Developing Social Enhancements for a Web-Based, PositiveEmotion Intervention for Alzheimer Disease Caregivers:QualitativeFocus Group and Interview Study

Background: Alzheimer disease is a degenerative neurological condition that requires long-term care. The cost of theseresponsibilities is often borne by informal caregivers, who experience an elevated risk of negative physical and psychologicaloutcomes. Previously, we designed a positive emotion regulation intervention that was shown to improve well-being amongdementia caregivers when delivered through one-on-one videoconferencing lessons with a trained facilitator. However, the formatrequired significant resources in terms of logistics and facilitator time. To broaden the reach of the intervention, we aimed todevelop the Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers(SAGE LEAF) program, an iteration of the intervention in a self-guided, web-based format with enhanced opportunities for socialconnection. Objective: The aim of this study was to gather feedback to inform the design of social features for the SAGE LEAF intervention.In the absence of a facilitator, our goal with the self-guided SAGE LEAF intervention was to integrate various social features(eg, discussion board, automated support, and profiles) to maximize engagement among participants.Methods: Qualitative data were collected from 26 individuals through (1) interviews with participants who completed a previousversion of the intervention via videoconferencing with a facilitator, (2) focus groups with dementia caregivers who had notpreviously experienced the intervention, and (3) focus groups with Alzheimer disease clinical care providers. We conducted aqualitative thematic analysis to identify which social features would be the most helpful and how they could be implemented ina way that would be best received by caregivers. Results: Interview and focus group feedback indicated that participants generally liked the potential features suggested, includingthe discussion boards, multimedia content, and informational support. They had valuable suggestions for optimal implementation.For example, participants liked the idea of a buddy system where they would be matched up with another caregiver for the durationof the study. However, they expressed concern about differing expectations among caregivers and the possibility of matchedcaregivers not getting along. Participants also expressed interest in giving caregivers access to a podcast on the skills, whichwould allow them to review additional content when they wished. Conclusions: Taken together, the discussions with caregivers and providers offered unique insights into the types of socialfeatures that may be integrated into the SAGE LEAF intervention, as well as implementation suggestions to improve theacceptability of the features among caregivers. These insights will allow us to design social features for the intervention that areoptimally engaging and helpful for caregivers