Developing a Multicomponent Intervention for Family Caregivers of Older Adults in Singapore: A Delphi Study
Abstract
Singapore is experiencing both an ageing population and a decreasing birth rate, with fewer adults to care for older adults. Caregiving for older adults can be taxing, and hence, caregivers need support. Using previous literature and the study team’s interactions with caregivers, a multicomponent intervention, consisting of a mobile application, fall detection and response service, and peer support program, was conceptualized. To better understand the needs and challenges of caregivers and to determine the potential usefulness of the multicomponent intervention, the study team engaged ward nurses and Community Health Team (CHT) members, two groups of stakeholders that regularly interact with caregivers in their work, using a modified Delphi technique. Ward nurses and CHT members each formed one Delphi panel and answered statements specific to their panel over two rounds. Nineteen ward nurses and 15 CHT members participated. The final participation rate for both rounds was 100% (19/19) for ward nurses and 93% (14/15) for CHT members. A total of 17/30 statements (57%) and 10/32 statements (31%) reached consensus for ward nurses and CHT members, respectively. Ward nurses agreed that (a) caregivers will benefit from a one-stop digital resource library (84%), (b) the importance of having a wide array of localized information for this digital resource (79%–89%) and (c) several challenges associated with caregiver training (74%–79%). The CHT members agreed that (a) caregivers do not receive adequate support outside their immediate family (86%), (b) caregivers struggle to manage care recipients’ behaviours and emotions (80%), and (c) there is a lack of relevant community resources for caregivers (71%–93%). The agreements indicated the feasibility of certain components of the intervention. Refinements to the multicomponent intervention were also made based on the findings.
1. Introduction
Informal caregivers provide assistance with activities of daily living, perform medical tasks, provide support to dependent older adults and are often a family member [1, 2]. An estimated 14% of the population in the United States provided informal care to older adults [3], while the estimated figures for Europe ranged from 10% to 25% [4]. With an ageing world population, the number of informal caregivers is expected to increase [5]. However, informal caregiving poses challenges, including communication issues and managing older adults’ behaviours, along with insufficient informational and emotional support [6, 7]. These difficulties can lead to poorer mental and physical health [8], clinical anxiety [9], caregiving burden and depression [10], and risk of burnout [11] for caregivers.
Singapore faces an ageing population and a declining birth rate. By 2030, around 25% of its population will be over 65 years of age [12]. Additionally, the old-age support ratio is projected to decrease from 4.8 in 2018 to 2.7 by 2030 [12], meaning there will be fewer adults to care for older adults. Like their global counterparts, Singaporean caregivers experienced depression [13], higher rate of outpatient visits [14], poorer self-rated health and lower quality of life [15], as well as similar caregiving challenges. Caregivers from four European countries voiced difficulties in communicating with and managing their older adults’ behaviours, along with a lack of emotional support and informational support to create a safe environment or purchase needed equipment [7]. In the United States, caregivers expressed challenges finding information on available resources and services, a lack of knowledge and training on caregiving [16] and a lack of emotional support too [17]. These challenges were raised by Singaporean caregivers as well [18, 19]. However, differences in living environments mean that these seemingly similar challenges can change into difficulties that are unique to each country. For instance, a Singaporean caregiver who could not stop their demented older adult from throwing food out of their house’s window eventually had to deal with the legal consequences of a financial penalty and a warning [20]. Beyond the above challenges, Singaporean caregivers also need to contend with filial obligations, where families are supposed to be the first line of care and support [21], and the use of care services such as nursing homes could be seen as abandonment of their older adults [22]. Hence, there is a need for contextualized support for Singaporean caregivers of older adults to alleviate their caregiving burden.
To address caregivers’ difficulties with caregiving and the lack of emotional and informational support, Project Carer Matters was implemented with a suite of interventions delivered by a team of trained registered nurses [23]. Caregivers’ needs and stressors were assessed, after which they received personalized information on community services, financial aid eligibility and training courses to enhance caregiving skills such as managing their dependents’ difficult behaviour. Nurses also offered emotional and psychological support through telesupport and regular check-ins, providing advice as well as facilitating access to care services and community resources. Eventually, cases will be handed over to community partners for long-term follow-up. Early findings were promising, with caregivers noting their needs were met, as well as reduced burden and isolation [24].
