A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors

Abbey Couchman; Thando Katangwe-Chigamba; David Howe; Emma Flanagan; Morag Farquhar; Rebecca L. Gould; Lance M. McCracken; Izobel Clegg; Adaku Anyiam-Osigwe; Polly-Anna Ashford; Naoko Kishita

A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes.

Methods: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority).

Results: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers’ perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers’ resonance with metaphors and case examples, and by their engagement with intervention content (e.g., note-taking) and therapists (e.g., therapeutic relationships).

Conclusion: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.

Original language	English
Journal	Aging and Mental Health
Publication status	Accepted/In press - 30 Jun 2026

Keywords

acceptance and commitment therapy
process evaluation
mixed-methods
dementia
caregivers
online self-help
e-health

Embargoed Document

Carer Process Evaluation Accepted Manuscript
Accepted author manuscript, 961 KB
Licence: Unspecified
Embargo ends: 31/10/2026 00:00 GMT

Cite this

Couchman, A., Katangwe-Chigamba, T., Howe, D., Flanagan, E., Farquhar, M., Gould, R. L., McCracken, L. M., Clegg, I., Anyiam-Osigwe, A., Ashford, P.-A., & Kishita, N. (Accepted/In press). A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors. Aging and Mental Health.

@article{c63b0b3f6119438db9ba139babf79191,

title = "A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors",

abstract = "Objectives: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes. Methods: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21\% ethnic minority). Results: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers{\textquoteright} perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers{\textquoteright} resonance with metaphors and case examples, and by their engagement with intervention content (e.g., note-taking) and therapists (e.g., therapeutic relationships). Conclusion: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.",

keywords = "acceptance and commitment therapy, process evaluation, mixed-methods, dementia, caregivers, online self-help, e-health",

author = "Abbey Couchman and Thando Katangwe-Chigamba and David Howe and Emma Flanagan and Morag Farquhar and Gould, \{Rebecca L.\} and McCracken, \{Lance M.\} and Izobel Clegg and Adaku Anyiam-Osigwe and Polly-Anna Ashford and Naoko Kishita",

note = "Data Availability Statement: De-identified participant data will be made available upon request following publication of the trial results. Requests should be directed to the corresponding author and include the specific data fields required and the purpose of the request, ideally accompanied by a detailed protocol or, at minimum, a research plan. Requests will be reviewed on a case-by-case basis, and requestors will be required to complete a data-sharing agreement with the study sponsor prior to data transfer.",

year = "2026",

month = jun,

day = "30",

language = "English",

journal = "Aging and Mental Health",

issn = "1360-7863",

publisher = "Taylor and Francis",

}

Couchman, A , Katangwe-Chigamba, T , Howe, D , Flanagan, E , Farquhar, M, Gould, RL, McCracken, LM, Clegg, I , Anyiam-Osigwe, A , Ashford, P-A & Kishita, N 2026, 'A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors', Aging and Mental Health.

A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors. / Couchman, Abbey ; Katangwe-Chigamba, Thando ; Howe, David et al.
In: Aging and Mental Health, 30.06.2026.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - A mixed-methods process evaluation of internet-delivered self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): Engagement, mechanisms, and contextual factors

AU - Couchman, Abbey

AU - Katangwe-Chigamba, Thando

AU - Howe, David

AU - Flanagan, Emma

AU - Farquhar, Morag

AU - Gould, Rebecca L.

AU - McCracken, Lance M.

AU - Clegg, Izobel

AU - Anyiam-Osigwe, Adaku

AU - Ashford, Polly-Anna

AU - Kishita, Naoko

N1 - Data Availability Statement: De-identified participant data will be made available upon request following publication of the trial results. Requests should be directed to the corresponding author and include the specific data fields required and the purpose of the request, ideally accompanied by a detailed protocol or, at minimum, a research plan. Requests will be reviewed on a case-by-case basis, and requestors will be required to complete a data-sharing agreement with the study sponsor prior to data transfer.

PY - 2026/6/30

Y1 - 2026/6/30

N2 - Objectives: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes. Methods: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority). Results: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers’ perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers’ resonance with metaphors and case examples, and by their engagement with intervention content (e.g., note-taking) and therapists (e.g., therapeutic relationships). Conclusion: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.

AB - Objectives: A mixed-methods process evaluation was conducted alongside a randomised controlled trial of iACT4CARERS: an eight-session, online, self-help, Acceptance and Commitment Therapy (ACT) intervention with minimal therapist support for family carers of people with dementia. While the RCT evaluated its effects on anxiety, depression, and psychological flexibility, this study examined intervention implementation (fidelity and dose), contextual factors influencing engagement, and mechanisms of impact, focusing on how participants engaged with intervention content and therapist support to produce expected changes. Methods: Data were collected from 249 intervention-group carers, including demographics, between-session ACT skill use, weekly values-based goal completion, and change in psychological flexibility (CompACT) from baseline to post-intervention. Platform analytics captured session completion and therapist interaction. Semi-structured interviews were conducted with a purposive sample of 28 carers (21% ethnic minority). Results: iACT4CARERS was generally well received, with high completion, particularly among older, unemployed, and spousal carers. Engagement was shaped by carers’ perceived need, reflecting subjective experience rather than dementia stage. Changes in psychological flexibility were influenced by carers’ resonance with metaphors and case examples, and by their engagement with intervention content (e.g., note-taking) and therapists (e.g., therapeutic relationships). Conclusion: iACT4CARERS largely operated as intended; identified refinements could further enhance engagement and benefits.

KW - acceptance and commitment therapy

KW - process evaluation

KW - mixed-methods

KW - dementia

KW - caregivers

KW - online self-help

KW - e-health

M3 - Article

SN - 1360-7863

JO - Aging and Mental Health

JF - Aging and Mental Health

ER -