title: Development and Initial Evaluation of the Web-Based Self-Management Program "Partner in Balance" for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study.
abstract: BACKGROUND
  People with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost.
  
  
  OBJECTIVE
  This study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program's feasibility and report preliminary data on effectiveness.
  
  
  METHODS
  Based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention.
  
  
  RESULTS
  The different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed "Partner in Balance" program. At the start, system failures resulted in a high noncompleter rate (7/17, 41%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising.
  
  
  CONCLUSIONS
  Adaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and preliminary effectiveness is a valuable step toward examining the effectiveness of this newly developed intervention.
  
  
  BACKGROUND
  Dutch Trial Register (NTR): NTR4217; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4217 (Archived by WebCite at http://www.webcitation.org/6f6B8lvRP).
authors.affiliation: School for Mental Health and Neurosciences and Alzheimer Centre Limburg, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands. l.boots@maastrichtuniversity.nl.
authors.forename: Lizzy Mm
authors.identifier: http://orcid.org/0000-0002-8309-4502
authors.initials: LM
authors.lastname: Boots
authors.forename: Marjolein E
authors.identifier: http://orcid.org/0000-0002-2113-4134
authors.initials: ME
authors.lastname: de Vugt
authors.forename: Hanneke Ej
authors.identifier: http://orcid.org/0000-0003-1769-8313
authors.initials: HE
authors.lastname: Withagen
authors.forename: Gertrudis Ijm
authors.identifier: http://orcid.org/0000-0002-7053-2198
authors.initials: GI
authors.lastname: Kempen
authors.forename: Frans Rj
authors.identifier: http://orcid.org/0000-0002-8307-8406
authors.initials: FR
authors.lastname: Verhey
keywords: Internet; carers; dementia; focus groups; psychosocial support systems