Fill the implementation gap: a mixed methods study of theory-based adaptation and implementation approaches and processes of a low-dose psychosocial intervention for caregivers

Informal caregivers are unpaid individuals who provide pivotal care, assistance, and treatment to a relative, a friend, or an acquaintance facing illness, disability, or any condition requiring support. In Switzerland, nearly one in 20 people are family caregivers. Caregiving may be associated with psychological distress and frequently leads to negative impacts on both mental and physical health outcomes. Addressing psychological distress is important not only for caregivers, but also for care recipients, and society at large. However, though several psychosocial interventions exist, they typically lack an explicit theory-base. Evidence on their effectiveness in reducing stress provides heterogeneous results, and implementability has been little investigated. The beneficial effects, implementability and sustainability of psychosocial interventions is largely dependent on their adaptation to the context, culture, and the preferences and values of caregivers. In this study we will focus on Doing What Matters in times of stress (DWM), an evidence- and theory-based psychosocial intervention developed by the WHO aimed at reducing stress and improving mental health.Overall objectives and specific objectives. The goal of this project is to advance knowledge on the effectiveness, adaptation, implementability, and scalability of DWM. We have several aims: a) to systematically collect and meta-analyze all available evidence on implementation outcomes and measures in studies delivering psychosocial interventions to informal caregivers; b) to capture whether psychosocial interventions for caregivers were theory-driven, and which were the most widely adopted; c) to culturally and contextually adapt DWM with and for informal caregivers in Ticino; d) to identify barriers and facilitators for the implementability of the intervention; e) to generate preliminary evidence on the effectiveness of the adapted version of DWM in informal caregivers; f) to explore the hypothesis, based on Bandura’s Social Cognitive Theory (SCT) that poor social network and interactions, and low self-efficacy have an impact on the effectiveness of DWM; g) finally, we seek to explore the implementability features (e.g., acceptability, adoption, appropriateness, feasibility, fidelity) of DWM. Methods. For study 1 we will design and conduct a systematic review and meta-analysis according to the Cochrane standards. For study 2 and 3 we will use mixed methods, and a combination of participatory action research. Adaptation will follow WHO recommendations, and we will conduct qualitative research to identify barriers and facilitators for the implementation of the intervention. For study 3 we will conduct a within-subjects, pre-post quasi-experiment to formally assess the efficacy and implementability of DWM in caregivers.Expected results and Impact. We expect to contribute to advance knowledge in a crucial field of research: consolidation of evidence on the effectiveness of, adaptability, and implementability strategies, outcomes, and measures of an evidence-based psychosocial intervention to reduce stress and improve the mental health of caregivers. Our results can have relevant implications for caregivers, their family and communities, for policy action, and for social sciences, and the rapidly growing field of implementation research.