Social media-based bibliotherapy for improving the mental health of informal caregivers of people with dementia: a randomized controlled trial

Background: Despite their own experience of mental health issues, informal caregivers of individuals with dementia are often overlooked, and there is a limited availability of community services tailored specifically for them. A self-help intervention, bibliotherapy, shows promise as an intervention to enhance the mental well-being of caregivers in resource-constrained settings, and social media has demonstrated its efficacy as a user-friendly platform for delivering health interventions. However, the efficacy of social media-based bibliotherapy remains untested. Aim: This study aims to test the efficacy of social media-based bibliotherapy on improving the mental health of informal caregivers of people with dementia through a randomized controlled trial. Methods: A total of 60 informal caregivers were enrolled in this randomized controlled trial. Participants were randomly assigned to either the social media-based bibliotherapy group, which received eight weekly sessions of bibliotherapy, or the usual care group, which only received routine services from community centers. Outcomes were assessed at baseline and immediately after the intervention. Post-intervention interviews were conducted to explore participants’ experiences with this intervention. Descriptive statistics, t-tests, Mann-Whitney U tests, χ² tests, and generalized estimating equations were used for quantitative data analysis. Content analysis was employed for qualitative data analysis. Results: The average age of caregivers was 57.41 (SD, 13.63), with a majority being female (79.3%). Baseline characteristics were similar between groups. Both quantitative and qualitative data demonstrated that social media-based bibliotherapy was acceptable for informal caregivers, with WhatsApp being the preferred medium in this study. The recruitment rate, retention rate, and completion rate of weekly tasks all met satisfactory levels. Caregivers found the intervention useful and flexible while experiencing changes in their perceptions towards caregiving responsibilities. The efficacy on mental health (Wald χ² = 8.918, p =.003) and all the subscales of stress (Wald χ² = 4.198, p =.040), anxiety (Wald χ² = 7.667, p =.006), depression (Wald χ² = 9.127, p =.003) was statistically significant. The efficacy on caregiving appraisal was only significant on the perceived caregiving burden subscale (Wald χ² = 4.954, p =.026). However, caregivers expressed changes in caregiving appraisal in qualitative interviews. The efficacy on the mental component scale of health-related quality of life approached significance (Wald χ² = 3.634, p =.057). However, the efficacy on the positive psychological well-being remains insignificant. Conclusions: To the best of our knowledge, this is the first attempt to use social media-based bibliotherapy among informal caregivers of individuals with dementia. The utilization of WhatsApp was well received among caregivers, and the positive effects on their mental health was demonstrated. Trial registration: The trial has been registered on ClinicalTrial.gov (Ref: NCT06327022).