Unpacking the black box of interventions such as peer support designed to optimize mental health outcomes of family caregivers

在英国，每8个成年人中就有1个（约650万人）是家庭照顾者。虽然人们更喜欢在家里接受家庭成员的照顾，每年节省NHS数百万美元，但这可能会导致严重的心理健康问题和照顾者负担。这些心理健康问题也可能导致家庭照顾者的身体疾病，进一步加重NHS的负担。例如，出院后重症监护幸存者的家庭照顾者的焦虑、抑郁和创伤后应激障碍水平远高于英国人口标准。近年来，同伴支助方案已广泛提供，但在结构、执行和期限方面各不相同。方案最常见的目的是支助患有某种疾病/失调的人，很少有专门针对家庭照顾者的方案。然而，尽管有理论基础，但同伴支持的有效成分仍然未知。这意味着我们不了解设计和提供同伴支持的最佳方式，以有效改善心理健康和福祉，并减少家庭照顾者的负担。我们建议使用新的方法，包括一个战略，提供非常简短的问卷调查，在非常频繁的时间间隔，在评估的经验。这种方法被称为生态瞬时评估。我们将使用来自这些问卷如何回答的连续数据以及在家中测量的感知可穿戴数据（如出汗，温度，心率）来调整问卷交付，即在不合适时关闭，如驾驶或睡眠。我们将在参加同伴支持计划的家庭照顾者和没有接受任何同伴支持的家庭照顾者中使用这些方法。所有数据收集方法将在工作开始时通过访谈和研讨会与家庭照顾者共同设计。此外，我们将探索开发一种易于使用的流体生物传感器，可以测量家中的皮质醇水平。皮质醇是压力的标志物，但目前是通过将样本送到实验室来测量的，而不是在家中进行即时检测。COVID-19侧流测试是用于家庭的护理点测试的一个例子。将家庭皮质醇测量与自适应速射问卷传递和其他感测到的可穿戴数据相结合，可以提供打开同伴支持黑匣子的关键，从而确定其有效成分。这些数据将有助于提供工具，以更好地优化家庭照顾者的心理健康结果。

In the UK, 1 in 8 adults (around 6.5 million people) are family carers. Although people prefer to receive care from a family member in the home, saving the NHS millions each year, caregiving can cause significant mental health issues and caregiver burden. These mental health issues also can cause physical illness in family caregivers, further burdening the NHS. For example, family caregiver of intensive care survivors after hospital discharge have levels of anxiety, depression, and PTSD well above UK population norms. In recent years, peer support programmes have become widely available but have differences in structure, delivery, and duration. Programmes are most commonly aimed at supporting people with a disease/disorder - few are specifically directed at family caregivers. However, although theory based, the effective ingredient of peer support remains unknown. This means we do not understand the optimal way to design and deliver peer support to effectively improve mental health and wellbeing and to reduce family caregiver burden. We propose to use novel methods including a strategy that delivers very brief questionnaires at very frequent intervals in the moment for assessment of experience. This method is called Ecological Momentary Assessment. We will use continuous data from how these questionnaires are answered as well as sensed wearable data (such as sweating, temperature, heart rate) measured in the home to adapt questionnaire delivery i.e. to turn off when not appropriate such as driving or sleeping. We will use these methods in family caregivers participating in peer support programmes and those not receiving any peer support.All data collection methods will be co-designed with family caregivers through interviews and workshops at the commencement of our work.In addition, we will explore development of an easy-to-use fluid biosensor that can measure cortisol levels in the home. Cortisol is a marker of stress but is currently measured by sending a specimen to a laboratory and not measured as a point-of-care test in the home. A COVID-19 lateral flow test is an example of a point-of-care test for use in the home. Combining home cortisol measurement with adaptive rapid fire questionnaire delivery and other sensed wearable data may provide the key to unpacking the black box of peer support thereby identifying its effective ingredient. These data will help to provide the tools to better optimise mental health outcomes of family caregivers.