Future studies designing and testing digital health interventions for family caregivers should tailor to caregivers from diverse communities, and comprehensive human-centered design approaches have the potential to support this effort.
Supplemental Material
sj-docx-1-dhj-10.1177_20552076231171967 - Supplemental material for Digital health interventions to support family caregivers: An updated systematic review
Supplemental material, sj-docx-1-dhj-10.1177_20552076231171967 for Digital health interventions to support family caregivers: An updated systematic review by Shumenghui Zhai, Frances Chu, Minghui Tan, Nai-Ching Chi, Teresa Ward and Weichao Yuwen in DIGITAL HEALTH
Footnotes
Contributorship:
SZ and WY conceived the study. SZ and FC developed the protocol. SZ, FC, and MT did literature review, selection and information extraction. SZ and FC wrote the first draft. All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Declaration of conflicting interests:
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical approval:
The authors confirm no Ethical Committee approval is needed since this project is a systematic review.
Funding:
The authors received no financial support for the research, authorship, and/or publication of this article.
Guarantor:
WY
Patient consent statements:
The authors confirm that the Patient Consent Statement is not required since this study did not involve any patients or subjects as this is a systematic review manuscript based on other published papers.
Supplemental material:
Supplemental material for this article is available online.
References
Supplementary Material
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