Effects of e-Health Training and Social Support Interventions for Informal Caregivers of People with Dementia—A Narrative Review

Round 1

Reviewer 1 Report

This is an interesting survey on the much-needed attention to IC of PwD. 

There are several issues that must addressed with this paper

1.- The organization of section 3 is quite messy. It would be nice if the authors could previously identify the different axes of presentation of results and then follow that structure.

2.- I do no think section 3.1.1 and 3.1.2 are relevant as they describe tools oriented towards the care of PwD more than supporting tools for ICs

3.- It is very important to describe the samples used in each article reviewed. It is mentioned that most ICs are 60+ and women. This should be further elaborated providing detailed information on the IC samples. Another important data is where the studies were carried out, which country or regions as this may influence the previous training or even the social and economic situation of the IC. It is also not mentioned whether ICs are professionals or relatives. As summary a deeper elaboration of the IC sample is required. I suggest to include a table with that info

3.- Most of the supporting tools are training platforms and/or forums. I suggest to include a table with the main features of each platform and provide specific information on the functionalities they provide for IC Social Support, not only for their training in caregiving

4.- The main conclusion is that we should reuse existing social networks like Facebook or whatsup for IC SS. Is this a personal opinion of the authors? Is this a common recommendation in the papers analysed. In general I do not find that the conclusions are solidly based on the results and discussion.

5.- Meaning of SS should be included already in the abstract

6.- It should be made clear from the abstract even the title that training and forums are the main tools that exist for IC SS.

7.- I do not think that the reviewed papers showed the effect of COVID. I suggest to remove the references to COVID as there is no proper analysis on how it influnced the situation of ICs beyond what we all may think.

Author Response

This is an interesting survey on the much-needed attention to IC of PwD. 

There are several issues that must addressed with this paper

1.- The organization of section 3 is quite messy. It would be nice if the authors could previously identify the different axes of presentation of results and then follow that structure.

Authors’ response: following the suggestion by reviewer 1, we have included a paragraph explaining how the results section is organized: “The results chapter is divided into two sections: the first section (3.1 to 3.1.3) provides results regarding tools used for training ICs in caregiving situations, whereas the second section (3.2 to 3.2.5) provides results regarding online interventions focused on improving SS for ICs of PwD.”

2.- I do no think section 3.1.1 and 3.1.2 are relevant as they describe tools oriented towards the care of PwD more than supporting tools for ICs

Authors’ response: we agree with reviewer 1 that these two methods are the most basic ones regarding supporting tolls for IC. However, their impact on IC has been analyzed, and thus we consider that they should be at least mentioned in our work. Thus, we prefer to keep that information in the paper.

3.- It is very important to describe the samples used in each article reviewed. It is mentioned that most ICs are 60+ and women. This should be further elaborated providing detailed information on the IC samples. Another important data is where the studies were carried out, which country or regions as this may influence the previous training or even the social and economic situation of the IC. It is also not mentioned whether ICs are professionals or relatives. As summary a deeper elaboration of the IC sample is required. I suggest to include a table with that info

Authors’ response: we believe that reviewers did not have access to the tables provided as an appendix. We apologize for this.

3.- Most of the supporting tools are training platforms and/or forums. I suggest to include a table with the main features of each platform and provide specific information on the functionalities they provide for IC Social Support, not only for their training in caregiving

Authors’ response: we believe that reviewers did not have access to the tables provided as an appendix. We apologize for this. That information can be found in tables A1-A6.

4.- The main conclusion is that we should reuse existing social networks like Facebook or whatsup for IC SS. Is this a personal opinion of the authors? Is this a common recommendation in the papers analysed. In general I do not find that the conclusions are solidly based on the results and discussion.

Authors’ response: we thank reviewer 1 for pointing out this issue. Using platforms that ICs are familiar with is one of the recommendations found in the literature if the objective is to improve social communication. Thus, we would not like that readers take this message as the general conclusion. We have rephrased the text to highlight this message: “Lastly, with regards to the objective of online platforms focused on improving SS, it is suggested that these platforms include social networks that users are already familiar with (e.g., Facebook, Whatsapp) [40,63]”. “The literature reviewed in the present work suggests that platforms specifically developed for improving SS of ICs should be tools that caregivers are familiar with, because familiarity with the tools, along with the presence of a moderator in the intervention [40,44,60,61,69,73], might improve the results of e-health interventions for ICs of PwD”.

5.- Meaning of SS should be included already in the abstract

Authors’ response: it has been included. Also, a brief definition of the concept has been included at the beginning of section 3.2.

6.- It should be made clear from the abstract even the title that training and forums are the main tools that exist for IC SS.

Authors’ response: it has been included in the abstract (line 19). We did not include it in the title because we feel that it would give the impression that our review was planned to focus on forums and training tools (rather than being the findings of our review).

7.- I do not think that the reviewed papers showed the effect of COVID. I suggest to remove the references to COVID as there is no proper analysis on how it influnced the situation of ICs beyond what we all may think.

