Results of a feasibility and adaptation study of a mobile application “CareFit”: supporting physical activity for informal carers of people with dementia

Background:

Health and social care models worldwide are facing perpetual crisis where the informal (family) caring role is becoming increasingly pivotal. Despite unparalleled societal and economic value, many informal carers face poor mental and physical health with limited opportunities for physical activity. There remains an urgent need to understand and support informal carers to stay well, including evidence based physical activity approaches.

Objective:

To codesign, adapt and explore the feasibility of a novel cross-platform approach to support physical activity in carers of people with dementia.

Methods:

This was a mixed-methods codesign, development and evaluation study of a smartphone app (CareFit) to support physical activity for unpaid dementia carers. We explored implementation of CareFit for carers, guided by both ‘RE-AIM’ and MRC Complex Intervention Frameworks in two stages: (i) codesign; (ii) feasibility study findings (i.e. recruitment, intervention and outcome selection). The codesign sessions for adaptation and expansion involved 3 development sprints gaining feedback and identifying priority areas from a range of stakeholders (e.g. carers, support professionals, charities, researchers and developers). This was followed by an 8-week feasibility study with participants recruited from local and national networks alongside Join Dementia Research (JDR) using a closed-testing release app on Google and Apple app stores.

Results:

We successfully codesigned, developed and user tested the CareFit app. Codesign resulted in an expanded and adapted CareFit suitable for 8-weeks of use. Final app design included a simplified navigation system, increased video content alongside more personalised delivery of content. Feasibility study results highlighted the challenges of recruiting carers of people with dementia. In total 41 carers of people with dementia were recruited with 21 completing the 8-week study. Study retention was considerably lower for those carers undertaking high levels of physical activity at baseline opposed to those who were not (36% retention vs 58% respectively) providing useful information on the target group of future interventions. CareFit rated well on the System Usability Scale and we observed common user patterns of behaviour (e.g. an initial focus on ‘learn’ section). Most outcome measures were largely suitable for future use in this group- this included novel measures introduced by the research team around the number of sedentary breakers and muscle and balance activities.

Conclusions:

Physical activity in carers of people with dementia remains a largely unmet need. We conclude that our approach fits largely within the context of preventative medicine where presentation to carers at the ‘right’ time in their trajectory (i.e. early) is critical for adoption and long-term use. A major challenge remains around recruitment. Despite value recognised by stakeholders including carers, we cannot currently recommend progression to randomised control trial. Of future interest would be to build upon this work further to accumulate evidence on optimising the active ingredients of the intervention.