Building on prior success and to develop an ecosystem of support for caregivers to meet their multidimensional needs, a multicomponent intervention was conceptualized. The first component is a mobile application for caregivers of older adults, based on Project Carer Matters, that enables rapid assessment of caregivers’ needs before providing personalized recommendations such as applicable community resources, information on care recipient’s condition, management strategies and caregivers’ self-care, along with caregiving training resources such as videos on home nursing skills. The use of mobile applications to deliver this information is meant to address caregivers’ informational needs and increase accessibility since caregivers can access the information when needed, instead of waiting for routine check-ins by nurses or having to find time to attend courses to learn caregiving skills. An added benefit is that the mobile application serves as a trusted information repository. Although the Internet has made information accessible, caregivers had trouble with assessing the accuracy and reliability of information they found and suggested the need for a trustworthy resource [25]. Additionally, previous research using mobile applications to teach caregiving and nursing skills showed promising results. Family caregivers or patients who were taught wound care via a mobile application showed increased knowledge and skills in wound care, as well as lower anxiety compared to a control group [26]. A mobile application was also used to impart nursing skills such as vital signs assessments and intravenous injections to nursing students, resulting in improved knowledge and skills compared to a control group [27]. Hence, mobile application was considered an appropriate medium.
The second component is a fall detection and response service to be installed in the homes of older adults at risk of falls. When a fall is detected, caregivers, their selected respondents or a response service can promptly attend to the older adult and assess the fall severity. The focus on falls was due to feedback from previous caregivers participating in Project Carer Matters, which identified caregivers’ concerns about falls as a source of stress. Caregivers felt a need to be with their older adults around the clock to prevent falls, which made it difficult to balance caregiving and their personal lives [28], contributing to caregivers’ poorer psychological health and issues such as anxiety and depression [29]. A third of Singaporean older adults experienced at least one fall, with the proportion increasing to one in two for Singaporean older adults above 80 years old, highlighting the prevalence of this issue [30]. A fall detection and response service could relieve caregivers of the need to accompany their older adults around the clock and potentially contribute to improvements in caregivers’ psychological health.
The third component is a peer support program organized in partnership with a community service agency to address caregivers’ emotional and social needs. Reviews of caregiving research consistently highlighted the importance [31, 32] and potential benefits of addressing these needs, such as improving quality of life along with reducing depression and burden [33–35]. This program supports caregivers by providing them with scheduled time for respite and connecting them with a wider community of caregivers for support. This can provide caregivers with validation for their actions and feelings, along with opportunities to learn caregiving strategies from their peers [36].
To better understand the needs and challenges of caregivers and to determine the potential usefulness of the conceptualized multicomponent intervention, the study team decided to engage with ward nurses and Community Health Team (CHT) members. Ward nurses work closely with caregivers and their care recipients from admission to discharge, while CHT members follow up with caregivers after discharge to facilitate the hospital-to-home transition. This decision was made for the following reasons.
First, the study team conducted previous studies with caregivers during their participation in Project Carer Matters [24, 28] and has continuous ongoing engagements with them. Consistent with previous literature on Singaporean caregivers [19, 37], we noticed a trend of caregivers over prioritizing their older adults at the expense of themselves. Therefore, caregivers might downplay the psychological and social self-care aspects of the multicomponent intervention. We chose to engage with ward nurses and CHT members to seek further confirmation on the previously identified informational, psychological, training and social needs of caregivers, along with the observation that caregivers prioritized care recipients over themselves. This engagement could provide fresh perspectives and insights on needs and challenges that would otherwise be dismissed by caregivers.
Second, the study team wanted to explore if there was consensus among ward nurses and CHT members on the feasibility and potential usefulness of aspects of the conceptualized multicomponent intervention, such as video training for caregiving skills. These two groups work closely with caregivers and hence would have insights in these areas. Additionally, we intend to enlist ward nurses and CHT members to help with future implementation of the multicomponent intervention, and engaging these two groups could increase buy-in [38]. Their feedback could also be used to further refine the conceptualized multicomponent intervention to facilitate the incorporation of the intervention into healthcare settings. This would help the team in planning subsequent feasibility studies.
2. Methods
A modified version of the Delphi method was used for the following reasons. First, the study team wanted to examine if ward nurses and CHT members agreed with the identified caregivers’ needs and if there was consensus on the feasibility and potential usefulness of aspects of the conceptualized multicomponent intervention. Since the Delphi technique is commonly used to gather informed consensus on a topic [39], it was deemed to be a suitable method.
Second, ward nurses and CHT members have heavy workload and varied work schedules, making it difficult to gather them together. Thus, methods such as focus group discussions or other consensus-gathering methods such as the nominal group technique would not be feasible. Third, administering a Delphi survey that participants can complete alone in their free time would minimize the impact of peer pressure and power dynamics on participants’ responses [39, 40], in addition to being nondisruptive to their work. Fourth, the Delphi technique has been used in previous studies to inform or assess the potential usefulness of an intervention [41–43]. The benefits and constraints listed above made Delphi the most suitable choice for this study.
2.1. Statement Development
Draft statements based on the different components of the intervention were developed and revised several times by the study team. These statements were also piloted by three nurses who were not part of the study team and working either in a helpline service for caregivers or overseeing nursing training.
