A blended intervention based on Acceptance and Commitment Therapy (ACT) for Informal Caregivers of People with Dementia- A mixed method approach to evaluate feasibility, acceptability and preliminary effectiveness

Informal caregivers of people with dementia (PwD) invest time, emotion, and
effort in their caregiving responsibilities. Due to various care demands,
informal caregivers may experience substantial negative mental health effects
such as burden, stress, depression, and anxiety. Therefore, they are holding a
unique position of both providing and needing support.
Acceptance and commitment therapy (ACT) is a transdiagnostic and evidence-based
approach that empowers individuals to change their behavior toward value-based
activities. To date, ACT can be applied not only in face-to-face sessions but
also via self-guided online programs, which increases the individual
time-flexibility and might be particularly suitable for caregivers of PwD.
Moreover, ACT has shown promise in improving individuals* mental health and
overall wellbeing. However, only a small number of studies investigated ACT in
older caregivers which is usually found in the context of dementia care.
In addition to ACT, setting realistic goals toward value-based activities
supports individuals to orient their actions and subsequently their behavior
toward a more meaningful and less distressing life. This strategy might support
informal caregivers of PwD further to balance the care demands with their
individual needs. However, engaging with life values, defining goals, and
taking action toward those values might be challenging and yet require further
motivation for informal caregivers of PwD.
Therefore, a web-based ACT intervention blended with complementary components
including collaborative goal-setting and motivational coaching might enable
informal caregivers of PwD to live a more meaningful and less distressing life.

The primary objective of this study is to evaluate the feasibility and
acceptability of the blended ACT-based intervention among informal caregivers
of PWD.
The secondary objectives are to evaluate (i) the preliminary effectiveness of
the blended ACT-based intervention on clinical outcomes (e.g. psychological
flexibility), and (ii) maintenance of changes after the intervention in short-
and long-term follow ups.

This study includes a single-arm, non-randomised trial with a baseline
assessment, a 9-week internet-based intervention period, a post-intervention
assessment, and two follow-ups at 3 and 6 months.

All eligible and consenting informal caregivers of PwD will be asked to
participate in an individual goal-setting session with a motivational coach.
Afterward, participants follow the internet-delivered ACT-based modules on a
digital platform called *Embloom*. A total of 9 modules (one module per week)
can be completed over 9 to 12 weeks. During the intervention, the motivational
coach will contact the participants weekly to encourage them to follow their
goals and stay engaged with the modules. After the intervention, 6 monthly
booster sessions (one session per month) will be provided by the motivational
coach to motivate the informal caregivers to continue their value-based
activities or revisit the ACT modules, if needed.
Before and after the intervention as well as at 3-and 6-month follow up,
participants will be asked to fill out a number of retrospective
questionnaires. Furthermore, a semi-structured interview will be conducted to
assess the user experience, feasibility, and acceptability of the intervention.

Although the risk of participation in this study can be considered
minimal/negligible, engaging with technology and internet-based intervention
might be confusing or require effort from older informal caregivers.
Furthermore, informal caregivers should follow the modules, fill in the
exercises, and at the same time stay actively engaged with their SMART goals.
Being called weekly by a motivational coach and staying in touch 6 months after
the intervention might be associated with a considerable perceived burden.
Individuals who choose to participate in the blended ACT intervention will
receive the potential benefits associated with the intervention in terms of
their clinical, functional, and social functioning to live a more meaningful
and less distressing life. Moreover, an incentive voucher with a value of 25¤
will be sent to the research participants who complete the study.