PMID- 36314782 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20221217 IS - 2368-7959 (Print) IS - 2368-7959 (Electronic) IS - 2368-7959 (Linking) VI - 9 IP - 11 DP - 2022 Nov 30 TI - Implementation of e-Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis. PG - e41891 LID - 10.2196/41891 [doi] LID - e41891 AB - BACKGROUND: Informal caregivers commonly experience mental health difficulties related to their caregiving role. e-Mental health interventions provide mental health support in a format that may be more accessible to informal caregivers. However, e-mental health interventions are seldom implemented in real-world practice. OBJECTIVE: This mixed methods systematic review aimed to examine factors associated with the effectiveness and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: combinations of implementation and intervention characteristics sufficient for intervention effectiveness were explored using qualitative comparative analysis, and barriers to and facilitators of implementation of e-mental health interventions for informal caregivers were explored using thematic synthesis. METHODS: We identified relevant studies published from January 1, 2007, to July 6, 2022, by systematically searching 6 electronic databases and various secondary search strategies. Included studies reported on the effectiveness or implementation of e-mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers' mental health outcomes were included in a crisp-set qualitative comparative analysis. We assessed randomized controlled trials for bias using the Risk of Bias 2.0 tool, and we assessed how pragmatic or explanatory their trial design was using the Pragmatic Explanatory Continuum Indicator Summary 2 tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research to identify barriers to and facilitators of implementation. RESULTS: Overall, 53 reports, representing 29 interventions, were included in the review. Most interventions (27/29, 93%) focused on informal cancer or dementia caregivers. In total, 14 reports were included in the qualitative comparative analysis, exploring conditions including the presence of peer or professional support and key persuasive design features. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. Overall, 44 reports were included in the thematic synthesis, and 152 barriers and facilitators were identified, with the majority related to the intervention and individual characteristic domains of the Consolidated Framework for Implementation Research. Implementation barriers and facilitators in the inner setting (eg, organizational culture) and outer setting (eg, external policies and resources) domains were largely unexplored. CONCLUSIONS: e-Mental health interventions for informal caregivers tend to be well-designed, with several barriers to and facilitators of implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers to and facilitators of implementing e-mental health interventions for informal caregivers, focusing on inner and outer setting barriers and facilitators. TRIAL REGISTRATION: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020155727; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020155727. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2019-035406. CI - (c)Chelsea Coumoundouros, Erika Martensson, Giulia Ferraris, Justine Margaux Zuidberg, Louise von Essen, Robbert Sanderman, Joanne Woodford. Originally published in JMIR Mental Health (https://mental.jmir.org), 30.11.2022. FAU - Coumoundouros, Chelsea AU - Coumoundouros C AUID- ORCID: 0000-0001-5539-974X AD - Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. FAU - Martensson, Erika AU - Martensson E AUID- ORCID: 0000-0003-0406-4880 AD - Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. AD - Centre for Gender Research, Uppsala University, Uppsala, Sweden. FAU - Ferraris, Giulia AU - Ferraris G AUID- ORCID: 0000-0003-0957-0918 AD - Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. FAU - Zuidberg, Justine Margaux AU - Zuidberg JM AUID- ORCID: 0000-0002-3465-1384 AD - Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. FAU - von Essen, Louise AU - von Essen L AUID- ORCID: 0000-0001-5816-7231 AD - Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. FAU - Sanderman, Robbert AU - Sanderman R AUID- ORCID: 0000-0002-0823-1159 AD - Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands. AD - Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands. FAU - Woodford, Joanne AU - Woodford J AUID- ORCID: 0000-0001-5062-6798 AD - Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. LA - eng PT - Journal Article PT - Review DEP - 20221130 PL - Canada TA - JMIR Ment Health JT - JMIR mental health JID - 101658926 PMC - PMC9752475 OTO - NOTNLM OT - Consolidated Framework for Implementation Research OT - chronic diseases OT - e-mental health OT - implementation OT - informal caregivers OT - qualitative comparative analysis OT - systematic review OT - thematic synthesis COIS- Conflicts of Interest: None declared. EDAT- 2022/11/01 06:00 MHDA- 2022/11/01 06:01 PMCR- 2022/11/30 CRDT- 2022/10/31 08:53 PHST- 2022/08/15 00:00 [received] PHST- 2022/10/25 00:00 [accepted] PHST- 2022/11/01 06:00 [pubmed] PHST- 2022/11/01 06:01 [medline] PHST- 2022/10/31 08:53 [entrez] PHST- 2022/11/30 00:00 [pmc-release] AID - v9i11e41891 [pii] AID - 10.2196/41891 [doi] PST - epublish SO - JMIR Ment Health. 2022 Nov 30;9(11):e41891. doi: 10.2196/41891.