ESR14: Implementing eHealth psychological support for informal carers: a pragmatic realist complex intervention approach

Work package 3
ESR Chelsea Coumoundouros
Supervisor Prof. Louise von Essen
Co-supervisor Prof. Robbert Sanderman
Host institution Uppsala Universitet, Sweden
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Objectives: To follow Phase I (development) and II (feasibility) of the Medical Research Council (MRC) Complex Interventions Framework, utilising a pragmatic realist approach. The ESR project aims to further adapt and examine the feasibility and acceptability of an eHealth solution within varying real-world practice contexts.

Access to psychological support across Europe is limited. Potential explanations for poor access include carer level barriers (e.g., lack of time, competing demands) and a lack of appropriately trained professionals to deliver traditional psychological support. A potential solution resides in eHealth solutions, providing not only psychological support, but facilitating communication between all professionals involved in care and assisting complex health and social care navigation. However, much of the existing evidence base for eHealth solutions has been generated in artificial research settings. As such, there is a lack of knowledge concerning real-world delivery e.g., needs for adaptation across varying healthcare settings/professionals/carer subgroups/cultures, barriers and facilitators to implementation, and factors associated with long-term sustainability across diverse contexts. The eHealth solution itself represents an integration of a psychological treatment for carers developed in the UK (CEDArS) with the U-CARE portal, which delivers eHealth interventions to chronic health populations and family members. The ESR will utilise pragmatic realist methods (formative case studies; pragmatic formative process evaluation; realist feasibility study) to: (1) adapt the ehealth solution for delivery within diverse real-world healthcare settings alongside key stakeholders (carers, care recipients, healthcare professionals, industry); (2) develop an understanding of barriers and facilities to implementation; (3) appreciate variations in implementation across contexts, including factors that may compromise intervention integrity; and (4) identify factors associated with the long-term intervention sustainability.

Expected Results:

(1) the development of an eHealth solution easily adapted for implementation within different routine healthcare settings, both within and across countries, thereby increasing utility and acceptability for policy makers, professionals, carers and care recipients; and (2) guideline development to facilitate real-world intervention adaptation and implementation, taking into account diverse needs and contexts, that could be utilised by countries across Europe to further adapt the eHealth solution for future scale-up within their own healthcare settings.


Coumoundouros, C., Mårtensson, E., Ferraris, G., Zuidberg, J. M., von Essen, L., Sanderman, R., & Woodford, J. (2022). Implementation of e–Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis. JMIR Mental Health, 9(11), e41891. DOI:10.2196/41891

Mårtensson, E., Coumoundouros, C., Sörensdotter, R., von Essen, L., & Woodford, J. (2022). Psychological interventions for symptoms of depression among informal caregivers of older adult populations: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders.

Coumoundouros, C., Farrand, P., Hamilton, A., & Woodford, J. (2022). Partners in care: who’s supporting the supporters. Kidney Matters. Issue 16. Pg 10-11.

Svedin, F., Brantnell, A., Farrand, P., Blomberg, O., Coumoundouros, C., von Essen, L., Åberg, A. C., & Woodford, J. (2021). Adapting a guided low-intensity behavioural activation intervention for people with dementia and depression in the Swedish healthcare context (INVOLVERA): a study protocol using codesign and participatory action research.
BMJ Open, 11(7), e048097.

Coumoundouros, C., Mårtensson, E., Ferraris, G., von Essen, L., Sanderman, R., & Woodford, J. (2020). Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases: a systematic review.
Implementation Science, 15(Suppl 4), P10.

Coumoundouros, C., von Essen, L., Sanderman, R., & Woodford, J. (2020). Implementation of e-mental health interventions for informal caregivers of adults with chronic diseases: a protocol for a mixed-methods systematic review with a qualitative comparative analysis.
BMJ Open, 10(6), e035406.

Farrand P, Woodford J, Coumoundouros C, & Svedin F. (2020). Supported cognitive-behavioural therapy self-help versus treatment-as-usual for depressed informal caregivers of stroke survivors (CEDArS): Feasibility randomized controlled trial.
Cogn Behav Ther. 13:e24.

Coumoundouros C, Ould Brahim L, Lambert SD, McCusker J. (2019). The direct and indirect financial costs of informal cancer care: A scoping review.
Health Soc Care Community. 27(5):e622-e636.


Host Secondment supervisor Aim Duration
Chorus, Sweden Thomas Bergqwist To learn about product development in a commercial environment 3 months
University of Exeter, UK Prof. Paul Farrand On how to assess health technology 3 months