A Comparison of Users and Nonusers of a Web-Based Intervention for Carers of Older Persons With Alzheimer Disease and Related Dementias: Mixed Methods Secondary Analysis
Open accessAbstract
Background: A self-administered Web-based intervention was developed to help carers of persons with Alzheimer disease and related dementias (ADRD) and multiple chronic conditions (MCC) deal with the significant transitions they experience. The intervention, My Tools 4 Care (MT4C), was evaluated during a pragmatic mixed methods randomized controlled trial with 199 carers. Those in the intervention group received free, password-protected access to MT4C for three months. MT4C was found to increase hope in participants at three months compared with the control group. However, in the intervention group, 22% (20/92) did not use MT4C at all during the three-month period. Objective: This mixed methods secondary analysis aimed to (1) examine differences at three months in the outcomes of hope, self-efficacy, and health-related quality of life (HRQOL) scores in users (ie, those who used MT4C at least once during the three-month period) compared with nonusers and (2) identify reasons for nonuse. Methods: Data from the treatment group of a pragmatic mixed methods randomized controlled trial were used. Through audiotaped telephone interviews, trained research assistants collected data on participants’ hope (Herth Hope Index; HHI), self-efficacy (General Self-Efficacy Scale; GSES), and HRQOL (Short-Form 12-item health survey version 2; SF-12v2) at baseline, one month, and three months. Treatment group participants also provided feedback on MT4C through qualitative telephone interviews at one month and three months. Analysis of covariance was used to determine differences at three months, and generalized estimating equations were used to determine significant differences in HHI, GSES, and SF-12v2 between users and nonusers of MT4C from baseline to three months. Interview data were analyzed using content analysis and integrated with quantitative data at the result stage. Results: Of the 101 participants at baseline, 9 (9%) withdrew from the study, leaving 92 participants at three months of which 72 (78%) used MT4C at least once; 20 (22%) participants did not use it at all. At baseline, there were no statistically significant differences in demographic characteristics and in outcome variables (HHI, GSES, and SF-12v2 mental component score and physical component score) between users and nonusers. At three months, participants who used MT4C at least once during the three-month period (users) reported higher mean GSES scores (P=.003) than nonusers. Over time, users had significantly higher GSES scores than nonusers (P=.048). Reasons for nonuse of MT4C included the following: caregiving demands, problems accessing MT4C (poor connectivity, computer literacy, and navigation of MT4C), and preferences (for paper format or face-to-face interaction). Conclusions: Web-based interventions, such as MT4C, have the potential to increase the self-efficacy of carers of persons with ADRD and MCC. Future research with MT4C should consider including educational programs for computer literacy and providing alternate ways to access MT4C in addition to Web-based access. Trial Registration: ClinicalTrials.gov NCT02428387; https://clinicaltrials.gov/ct2/show/NCT02428387
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Interventions to support carers were limited.
“Interventions to support carers were limited, though online self-care education showed potential to improve mental health, wellbeing, and self-efficacy, helping carers feel more confident in their roles, and supported higher engagement in patient-focused interventions (CMOC30) [28, 44, 52, 63, 68, 100, 101].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [63]
The Introduction says web-based interventions to support family carers are increasingly available, rather than describing interventions as limited. It identifies limited interaction with other carers as a concern, but that is a limitation of the interventions, not a claim that interventions themselves were limited. (LLM, conf=0.77)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredExisting structures that had been adapted for dementia reported some improvement in preparing carers to support the patient's needs during transitions, but often neglected to provide health and wellbeing support for the carer.
“Existing structures that had been adapted for dementia (e.g., online education programmes) reported some improvement in preparing carers to support the patient’s needs during transitions, but often neglected to provide health and wellbeing support for the carer [28, 44, 52, 63, 68, 100, 101].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [63]
The Introduction (page unavailable) says the web-based intervention was developed to help carers manage significant transitions, but it does not report improved preparation to meet patients’ needs. More importantly, it describes increased carer mental health as an outcome of web-based interventions and reports increased hope with My Tools 4 Care, contrary to portraying the cited intervention as neglecting carers’ wellbeing. (LLM, conf=0.82)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOnline self-care education showed potential to improve mental health, wellbeing, and self-efficacy, helping carers feel more confident in their roles, and supported higher engagement in patient-focused interventions.
“Interventions to support carers were limited, though online self-care education showed potential to improve mental health, wellbeing, and self-efficacy, helping carers feel more confident in their roles, and supported higher engagement in patient-focused interventions (CMOC30) [28, 44, 52, 63, 68, 100, 101].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [63]
The Introduction (page unavailable) reports that web-based interventions for family carers have shown positive mental-health and self-efficacy outcomes. The Discussion > General Self-Efficacy section (page unavailable) reports increased self-efficacy among users of this intervention and describes it as confidence in dealing with difficult situations. This paper does not establish improved wellbeing from its intervention or report that it increased engagement in patient-focused interventions; its Results (page unavailable) found no significant user–nonuser difference in measured health-related quality of life. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPost-discharge follow-up was linked to carers understanding of condition management, and confidence to support the patient's needs.
“Post-discharge follow-up was linked to carers understanding of condition management, and confidence to support the patient’s needs [28, 44, 53–55, 58–60, 62–65].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [63]
The Results and Discussion report higher general self-efficacy among carers who used the MT4C web intervention, but do not link that confidence to post-discharge follow-up or to understanding condition management. Searches for post-discharge follow-up and condition-management understanding found no passage addressing the claimed relationship. Page numbers were not available in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Duggleby, W., Ploeg, J., McAiney, C., Fisher, K., Jovel Ruiz, K., Ghosh, S., Peacock, S., Markle-Reid, M., Williams, A., Triscott, J., & Swindle, J.
- Affiliations
- University of Alberta (CA)
- McMaster University (CA)
- University of Waterloo (CA)
- Alberta Health Services (CA)
- University of Saskatchewan (CA)
- Corresponding author
- Duggleby, Wendy
- ORCID
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2019-10-17
- Volume
- 21
- Issue
- 10
- Pages
- e14254
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC6913509
- OpenAlex
- W2980600478
- Cited by
- 22
- References
- 32
- Citations by year
- 2026: 2 · 2025: 6 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Alzheimer Society
- University of Alberta
- Canada Research Chairs
- Canadian Institutes of Health Research (128261_1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- online intervention, caregiver burden, Alzheimer's disease and related dementias, hope, self-efficacy, health-related quality of life, multimorbidity, older adults, caregiver transition, Herth Hope Index, General Self-Efficacy Scale, SF-12v2, user feedback
- MeSH terms
- Multiple Chronic Conditions, Internet-Based Intervention, Aged, Aged, 80 and over, Alzheimer Disease, Dementia, Female, Humans, Male, Quality of Life, Caregivers
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