2.2. Delphi Panel
Ward nurses and CHT members each formed one Delphi panel and answered statements specific to their panel. Ward nurses were chosen for their expertise in training caregivers, preparing patients for discharge and answering caregivers’ questions. They were familiar with the informational and training needs of caregivers during and after patients’ discharge. Therefore, ward nurses could provide relevant feedback on the first component of the intervention, the mobile application for needs assessment and personalized recommendations. An example of a Delphi statement is ‘It is challenging to plan discharges with caregivers looking after care recipients with complex needs’.
CHT members include doctors, nurses, allied health professionals, pharmacists and health coaches [44]. They follow up with caregivers and their care recipients after discharge, providing services such as functional assessments and home safety reviews, as well as assisting them with problems encountered during the hospital-to-home transition. Hence, CHT members would be familiar with the challenges faced by caregivers during transition and daily caregiving, along with caregivers’ informational, psychological and social needs. Therefore, CHT members could provide relevant feedback on the second and third components of the intervention, which are the fall detection and response service, and the peer support program. An example of a Delphi statement for the CHT members is ‘caregivers do not receive adequate support from community agencies’.
A minimum of 12 respondents is generally considered sufficient for a Delphi study [45]. We recruited 19 inpatient ward nurses and 15 CHT members via convenience sampling. For ward nurses, we approached the unit nursing managers from four wards with predominantly older patients. The managers were asked to identify nurses with at least 1 year of working experience in their current role or who have had extensive prior experience engaging with caregivers. After the unit nursing managers obtained verbal consent from the nurses to be contacted by the study team, a study team member would meet the nurses to explain the study and to obtain informed consent. For CHT members, the study team approached the team’s senior management to help identify staff members with at least 1 year of experience engaging with caregivers of older residents. Three team leaders were delegated by the senior management to contact the study team when a CHT member gave their verbal consent to participate. A study team member would meet the interested member to explain the study and obtain informed consent.
Among the ward nurses, the research team contacted 20 nurses and 19 participated in both rounds of the Delphi survey. One nurse could not participate as she was on long leave during the survey period. For the CHT, the research team contacted 16 members, but one was found unsuitable due to limited experience working with caregivers.
Out of the 19 ward nurses who participated, 13 were assistant nurse clinicians (senior clinical nurses who were expected to lead other nurses), two were senior staff nurses, and four were staff nurses, indicating that most participants have extensive clinical nursing experience. Among the 15 CHT members who participated, there were 10 nurses, two occupational therapists, two medical social workers, and one physiotherapist.
2.3. Delphi Process and Consensus
The panellists rated the statements on a scale of one (strongly disagree) to seven (strongly agree). An a priori criterion was used to define consensus. Consensus was deemed to have been achieved if 70% of respondents agreed (defined as a rating of six or seven) or disagreed (defined as a rating of one or two) with a statement. The rating scale was bolded and indicated at the start of every page to ensure all participants had the same understanding of the scale. Each statement also had an open-text box for participants to leave comments. Round 2 of the study contained statements that did not reach consensus in Round 1. Some statements for Round 2 were modified after the study team reviewed and discussed participants’ comments. For example, one statement ‘caregivers do not receive adequate support from their immediate family members’ was modified to ‘the main caregiver requires additional support from their immediate family members’. This was to account for participants’ observations on the diversity of caregiving arrangements within families, such as cases where every family member contributes to caregiving, with someone assigned as a main caregiver to oversee all caregiving activities. In Round 2, participants were also informed of the highest and lowest ratings, as well as the median rating for each statement. Participants were then asked to provide their new rating or could choose to retain their earlier rating. Both rounds were conducted via email. To complete the Delphi process, participants were required to respond to both rounds.
2.4. Ethics Consideration
This study was approved by the National Health Group Domain Specific Review Board in Singapore (NHG DSRB Reference Number: 2022/00610). Informed consent was obtained from all participants prior to their participation.
3. Results
3.1. Response Rate
Nineteen ward nurses and 15 CHT members were recruited and participated in Round 1. However, one member from the CHT resigned from their job before Round 2. Hence, the final participation rate for both rounds was 100% (19/19) for ward nurses and 93% (14/15) for CHT.
