mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review

Abstract

Background Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers’ health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers’ expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers’ access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity’s PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status–plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers’ health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers’ physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers’ use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation.

Informal carers’ information needs in managing behavioural and psychological symptoms of people with dementia and related mHealth applications: a systematic integrative review to inform the design of an mHealth application

“…Based on the current review, functions of mHealth applications include monitoring BPSD. Literature reported the several functions of mHealth applications that focused on providing education and support for informal carers, for example, providing information about patients (eg, clinical information, daily activities),23 100 101 linking to useful websites;26 101 sharing experience among carers;23 101 providing digital calendars;100 communication between carer and healthcare team;23 100 101 sharing checklist for assessing carer/care recipients’ condition;23 101 reminders for taking medications;23 26 100 101 connecting to social support and services;23 100 101 and sending encouragement message 100. A study conducted in Sweden explored family carers’ and health professionals’ perspectives on mHealth applications 102.…”

Health Experiences of Sexual and Gender Minority People Living With Dementia and Their Care Partners: Protocol for a Scoping Review

“…Many SGM older adults experience health care access barriers, including nonaffirming providers that can delay pursuit of general and specialist care [ 2 ]. Care partners of SGM older adults also experience barriers to providing optimal care due to discrimination, providers that may not acknowledge nontraditional partnerships, and health care systems and interventions that do not promote health equity or address social determinants of health [ 13 , 14 ]. Although such barriers are known to affect health outcomes among SGM older adults, little is known about the unique health and health care experiences of SGM people living with dementia and their care partners.…”

Leveraging mHealth and Virtual Reality to Improve Cognition for Alzheimer’s Patients: A Systematic Review

“…mHealth is a subset of telemedicine that leverages mobile technology to deliver some sort of intervention or interaction with a provider. mHealth interventions with patients who have AD suffer from barriers such as cognition, perception, physical ability, frame of mind, speech and language [ 9 ]. mHealth design must break steps into very simple, easy to understand modules, must often repeat instructions to keep the attention of the users, and use simple memory tests to avoid overwhelming the user [ 10 ].…”

“…A systematic literature review was published in 2022 that analyzed 28 studies over 10 years [ 9 ]. It evaluated several aspects of mHealth.…”

“…Our review will be different from previous reviews. We will use a larger group of articles for analysis than the former review [ 15 ], and it will analyze effectiveness, different from the latter review [ 9 ].…”