Table 1. Online synchronous interventions for informal caregivers of people with dementia.

Author(s)	Country	Design	Participants	Intervention	Main findings	Conclusions
Austrom et al. 12	The United States	Pilot study involving single group and assessments at pre- and posttests, and posttest focus group.	Family caregivers of persons with dementia (n=5).	Psychosocial educational web-based VC support group held once a week for 6 months. The group was facilitated by first author of the study and had general format comprising presentations, followed by educational instructions, questions and answers, and sharing and support. Three guest speakers also covered content in genetics, genetic counseling, elder law issues, and community-based social services. Alzheimer’s Association brochures and educational modules were also made available.	Improvement in several aspects of mental health were noted in participants at posttest relative to pretest, with the following mean differences in scores: anxiety (1.5 points), depression (3.3 points), physical health (-2.7 points), and controlling upsetting thoughts and response to disruptive behavior (−1.5 and −9.5 points, respectively). Qualitative data in form of feedback from program participants showed generally very positive views (e.g., appreciation for convenience of remote format, guest speakers, and technical support of research team).	Web-based support groups for caregivers using online tools proved feasible, acceptable, and low-cost, where pros outweighed cons (e.g., missing being in person with other caregivers) of this format.
Banbury et al. 13	Australia	Staggered randomized waitlist design.	Primary dementia caregivers socially or geographically isolated (n=69).	Support intervention by group VC for 6 weeks. There were 16 groups and sessions lasted an average of 90 min each. Sessions were led by a facilitator who facilitated discussions on different topics, and participants were able to share their experiences and knowledge. The program also provided IT support via a technician.	Most participants had no prior experience of using VC. However, following completion of the program, they reported positive views about the tool. Although all adjusted to communicating digitally, some preferred in-person meetings. Other participants, however, reported feeling more comfortable meeting by VC. Most (n=51) indicated they would like to continue meeting on a self-organized basis, and eight groups self-organized to meet.	Remote support groups based on telecommunication technology are telehealth interventions that may have the potential to develop networks among isolated caregivers of people with dementia.
Griffiths et al. 14	The United States	Pilot study involving single group with pre- and posttests.	Family caregivers of persons with dementia (n=57).	“Tele-Savvy” (TS) comprised six group sessions with four to eight caregivers by VC, with weekly 75 min sessions. Each VC session was dedicated to a key topic in a discussion and lecture style. Modules were delivered of six asynchronous daily 5–15 min long videos per week. Participants were provided with a manual and a workbook that complemented and reinforced their learning.	Apparently, TS contributed to significant improvement in caregivers´ well-being for burden (p<0.01), depressive symptoms (p<0.05), and self-reported competence (p<0.001). There was also a significant decrease in average BPSD frequency (p<0.05) and number of BPSD that occurred more often p<0.01).	The TS is a feasible, efficacious psychoeducation program for promoting improvement in mental health of caregivers and reducing BPSD of care recipients with dementia.
Kovaleva et al. 15	The United States	Intervention involving single group and posttest assessment.	Unpaid family caregivers of persons living with dementia (n=36).	TS comprised seven group sessions with weekly 60–80 min sessions. Instructors led lectures and discussions and sharing of caregiver experiences. Prerecorded video classes were made available daily, presenting educational content. A caregiver manual was also provided to promote self-efficacy.	The intervention proved viable and acceptable by participants, most of whom preferred the online mode. Almost all participants reported connectedness with other caregivers and instructors. Many participants requested inclusion of specific content (e.g., information on each dementia stage) and greater content diversity in videos (e.g., inclusion of actors of other ethnicities).	The TS addresses the needs of caregivers, promotes connectedness in in-person interactions, with benefit of convenient delivery. However, the program should by split into modules according to the different profiles of caregivers (e.g., dementia stage based).
Moskowitz et al. 16	The United States	Randomized clinical trial with control group and pre- and posttests.	Primary caregivers of persons with degenerative dementia (n=170). Intervention group (n=86) Control group (n=84)	“Positive emotion regulation intervention” (LEAF, Life Enhancing Activities for Family caregivers) comprising six synchronous online sessions individually delivered by trained facilitators. During the course of sessions, emotion regulation skills were taught to increase positive emotion levels.	Intervention group showed significantly greater improvements in outcomes of dependent variables at posttest compared to control group: positive emotion (d=0.58; p<0.01), depression (d=-0.25; p=0.02), anxiety (d=-0.33; p<0.01), physical (d=0.24; p=0.02), and positive aspects of caring (d=0.36; p<0.01). According to analyses of multilevel moderate mediation, increased positive emotion significantly mediated the effect of the intervention on depression.	The intervention proved feasible and acceptable and promises to be effective for family caregivers of persons with dementia experiencing stress associated with caregiving.
Paun and Cothran 17	The United States	Pilot study involving single group with pre- and posttests.	Family caregivers of individuals with AD and related dementias residents of long-term care institution (n=5).	Online group-based intervention “Chronic Grief Management – A Live-Streaming, Online Intervention” (CGMI-V) comprising eight sessions by VC, with one session per week averaging 60 min each. The group addressed three central topics: “knowledge, communication abilities/conflict resolution and grief management.” 17	In general, participants were able to use technology without major problems, positively assessing small groups, and encountered no problems connecting emotionally with one another. Participants also reported the group made them feel less alone and guilty for institutionalizing the elderly relative.	CGMI-V is a feasible intervention for delivery online and led by a professional. Also, the intervention has the potential to promote a significant effect on chronic grief and other aspects of mental health of caregivers of persons with dementia.

BPSD:Behavioral and Psychological Symptoms of Dementia; VC: videoconferencing.