Authors’ response: we agree with reviewer 1 that papers did not show the effects of COVID. Our review is not focused on COVID. We wanted to state in the introduction that the pandemic, and the lockdown and social isolation associated with it, have shown that online interventions are essential for ICs, who already suffer social isolation due to caregiving duties. It was not our intention to link our results on online interventions with COVID. The introduction has been edited.

Author Response File: Author Response.docx

Reviewer 2 Report

SS abbreviation in abstract not explained

The topic covered by the paper significantly overlaps with eLearning, but it is not discussed

Results of the review are quite general and in overall not surprising and the same applies to the recommendations in the discussion chapter

 

Author Response

SS abbreviation in abstract not explained

Authors’ response: it has been included. Also, a brief definition of the concept has been included at the beginning of section 3.2.

 

The topic covered by the paper significantly overlaps with eLearning, but it is not discussed

Authors’ response: we have added some information for clarifying the differences between e-learning and e-health in our work (lines 408-413).

 

Results of the review are quite general and in overall not surprising and the same applies to the recommendations in the discussion chapter.

Authors’ response: we have rephrased the conclusion section in order to clarify the main messages we want to highlight with the specific recommendations for improving e-health interventions for ICs

Author Response File: Author Response.docx

Reviewer 3 Report

The paper reports a literature review regarding e-health training and social support to informal caregivers of persons with dementia.

Overall, the paper discusses an interesting topic. Some revisions are suggested in order to assist towards the improvement of this paper and its uptake by the scientific community, policy makers, and practitioners.

The paper starts by elaborating on the motivation of this work regarding Covid-19; however it is not made clear how it affects the current study, which has researched works beyond the pandemic as well. In this respect, it would be good if the authors could connect this motivation with the articles that are reported. Are any of these articles relevant specifically with Covid-19? If yes, do they report particular concerns, challenges, or solutions emerging within the pandemic? An additional section or at least a paragraph in the discussion section could be added.

With regard to the methodology
- the authors could clarify which were the exclusion criteria for excluding studies from the set of 176 potential candidates.
- Information regarding the years of publications should also be provided in the method description, if it was used as an exclusion criterion.
- In the materials and methods section it is mentioned that 59 results were retrieved. In the results section however, 179 potential articles are reported plus 118 additional records. It is not clear how this discrepancy in numbers occurs. Perhaps an explanation of a step in the methodology followed is missing from the provided descriptions. 

The authors should also provide additional methods of organizing and presenting information. In particular, the following would benefit the paper:
- Chart illustrating the trend of work on the topic, by presenting how many articles were published per year. 
- Tables providing a classification of the work reported and giving references to the relevant papers would greatly benefit readers
- A word cloud might be a useful visualization, giving direct hints to readers on which topics are discussed more in literature

Finally, the paper would greatly benefit from a discussion on open research issues and challenges that need to be addressed in the near future.

Author Response

The paper reports a literature review regarding e-health training and social support to informal caregivers of persons with dementia.

Overall, the paper discusses an interesting topic. Some revisions are suggested in order to assist towards the improvement of this paper and its uptake by the scientific community, policy makers, and practitioners.

The paper starts by elaborating on the motivation of this work regarding Covid-19; however it is not made clear how it affects the current study, which has researched works beyond the pandemic as well. In this respect, it would be good if the authors could connect this motivation with the articles that are reported. Are any of these articles relevant specifically with Covid-19? If yes, do they report particular concerns, challenges, or solutions emerging within the pandemic? An additional section or at least a paragraph in the discussion section could be added.

Authors’ response: we are very grateful to reviewer 3 for highlighting this issue. We did not intend to focus on COVID. We only mentioned the COVID pandemic because the lockdown associated with it has increased the need for online contact with caregivers and people with dementia. It is obvious that online interventions were developed much earlier that the COVID pandemic. We rephrased the text to clarify this message.

 

With regard to the methodology

- the authors could clarify which were the exclusion criteria for excluding studies from the set of 176 potential candidates.

Authors’ response: we have edited the flow chart. It was a typo. 37 papers from the set of 176 potential candidates were not excluded. Rather, they were not included because they did not meet inclusion criteria. Exclusion criteria for those included in the full-text step were already shown within the flow chart.

- Information regarding the years of publications should also be provided in the method description, if it was used as an exclusion criterion.

Authors’ response: year of publication was not an exclusion criterion. Information regarding year of publication appears in the tables that, we believe, reviewers did not have access to. A figure with the number of publications per year has been included (figure 3)

- In the materials and methods section it is mentioned that 59 results were retrieved. In the results section however, 179 potential articles are reported plus 118 additional records. It is not clear how this discrepancy in numbers occurs. Perhaps an explanation of a step in the methodology followed is missing from the provided descriptions.

