Abstract
Abstract Demands placed on informal caregivers can result in an increased likelihood of experiencing common mental health difficulties that may affect their ability to undertake the caring role. Currently, however, few evidence-based interventions have been specifically developed for informal caregivers and available interventions are difficult to access. The Improving Access to Psychological Therapies (IAPT) programme aims to improve access to evidence-based psychological therapies for all groups and may therefore present an opportunity to meet informal caregiver needs. Located within the MRC Complex Intervention Framework, a Phase II feasibility randomised controlled trial (RCT) examines key methodological, procedural and clinical uncertainties associated with running a definitive Phase III RCT of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. Recruitment was low despite different recruitment strategies being adopted, highlighting significant challenges moving towards a Phase III RCT until resolved. Difficulties with study recruitment may reflect wider challenges engaging informal caregivers in psychological interventions and may have implications for IAPT services seeking to improve access for this group. Further attempts to develop a successful recruitment protocol to progress to a Phase III RCT examining effectiveness of the adapted CBT self-help intervention should be encouraged. Key learning aims After reading this article, readers should be able to: (1) Consider key feasibility issues with regard to recruitment and attrition when running a randomised controlled trial of an adapted written cognitive behavioural therapy (CBT) self-help intervention for informal caregivers of stroke survivors. (2) Understand potential barriers experienced by an informal caregiving population to accessing psychological interventions. (3) Appreciate implications for clinical practice to enhance access to IAPT services and low-intensity CBT working with an informal caregiver population.
Highlights
Stroke commonly occurs in people from late middle age and represents a leading cause of mortality and disability worldwide (Johnson et al, 2019)
Provision of informal care is associated with greater risk of poor physical health (Hiel et al, 2015) and mental health (Haley et al, 2015) in informal caregivers themselves, with pooled prevalence rates of 40.2 and 21.4% found for depressive and anxiety-related symptoms, respectively (Loh et al, 2017)
Located within Phase II of the Medical Research Council (MRC) Complex Interventions Framework (Craig et al, 2008), this study examined the feasibility of conducting an randomised controlled trial (RCT) comparing an adapted cognitive behavioural therapy (CBT) self-help
Summary
Stroke commonly occurs in people from late middle age and represents a leading cause of mortality and disability worldwide (Johnson et al, 2019). Significant physical, emotional, cognitive and behavioural impairment associated with stroke places large demands on stroke survivors (Lui and Nguyen, 2018), alongside wider society and the economy (Dunbar et al, 2018; Johnson et al, 2019). Given these long-term impairments, support is often provided by informal caregivers in the home (Sumathipala et al, 2012). The need for evidence-based psychological interventions to support the long-term mental health needs of informal caregivers of stroke survivors is justified. The long-term mental health needs of informal caregivers have been neglected (Silva et al, 2013; Simon et al, 2009)
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