Effect of a web-based intervention on the mental health of informal caregivers of the elderly: a randomized controlled trial.

Abstract

Background: Iran's demographic trends indicate significant aging, with intensive caregiving linked to mental health issues among caregivers, especially during the Covid-19 pandemic. This study aimed to evaluate the impact of Mehrpishegan's web-based intervention on depression, anxiety, and stress levels among informal primary caregivers of older adults in Iran.

Methods: This study was a parallel-group, superiority, single-blinded randomized controlled trial conducted in Tehran. Eligible participants were informal caregivers with primary caregiving responsibility, access to the internet and a smart device, at least one month of caregiving experience, and the ability to use a web-based intervention. The primary outcomes were measured at baseline, 3 months, and 6 months using DASS-21. Participants with mild and moderate levels at baseline were randomized into intervention (n = 83) and control (n = 80) groups. The intervention group accessed the website, which provided structured educational content and chatrooms(psychologist-led for three months, then peer-led). Engagement was measured via session attendance, forum participation, and educational material usage. Data were analyzed using repeated measures ANOVA based on the intention-to-treat (ITT) and per-protocol approaches.

Results: Of the participants, 128 completed the final assessment at six months, resulting in an attrition rate of 20%. The intervention group showed a small decrease in depression (10.23 ± 0.80 vs. 10.48 ± 0.75, diff = 0.253; 95% CI = -0.24, 1.94), anxiety (6.70 ± 0.64 vs. 7.86 ± 0.60, diff = 1.17; 95% CI = -2.93, 0.59), and stress (13.94 ± 0.78 vs. 15.16 ± 0.74, diff = 1.22; 95% CI = -3.37, 0.92), but none of these differences were statistically significant (p > 0.05). Effect size calculations indicated small reductions in anxiety (d = -0.30) and depression (d = -0.28) at three months, though these remained below the threshold for clinical significance (|d| < 0.5).

Conclusions: Although the web-based intervention showed some improvements in caregivers' mental health outcomes, the changes were not significantly different from those in the control group. Several challenges, including internet disruptions, voluntary participation, and the impact of the COVID-19 pandemic, may have influenced these outcomes. To enhance the effectiveness of web-based support programs, future interventions must overcome technological barriers, strengthen caregivers' digital competencies, tailor content to individual needs, and address key mental health risk factors. A more personalized and accessible approach could improve engagement and long-term benefits for caregivers.

Trial registration: The protocol of this research was registered in the Iran Randomized Clinical Trial Center with registration number IRCT2 02010 12,048 999N1 on 25 December 2020.