Online interventions for dementia caregiver burden and self-efficacy: A systematic review and meta-analysis

There is growing interest in online psychosocial interventions to address burden and self-efficacy among informal caregivers of people with dementia. However, their effectiveness remains unclear, especially given ongoing debates and limited evidence of online delivery modes. We aimed to synthesize evidence on these online psychosocial interventions, highlight the current state of research, and identify priorities for future studies. A systematic review with meta-analyses was conducted. We included randomized controlled trials comparing online psychosocial interventions to usual care or waitlist control for burden and self-efficacy. Six electronic databases were searched for studies published over the last two decades. Two reviewers evaluated eligibility, extracted data, and assessed risk of bias and quality of evidence. Patient and Public Involvement, as a means to contextualise the results in the lived experience of caregivers, was employed to aid interpretation of the findings. The review protocol was registered in PROSPERO (CRD42023392232) Nineteen articles involving 2,264 participants were included. Of these, 15 reported caregiver burden, seven reported self-efficacy, and three studies reported both outcomes. Most interventions were multi-component online psychosocial programs delivered via web-based platforms, mobile applications, or videoconferencing tools. They incorporated asynchronous, synchronous, or blended delivery modes and were delivered either individually or in groups. Core components of the psychosocial intervention included information provision and education, caregiving tasks support, and caregiver self-care. Meta-analysis of 13 studies showed no statistically-significant post-intervention effect on reducing burden (Standardized Mean Difference [SMD]: −0.06, 95% Confidence Interval [CI]: −0.25, 0.12, p =0.50; I ² = 47%), yet analysis of three studies indicated an effect on improving self-efficacy (SMD: 0.20, 95% CI: 0.03, 0.37, p =0.02; I ² = 0%). The evidence grade for both outcomes was low due to risk of bias, inconsistency, and imprecision of the results. We suggest that online psychosocial interventions have little to no short-term effect on caregiver burden but may enhance self-efficacy, though the evidence grade remains low. Online psychosocial interventions featured diversity in their design, content, and delivery characteristics. From the findings, we have identified key areas for development of future research within this field, with a particular focus on addressing methodological limitations and ensuring rigorous design. Sustained support incorporating interactive and real-time elements, tailored approaches, and the integration of lived experience throughout the research process should be considered to improve both the effectiveness and relevance of these interventions. • Online psychosocial interventions can promote positive psychological outcomes for informal caregivers of people with dementia. • Despite the rapid acceleration in the development and implementation of online psychosocial interventions, there is limited evidence on their impact on caregiver burden and self-efficacy among informal caregivers of people with dementia. • Online psychosocial interventions showed no statistically-significant reduction in caregiver burden but demonstrated a positive effect on caregiver self-efficacy. • We have highlighted essential areas for advancing future research in this field, emphasizing the need to enhance methodological rigor and outlining key factors that could contribute to improving the effectiveness of online psychosocial interventions.