Authors’ response: we believe that reviewer 3 refers to 59 results from the ProQuest search, that was included as an example of one of the searches according to PRISMA guidelines: “As an example, the ProQuest search “ab,ti(informal AND (caregiver OR carer* OR caregiving) AND (internet OR telemed* OR online OR on-line OR e-health OR electr*) AND (intervention OR support OR training) AND dementia)” gave 59 results”. The flow chart shows that the sum of results from several databases gave 179 results.

 

The authors should also provide additional methods of organizing and presenting information. In particular, the following would benefit the paper:

- Chart illustrating the trend of work on the topic, by presenting how many articles were published per year.

Authors’ response: we are very grateful to reviewer 3 for this suggestion. We have included a figure with the articles by year.

- Tables providing a classification of the work reported and giving references to the relevant papers would greatly benefit readers. Tables A1-A6

- A word cloud might be a useful visualization, giving direct hints to readers on which topics are discussed more in literature.

Authors’ response: We appreciate this comment from reviewer 3 and think it is a good idea to improve our article. We have included a figure with the cloud (figure 2).

Finally, the paper would greatly benefit from a discussion on open research issues and challenges that need to be addressed in the near future.

Authors’ response: we have rephrased the conclusion section in order to clarify the main messages we want to highlight with the specific recommendations for improving e-health interventions for ICs

Round 2

Reviewer 1 Report

Section 3 is still messy. This is not solved by simply including a paragraph. The organization needs to be supported by arguments and clearly explained

The paper as it is is hard to follow, particularly section 3, I would suggest to review the writing of the whole paper before publication.

Author Response

1. Section 3 is still messy. This is not solved by simply including a paragraph. The organization needs to be supported by arguments and clearly explained.

Authors’ response: Thank you for your comment. We have rearrenged the results section. We have added the following text: “The results chapter is divided into two sections: the first section (3.1 to 3.1.3) provides results regarding tools used for training ICs in caregiving situations, whereas the second section (3.2 to 3.2.5) provides results regarding online interventions focused on improving SS for ICs of PwD. In order to ease the readiness of this chapter, the information related to each of the training programs is reported following the same structure: design, results and conclusions.”, and now each result is reported following that structure.

2. The paper as it is is hard to follow, particularly section 3, I would suggest to review the writing of the whole paper before publication.

Authors’ response: We have organised each sub-section to make the reading more structured. If you still find it difficult to read, we would appreciate specific and concrete comments in order to improve our work.

Author Response File: Author Response.docx

Reviewer 3 Report

The revised version of the manuscript has addressed the concerns identified in my review.

With regard to the wordcloud included, unfortunately, it is not readable. The authors could try using other online services for producing wordclouds, and see if they yield an improved outcome. Currently, the most common words are over-emphasized, making other words which are not so common in the dataset unreadable.

A proofreading would also be beneficial, since there are some minor English syntax and style mistakes. Indicatively:

• Webs --> web (in the supplementary material)
• These have a maximum duration of 9 weeks and aim at proving ICs’ quality of life, including their capacity to cope and personal effectiveness with regard to caregiving[15], by increasing knowledge about dementia care and promote social support (SS) for ICs[16] -->  cope with what?
• NNTT in the conclusions section should be fully expanded on first occurrence
• In the conclusions section: "digitalization of ICs" --> needs rephrasing. A person cannot be digitalized.

Author Response

1. The revised version of the manuscript has addressed the concerns identified in my review.

Authors’ response: We hope that the changes introduced in this second revision will help to improve the work.

2. With regard to the wordcloud included, unfortunately, it is not readable. The authors could try using other online services for producing wordclouds, and see if they yield an improved outcome. Currently, the most common words are over-emphasized, making other words which are not so common in the dataset unreadable.

Authors’ response: Thank you for your comment. The word cloud did indeed contain a lot of terms. We have looked for another word cloud generator. We have put only the 50 most repeated words so that they can all be read correctly. We have explained this in section 3.

3. A proofreading would also be beneficial, since there are some minor English syntax and style mistakes. Indicatively:

Authors’ response: Thank you for being so specific in your suggestions for changes in syntax and style, as the article has been revised in English and in formatting by the journal's editors.

4. Webs --> web (in the supplementary material)

Authors’ response: We have detected this inconsistency and in the manuscript we have changed the term web to webs.

5. These have a maximum duration of 9 weeks and aim at proving ICs’ quality of life, including their capacity to cope and personal effectiveness with regard to caregiving[15], by increasing knowledge about dementia care and promote social support (SS) for ICs[16] --> cope with what?

Authors’ response: Thank you for this comment, we have changed the sentence to make it more understandable.

6. NNTT in the conclusions section should be fully expanded on first occurrence

Authors’ response: Indeed, the concept of New Technologies (NNTT) can be very broad and generic. We have changed it to Information and Communication Technologies (ICT) and have indicated in the text what these acronyms stand for.

7. In the conclusions section: "digitalization of ICs" --> needs rephrasing. A person cannot be digitalized.

Authors’ response: We agree, the expression was not clear and that is why we have changed it both in the conclusion and in the summary.

Author Response File: Author Response.docx