Intervenções para Promover a Saúde Mental Positiva em Cuidadores Familiares: Uma Revisão Sistemática

Alpuim-Gonçalves, Sandra Marisa Barbosa de; Soares, Vânia Lídia da Silva; Querido, Ana Isabel Fernandes; Tomás, Catarina Cardoso Cardoso; Andrade, Carmen Maria da Silva Maciel

doi:10.1590/0034-7167-2024-0622

person Sandra Marisa Barbosa de Alpuim-Gonçalves

conception or design of the study/research · to the analysis and/or interpretation of data · to the final review with critical · intellectual participation in the manuscript

schoolISAVE - Higher Institute of Health. Amares, Braga, Portugal

0000-0003-0020-6538

person Vânia Lídia da Silva Soares

conception or design of the study/research · to the analysis and/or interpretation of data · to the final review with critical · intellectual participation in the manuscript

schoolUniversidade do Porto. Porto, Portugal

0000-0001-6156-7869

person Ana Isabel Fernandes Querido

conception or design of the study/research · to the analysis and/or interpretation of data · to the final review with critical · intellectual participation in the manuscript

schoolInstituto Politécnico de Leiria. Leiria, Portugal

0000-0002-5021-773X

person Catarina Cardoso Cardoso Tomás

conception or design of the study/research · to the analysis and/or interpretation of data · to the final review with critical · intellectual participation in the manuscript

schoolInstituto Politécnico de Leiria. Leiria, Portugal

0000-0003-3713-3352

person Carmen Maria da Silva Maciel Andrade

conception or design of the study/research · to the analysis and/or interpretation of data · to the final review with critical · intellectual participation in the manuscript

schoolUniversidade dos Açores. Ponta Delgada, Portugal

0000-0002-4483-8396

Corresponding author: Sandra Marisa Barbosa de Alpuim-Gonçalves, E-mail:
sandra.alpuim@isave.pt

EDITOR-IN-CHIEF:

Dulce Barbosa

ASSOCIATE EDITOR:

Mitzy Danski

Research Strategy Scopus (June 30, 2022)		Results
S1	“mental health” OR “mental hygiene” OR “positive mental health” OR “positive psychology” OR “psychology, positive” OR “well-being” OR “mental well-being” OR “life satisfaction” OR “subjective well-being” OR “psychological well-being” OR “social well-being” OR “personal satisfaction”	(N=242,614)
S2	famil^* OR Caregiver^* OR “Informal caregiver^” OR Carer^ OR “Spouse caregiver^*”	(n=595,860)
S3	“Mental Health Literacy” OR “Health literacy”	(n=11,851)
S4	Intervention^* OR Program^* OR Promotion^* OR Impact^* OR Program development OR Home Health Nursing OR “Evidence-Based Nursing”	(n=9,640)
S5	S1 AND S2 AND S3 AND S4	(n=4)

