A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors

Couchman, Abbey, Katangwe-Chigamba, Thando, Howe, David, Flanagan, Emma, Farquhar, Morag ORCID: https://orcid.org/0000-0001-7991-7679, Gould, Rebecca L., McCracken, Lance M., Clegg, Izobel, Anyiam-Osigwe, Adaku, Ashford, Polly-Anna and Kishita, Naoko ORCID: https://orcid.org/0000-0001-8453-2714 (2026) A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors. Aging and Mental Health. ISSN 1360-7863 (In Press)

PDF (Carer Process Evaluation Accepted Manuscript) - Accepted Version Restricted to Repository staff only until 31 October 2026. Available under License Unspecified licence. Request a copy

Abstract

Objectives: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes. Methods: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority). Results: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers’ perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers’ resonance with metaphors and case examples, and by their engagement with intervention content (e.g., note-taking) and therapists (e.g., therapeutic relationships). Conclusion: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.

Item Type:	Article
Additional Information:	Data Availability Statement: De-identified participant data will be made available upon request following publication of the trial results. Requests should be directed to the corresponding author and include the specific data fields required and the purpose of the request, ideally accompanied by a detailed protocol or, at minimum, a research plan. Requests will be reviewed on a case-by-case basis, and requestors will be required to complete a data-sharing agreement with the study sponsor prior to data transfer.
Uncontrolled Keywords:	acceptance and commitment therapy,process evaluation,mixed-methods,dementia,caregivers,online self-help,e-health
Faculty \ School:	Faculty of Medicine and Health Sciences > School of Health Sciences Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Mental Health and Social Care (fka Lifespan Health) Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit Faculty of Medicine and Health Sciences > Research Centres > Norwich Institute for Healthy Aging Faculty of Medicine and Health Sciences > Research Groups > Health Promotion Faculty of Medicine and Health Sciences > Research Centres > Public Health
Depositing User:	LivePure Connector
Date Deposited:	07 Jul 2026 16:42
Last Modified:	16 Jul 2026 23:02
URI:	https://ueaeprints.uea.ac.uk/id/eprint/103783
DOI:

Actions (login required)

View Item