The WeACT Program for Family Caregivers of People Living With Dementia

Family caregivers of people living with dementia often experience psychological distress (such as depressive symptoms and stress) and face practical barriers to accessing support. This study will evaluate WeACT, a research-developed, self-paced, web-based acceptance and commitment therapy (ACT) skills program designed to support caregivers' mental health outcomes in a scalable format. This is a one-group, pretest-posttest mixed-methods pilot study conducted fully online. All enrolled participants will receive access to the WeACT program. The study will assess feasibility and user experience and will explore pre-to-post changes in caregiver mental health outcomes and ACT-related processes. WeACT includes six self-paced weekly ACT modules and a tailored daily practice section. Each weekly module includes ACT skills training materials. The daily practice section provides brief, in-the-moment ACT skill coaching based on participants' current self-ratings. Recruitment will occur by distributing a study flyer across the United States. Interested individuals will contact the study team and complete an online eligibility screening survey. Eligible individuals will complete electronic informed consent and then complete pretest questionnaires online. After completing baseline procedures, participants will receive program access and study-specific login credentials. Participants will be encouraged to complete one module per week and to use the daily practice section regularly during the intervention period. After completing the program modules, participants will complete posttest questionnaires online and participate in a one-time individual interview. Interviews will be conducted and recorded using the HIPAA-compliant version of Microsoft Teams. Feasibility will be evaluated using recruitment, retention, and adherence indicators and by documenting reasons for ineligibility and dropout. The program will also capture engagement and in-program response data. Pretest and posttest questionnaires will be used to explore changes in caregiver mental health outcomes and ACT-related processes and to assess perceived feasibility, acceptability, appropriateness, and usability at posttest. Qualitative interviews will be used to understand participant experiences and identify recommendations to refine the program and study procedures. Analyses will focus on feasibility and descriptive characterization of engagement. Pre-to-post changes will be explored using paired statistical tests as appropriate. Daily practice data will be explored using multilevel modeling to estimate average change and individual variability over time. Interview data will be analyzed using thematic analysis to summarize common experiences and improvement suggestions. All data will be collected electronically using university-approved secure platforms (Qualtrics, the WeACT program hosted on the secure USF Microsoft Azure environment, and HIPAA-compliant Microsoft Teams). WeACT is not publicly available and is accessible only to enrolled participants. Participants will use study-specific login credentials. Identifying information will be collected only as needed for study operations (e.g., communication and compensation) and stored separately from research data. Study data will be stored in secure, access-controlled USF systems (including USF Box), with access restricted to authorized study personnel. Only de-identified, aggregate results will be used for dissemination.

Inclusion criteria

Family caregivers of people living with dementia will be eligible to participate if they meet all of the following criteria:

• Are community-dwelling adults aged 18 years or older who have primary caregiving responsibilities for a relative diagnosed with dementia;
• Present mild to moderately severe depressive symptoms, as measured by the Patient Health Questionnaire-9 (PHQ-9), with scores between 5 and 19; and
• Have access to a web-enabled device, such as a smartphone, tablet, laptop, or desktop computer, with internet access.

Exclusion criteria

Family caregivers of people living with dementia will be excluded if they meet any of the following criteria:

• Have cognitive, physical, or sensory impairments, or are unable to complete study procedures in English, that may impede study participation;
• Present severe depressive symptoms, defined as PHQ-9 scores of 20 or higher;
• Report having thoughts of harming themselves or attempting suicide within the past six months;
• Have previously participated in a research study involving an ACT program;
• Are currently participating in another caregiver intervention study; or
• Have experienced more than three hospitalizations of either the family caregiver or the relative with dementia within the past year.