Background: Physical activity is a critical component of both well-being and preventative health, reducing the risk of both chronic mental and physical conditions and early death. Yet, there are numerous groups in society who are not able to undertake as much physical activity as they would like to. This includes informal (unpaid) carers, with the United Kingdom national survey data suggesting that 81% would like to do more physical activity on a regular basis. There is a clear need to develop innovations, including digital interventions that hold implementation potential to support regular physical activity in groups such as carers. Objective: This study aims to expand and personalize a cross-platform digital health app designed to support regular physical activity in carers of people with dementia for a period of 8 weeks and evaluate the potential for implementation. Methods: The CareFit for dementia carers study was a mixed methods co-design, development, and evaluation of a novel motivational smartphone app to support home-based regular physical activity for unpaid dementia carers. The study was planned to take place across 16 months in total (September 1, 2022, to December 31, 2023). The first phase included iterative design sprints to redesign an initial prototype for widespread use, supported through a bespoke content management system. The second phase included the release of the “CareFit” app across Scotland through invitations on the Apple and Google stores where we aimed to recruit 50 carers and up to 20 professionals to support the delivery in total. Partnerships for the work included a range of stakeholders across charities, health and social care partnerships, physical activity groups, and carers’ organizations. We explored the implementation of CareFit, guided by both Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and the Complex Intervention Frameworks. Results: Project processes and outcomes were evaluated using mixed methods. The barriers and enablers for professional staff to signpost and use CareFit with clients were assessed through interviews or focus groups and round stakeholder meetings. The usability of CareFit was explored through qualitative interviews with carers and a system usability scale. We examined how CareFit could add value to carers by examining “in-app” data, pre-post questionnaire responses, and qualitative work, including interviews and focus groups. We also explored how CareFit could add value to the landscape of other online resources for dementia carers. Conclusions: Results from this study will contribute new knowledge including identifying (1) suitable pathways to identify and support carers through digital innovations; (2) future design of definitive studies in carer populations; and (3) an improved understanding of the Reach, Effectiveness, Adoption, Implementation, and Maintenance across a range of key stakeholders.
Background: Informal carers are critical in looking after people with dementia. The value of all informal care as a total in the United Kingdom is now estimated to be £184 billion (US $249 billion). However, many carer groups are inadequately supported and face poor mental and physical health with limited opportunities for physical activity. There is a public health priority to address such challenges and a lack of innovation regarding approaches to promote physical activity. Objective: This study aimed to co-design, adapt, and explore the feasibility of a novel cross-platform approach to support physical activity among carers of people with dementia. Methods: Project stages included a co-design phase followed by a feasibility study guided by both the reach, effectiveness, adoption, implementation, and maintenance and Medical Research Council complex intervention frameworks. Co-design involved 3 development “sprints,” gaining feedback from a range of stakeholders (eg, carers, support professionals, charities, researchers, and developers) and identifying priority areas. Our feasibility study involved the evaluation of our recruitment, intervention, and outcome approaches over 8 weeks (target population: N=50) with participants. Participants were recruited from local community networks in Scotland as well as research study registries. Results: We successfully co-designed, developed, and user tested the CareFit app. Final app design included a simplified navigation system and increased delivery of video content as well as a more personalized delivery approach. In total, 41 carers of people with dementia were recruited, with 21 (51%) completing the 8-week study. Study retention was considerably lower for carers with higher levels of physical activity at baseline as opposed to those with lower levels (5/14, 36% vs 16/27, 59%, respectively). CareFit was rated as “acceptable” on the System Usability Scale, and we observed common user patterns of behavior (eg, an initial focus on the Learn section). The feasibility study results demonstrated that the intervention appeared safe for use (no adverse events reported) and the video content for carers was well received. A greater depth of social elements appears critical for future development. Although professional stakeholders did not reach consensus on the outcome of greatest utility, the outcome measures tested were largely suitable for future use in this group, including novel sedentary behavior and muscle and balance measures. Conclusions: Many carers of people with dementia do not have the same access to physical activity as noncarers. Our findings show key challenges regarding recruitment and retention. Although we cannot currently recommend progression to a randomized controlled trial, we conclude that further work is needed to better understand the “active ingredients” of the intervention outlined. This includes exploring the delivery of a preventative intervention earlier in the carer trajectory—something critical for adoption and long-term use.