Revisão metodológica, usabilidade do iSupport-Brasil e associação com a sobrecarga em cuidadores informais de pessoas que vivem com demência

Abstract

Introduction: iSupport is an online intervention program designed to support informal caregivers of people living with dementia. Objectives: To conduct a methodological review of iSupport for dementia; to analyze the usability of iSupport-Brazil among caregivers of people living with dementia; and to examine the association between usability and burden. Three studies were conducted: (1) an analysis of published articles on the adaptation, testing, and use of iSupport for dementia; (2) an analysis of the usability of iSupport-Brazil among informal caregivers participating in a randomized clinical trial; and (3) Analysis of the association between usability and caregiver burden. Methods: In Study 1, a systematic review was conducted (PROSPERO CRD42022343168), including articles published up to February 2024 in the Virtual Health Library, PubMed, EMBASE, and Scopus. For Studies 2 and 3, data from a randomized clinical trial (RBR-22cv4kv) were used. Participants in the intervention group (n = 87) had access to the program for three months and were assessed at pre- and postintervention. Data were collected using the Sociodemographic and Care Characteristics Questionnaire, Platform Use Questionnaire, System Usability Scale (SUS), Zarit Burden Interview, Quality of Life – Alzheimer Disease (QoL-AD), and the Hospital Anxiety and Depression Scale (HADS). Descriptive and exploratory analyses were conducted, and structural equation models and Poisson regression analyses were performed using SAS 9.4. Results: In the review study, 10 articles on the cultural adaptation of iSupport were identified, along with eight randomized clinical trial protocols and two studies reporting preliminary results. In Studies 2 and 3, the mean age of caregivers was 52.4 years (SD = 10.21); most were female (90.1%), had 12 or more years of education (89.7%), were sons or daughters (69%), provided care six to seven days per week (73.6%), and 39.1% provided care for more than 13 hours per day. Most participants presented some level of burden (94.3%) and symptoms of anxiety (64.4%), with 48.3% experiencing moderate to severe burden. In Study 2, the usability scale showed a mean score of 72.38 (SD = 16.2), indicating good usability. Moreover, 34.7% of lessons were completed, and 75.6% of participants completed at least one module. The program met the expectations of most participants (86.9%), and 96.4% would recommend it. In Study 3, results showed a significant effect on burden (p < 0.01) and anxiety symptoms (p = 0.02) at post-intervention. In the structural equation model, anxiety (β = 1.47; p < 0.01) and quality of life (β = −0,70; p < 0.01) were directly associated with burden. Age (β = −0.29; p < 0.01), percentage of completed lessons (β = 0.20; p < 0.01), and quality of life (β = 0.58; p < 0.01) were directly associated with usability. Caregivers with good usability (SUS ≥ 68) had a 3.85 times higher prevalence ratio (PR = 3.85; 95% CI: 1.4–10.65; p = 0.01) of improving or maintaining minimal levels of burden compared to those with scores < 68. Conclusion: iSupport-Brazil proved to be a useful program with good usability and a predictor of improvement or maintenance of minimal levels of caregiver burden. It is a viable tool for public policies in dementia care.