@article{41a995b64e26423fa215e089970bf03d,
title = "eHealth interventions to support caregivers of people with dementia may be proven effective, but are they implementation-ready?",
abstract = "Objectives: A variety of health services delivered via the Internet, or {"}eHealth interventions,{"} to support caregivers of people with dementia have shown evidence of effectiveness, but only a small number are put into practice. This study aimed to investigate whether, how and why their implementation took place.Methods: This qualitative study followed up on the 12 publications included in Boots et al.'s (2014) widely cited systematic review on eHealth interventions for informal caregivers of people with dementia, in order to explore further implementation into practice. Publicly available online information, implementation readiness (ImpRess checklist scores), and survey responses were assessed.Findings: Two interventions were freely available online, two were available in a trial context, and one was exclusively available to clinical staff previously involved in the research project. The remaining seven were unavailable. All scores on the ImpRess checklist were at 50% or lower of the total, indicating that the interventions were not ready to implement at the time of the Boots et al. (2014) review, though some interventions were scored as more implementation-ready in subsequent follow-up publications. Responses to the survey were received from six out of twelve authors. Key learnings from the survey included the importance of the involvement of stakeholders at all stages of the process, as well as the flexible adaptation and commercialization of the intervention.Conclusions: In general, low levels of implementation readiness were reported and often the information necessary to assess implementation readiness was unavailable. The only two freely available interventions had long-term funding from aging foundations. Authors pointed to the involvement of financial gatekeepers in the development process and the creation of a business model early on as important facilitators to implementation. Future research should focus on the factors enabling sustainable implementation.",
keywords = "Dementia, Caregiver, Internet, eHealth, Implementation, FAMILY CAREGIVERS, HEALTH INFORMATION, INTERNET, CARERS, TECHNOLOGY, ALZHEIMERS, BARRIERS, PROGRAM, DISEASE, ONLINE",
author = "Christie, {Hannah L.} and Martin, {Jennifer L.} and Jade Connor and Tange, {Huibert J.} and Verhey, {Frans R. J.} and {de Vugt}, {Marjolein E.} and Martin Orrell",
note = "Funding Information: This research was carried out as part of the H2020 Marie Sk{\l}odowska-Curie Actions Innovative Training Network (ITN) action, H2020-MSCA-ITN-2015, under grant agreement number 676265.The authors would like to thank Dr Lizzy Boots, for her cooperation and help accessing the included publications, and Dr Rosalie van Knippenberg, for her help in improving the first version of the survey. The authors especially wish to thank the authors who responded to the survey. This research was a collaboration between Mindtech and INDUCT (the Interdisciplinary Network for Dementia Using Current Technology). JM acknowledges the financial support of the NIHR Nottingham Biomedical Research Centre and NIHR MindTech MedTech Co-operative. Funding Information: In contrast to the pharmaceutical industry, there is no well-established mechanism for acquiring funding to market and implement eHealth interventions in practice. Hence, of the two interventions that were still available, both had received long-term, external aid from a funding body. Furthermore, the three additional interventions that were exclusively accessible through research also relied on long-term funding. Of course, having aid from national funding bodies was not a guarantee of enduring use - there were also interventions funded by these same types of funding bodies, which were no longer available. Indeed, most evidence-based interventions are funded by short-term, finite grants, centered around the creation of ever more new interventions, leading to the replication and eventual abandonment of increasingly similar interventions. In general, funding bodies focus on new development, rather than sustainability and long-term implementation, meaning most academically-developed interventions reach very few caregivers ( Gitlin et al., 2015 ). Interestingly, only one of the survey respondents mentioned this support from community and government organizations as a facilitator for long-term implementation, though lack of funding in general was mentioned as a barrier. In the theme {\textquoteleft}Iterative Development Process{\textquoteright}, a number of the surveyed authors pointed to the creation of a business model early on as important facilitator to implementation. However, the evidence suggests that none of the interventions from the Boots et al. (2014) review developed a self-sustaining, commercial business model, and were instead reliant on external funding. Conversely, there are many commercially-developed interventions on the market that are not scientifically tested for effectiveness ( Eysenbach et al., 2002 ). This is in part caused by the golden standard of randomized controlled trials (RCTs) for eHealth research. While RCTs do provide valuable insights to eHealth effectiveness and mechanisms, they are time-consuming, resource-intensive, and often lacking important, qualitative implementation data ( Vernooij-Dassen and Moniz-Cook, 2014 ). Much like this study's survey respondents, Baker et al. (2014) suggest considering alternative, more efficient research designs. Moreover, there are differing concepts of success for academically versus commercially-developed eHealth interventions: For researchers something is successful if it works, whereas for commercial parties something is successful if it sells. Another potential solution is for policy makers and funding bodies to dedicate more funding to the sustainability and long-term development of evidence-based eHealth interventions. Good examples of recent projects addressing these issues by focusing on improving accessibility of existing eHealth interventions through national implementation platforms include Sweden's Health Innovation Platform ( Brown, 2016 ), Spain's AppSalut ( European Innovation Partnership on Active and Healthy Ageing, 2017 ), and the UK's NHS and NICE collaboration (NHS England, 2018 ). In this regard, it is also important to note that so far this article has discussed {\textquoteleft}available interventions{\textquoteright}, rather than {\textquoteleft}implemented interventions{\textquoteright}. While availability can be assessed with an internet search, for an intervention to be called an {\textquoteleft}implemented intervention{\textquoteright}, the intervention should be not only proven-effective and available, but also show a good fit with a specific context on the basis of experiential findings concerning what might succeed in that context ( Community Tool Box, 2018 ). Thus, this good fit with clinical practice could also mean funding in routine care instead of funding from a research context. Funding Information: This research was carried out as part of the H2020 Marie Sk{\l}odowska-Curie Actions Innovative Training Network (ITN) action, H2020-MSCA-ITN-2015, under grant agreement number 676265 . Publisher Copyright: {\textcopyright} 2019 The Authors; 10th Scientific Meeting of the International-Society-for-Research-on-Internet-Interventions (ISRII) ; Conference date: 13-02-2019 Through 15-02-2019",
year = "2019",
month = dec,
doi = "10.1016/j.invent.2019.100260",
language = "English",
volume = "18",
journal = "Internet Interventions",
issn = "2214-7829",
publisher = "Elsevier BV",
}