Author/ year	Study design	Intervention	Instruments	Outcomes assessed	Domains of health literacy assessed	Results
Jiang et al. 2024(¹⁷)	Pilot study design	Programme (C2C)	Dmographic questionnaires and evaluation questionnaires	Knowledge and skills development, self-care ability, trainer engagement and training content	Not reported	Results showed that their caregiving knowledge, skills and selfcare ability were improved and the positive effects were maintained above baseline over the course of C2C and at 2-month follow-up Participants gained significant support from other caregivers and healthcare professionals
Mousaei et al., 2023 (¹⁸)	Quasi-experimental study	Family-centered empowerment model (FCEM)	Demographic information questionnaire and Zarit caregiver burden inventory, including 22 questions about the burden imposed by a caring a patient on the caregiver and the responses are based on Likert scale (never = 0, rarely = 1, sometimes = 2, often = 3, and always = 4).	Level of care burden	Not reported	Intervention was effective in the changes of care burden scores (p < 0.036) and the interaction between time and treatment was not significant (p < 0.053). No statistically significant difference between the two groups (intervention and control) in terms of the care burden mean scores (p < 0.225)
Laine et al., 2021(²⁰)	Parallel mixed methods study design	Web-based psychoeducation course	Assessment of participants activity on the learning platform. Number of caregivers visiting every module and the number of finalized module tasks (calculated manually) Written feedback about course and the website were asked to participants Sociodemographic Information	Caregivers’ engagement Feedback about the course	Not reported	The web-based psychoeducation course for caregivers seems to be especially suitable for those who have little experience as a caregiver. Less than two-thirds (18/30, 60%) completed the course. Feedback on the course varied: over half (10/17, 59%) of the caregivers considered the content to be very good or good, about half (9/17, 53%) considered the website layout to be good, only 6% (1/17) felt that the usability of the website was poor, and no one felt that it was very poor.
Ferré-Grau et al., 2021(¹⁵)	RCT	TIVA App	Positive Mental Health Questionnaire (PMHQ) Zarit Caregiver Burden Interview (ZBI-7).	Caregivers’ outcomes: Positive mental Health; Caregiver burden.	Not reported	Positive mental health: Personal factor (factor 1 of the PMHQ): showed a significant difference between the groups, but it was not clinically relevant (0.96; p=0.03). IG obtained a higher mean change for the overall PMHQ score (mean change between groups:1.40; p=0.24); after the third month of the intervention showed an increment of PMHQ scores. The mean difference of change in the PMHQ score showed a significant difference between the groups (11.43; p<.001; d=0.82); were reported significant changes in 5 of the 6 factors, especially: (F 5) Problem solving and self-actualization (5.69; p<0.001; d=0.71), (F2) Prosocial attitude (2.47; p<0.001; d=1.18), and ( F3)Self-control (0.76; P=.03; d=0.50). Caregiver burden: results showed a decrease in caregiver burden in the intervention group.
Krieger et al., 2020(¹⁹)	Mix Study	Via outreach counselling	Two instruments were developed using the inputs of a combined stakeholder and risk analysis A semi-structured questionnaire measured health literacy and psychosocial health using 21 items on a five-point Likert scale (1 ‘very negative’ to 5 ‘very positive’). Health literacy was assessed using Freebody and Luke’s (1990) framework: Functional Health Literacy (3 items) Interactive Health Literacy (3 items) Critical Health Literacy (5 items) For psychosocial health, six items measured ‘sense of certainty’ and four items assessed ‘life balance’. Additionally, semi-structured face-to-face interviews with a caregiver subgroup underwent content analysis.	Caregivers’ health literacy and psychosocial health	Three indices of caregivers’ health literacy: Functional HL (knowledge); Interactive HL (capability to act); Critical HL (individual empowerment).	Individual Outcomes: Caregivers showed significant improvements in Functional Health Literacy (knowledge), Interactive Health Literacy (capability to act), and Critical Health Literacy (empowerment). Improvements in functional (p=0.000) and interactive (p=0.000) health literacy were statistically significant. Additionally, caregivers reported better psychosocial health. They demonstrated enhanced stroke-specific knowledge and capability to act, with professionals noting increased individual empowerment. System-Level Outcomes: From the professionals’ perspective, the program influenced their routines, inter-institutional support, patient care quality, and cooperation. It also increased their awareness of the complexity of caregivers’ needs.
Heckel et al., 2018(¹⁶)	RCT	PROTECT	Zarit Burden Interview; Centre of Epidemiologic Studies - Depression scale (CES-D); Supportive Care Needs Survey for Partners & Caregivers (SCNS-P&C); Supportive Care Needs Survey (SCNS-SF34); Health Literacy Questionnaire (HLQ); Health education impact Questionnaire (heiQ); Self-esteem subscale of the Caregiver Reaction Assessment (CRA); Self-designed utility assessment.	Caregivers’ outcomes: caregiver burden; unmet needs; self-empowerment and health literacy; self-esteem; depressive symptoms; caregiver risk for depression. Patients’ outcomes: depressive symptoms, unmet needs; health literacy.	HLS Health literacy: S1 - feeling understood and supported by healthcare providers; S2 - having sufficient information to manage my health; S3 - actively managing my health; S4 - social support for health; S5 - appraisal of health information; S6 - ability to actively engage with health care providers; S7 - navigating the health care system; S8 - ability to find good health information; S9 - understanding health information well enough to know what to do.	Caregiver outcomes: Caregiver burden: no effect was observed after intervention p= 0.921; Caregiver unmet: reduction after intervention in both groups(IG baseline, mean = 2.66, 95% , CI [1.91-3.54]; group 1 month post intervention, mean = 0.85, 95%CI [0.42-1.44]; control group baseline, mean = 1.30 95%CI [0.80-1.94]; control group 1 month post intervention, mean = 1.02 95%CI [0.52-1.69]; p = 0.023); Caregiver self-esteem: decline in both groups from baseline to months 1 and 6 (p= 0.045). No significant difference between the groups over the time (p= 0.320). Caregivers risk for depression: caregivers at risk had a significant effect on having sufficient information to manage their health (p = 0.040); patients’ depressive symptoms, unmet needs; self-empowerment and health literacy levels no significant effects were found. Patient outcomes: No significant differences between groups on patients’ depressive symptoms, unmet needs and health literacy
Ferré-Grau et al., 2013(¹¹)	RCT	ATDOM (home care program) + PST (problem-solving technique)	Questionnaire ‘Ad-Hoc’ (socio-demographic characteristics and care); Goldberg Scale - anxiety and depression in family caregivers.	Caregivers’ outcomes: Depression and anxiety.	Not reported	Caregiver outcomes: Statistically significant improvement in symptom of anxiety (p<0.05) and depression (p<0.01) after intervention.