3.2. Consensus Among Ward Nurses
Seventeen out of 30 statements (57%) achieved consensus. Nine and eight statements achieved consensus in Round 1 and Round 2, respectively. The list of consensus statements is in Table 1. Generally, the consensus statements indicated that caregivers would benefit from a one-stop digital resource and the importance of having a wide array of localized information. Challenges associated with caregiver training were another area of consensus as well. Mobile applications and websites were identified as possible platforms for the digital resource.
| Round 1 | Agreement (%) |
|---|---|
| It is important that the library has information for caregivers on signs and symptoms to look out for that would require urgent treatment | 89 |
| It is important that the library has information for caregivers on care recipients’ medication | 89 |
| It is important that the library has information for caregivers on coping with care recipients’ behaviours | 89 |
| Caregivers will benefit from having a one-stop digital resource they can refer to, on their care recipients’ conditions | 84 |
| It is important that the library has information for caregivers on self-care | 84 |
| The library should contain caregiving information that is relevant to caregivers in Singapore | 84 |
| The application should include a series of screening questions so that information can be customized according to each caregivers’ needs | 79 |
| It is important that the library has information for caregivers on available financial assistance | 79 |
| The library will be useful for healthcare professionals preparing caregivers before discharge | 79 |
| Round 2 | Agreement (%) |
| Caregiving information online needs to be localized for Singapore (e.g., demonstrate caregiving training in a HDB flat) | 84 |
| Multiple caregiver training sessions (e.g., wound dressing and tube feeding) are required for caregivers before their care recipients are discharged | 79 |
| Caregivers are not familiar with the financial subsidies they qualify for | 79 |
| Mobile applications are an appropriate way for caregivers to access caregiving information | 79 |
| It is time consuming for healthcare professionals to provide caregivers with comprehensive caregiving skills training (e.g., wound nursing and mobility training) | 74 |
| Manpower constraints make it challenging for healthcare professionals to provide consistent caregiver skills training (e.g., wound nursing and mobility training) before discharge | 74 |
| New caregivers need more time to practice caregiving skills learnt from healthcare professionals | 74 |
| Web-based sources such as websites are an appropriate way for caregivers to access caregiving information | 74 |
Among statements that did not achieve consensus, some uncertainty on the informational and training needs of caregivers after discharge was observed, as agreement rates for these statements were low, ranging from 21 to 37% (see Table 2).
| Statements | Agreement (%) |
|---|---|
| Caregivers do not seek clarification on their care recipients’ medication during the postdischarge call | 37 |
| Caregivers do not seek clarification on their care recipients’ daily-care needs (e.g., diet and nutrition) during the postdischarge call | 37 |
| Caregivers are uncertain which symptoms and signs require hospitalization/emergency department admissions and which do not | 26 |
| Caregivers need additional skills training at home, after discharge | 21 |
3.3. Consensus Among CHTs
A total of 10 statements (see Table 3) reached consensus out of 32 statements (31%). Seven and three statements achieved consensus in Round 1 and Round 2, respectively. Generally, there was consensus among CHTs on the lack of adequate support for caregivers outside of their immediate family, caregivers’ struggles with managing care recipients, and the lack of relevant community resources.
| Round 1 | Agreement (%) |
|---|---|
| Caregivers who need help frequently, find the cost of hiring private home help services unaffordable | 93 |
| Caregivers do not receive adequate support from their neighbours | 87 |
| Caregivers find it difficult to manage care recipients’ behaviours | 80 |
| Caregivers find it difficult to manage care recipients’ emotions | 80 |
| Lack of competency of home nursing skills (e.g., wound care and tube feeding) contributes to caregiver stress | 80 |
| Respite care options are inadequate for caregivers because there is a long waitlist | 80 |
| Caregivers should be given different options to the type of response service provided, should their care recipient experience a fall | 80 |
| Round 2 | Agreement (%) |
| Caregivers do not receive adequate support from relatives who are not immediate family and friends | 86 |
| Caregivers find it difficult to manage care recipients’ needs (e.g., feeding, showering, and mobility) as the home environment is different from the hospital training environment | 71 |
| Active ageing centres and active ageing care hubs are unable to support caregivers whose care recipients’ have multiple care needs | 71 |
- Note: Active ageing centres and active ageing care hubs are centres that provide a suite of services for older adults such as activities to keep older adults engaged and referrals for care services.
While 22 statements did not achieve consensus, several statements with agreement rates close to the criteria of 70% suggest that caregivers do not receive sufficient help and respite options are unsuitable. A list of statements with agreement rates of ≥ 60% is in Table 4.
| Statements | Agreement (%) |
|---|---|
| Insufficient help for caregivers | |
| The main caregiver requires additional support from their immediate family members | 64 |
| Caregivers spend a substantial amount of time managing care recipients’ symptoms | 64 |
| Unsuitability of respite options | |
| Current respite care options are inadequate for caregivers because the respite care options are unable to cater to all conditions that care recipients may have | 64 |
| Current respite care options are too costly | 64 |
| The operating hours of current active ageing centres and active ageing care hubs are inconvenient for caregivers as they are only open during office hours | 64 |
| Activities at active ageing centres and active ageing care hubs are not suitable for less mobile care recipients | 64 |
A full list of statements for Round 1 and Round 2 for each Delphi panel and the rate of agreement can be found in Appendix 1.
4. Discussion
The purpose of this Delphi study was twofold. First was to triangulate the identified informational, psychological, training and social needs of caregivers, along with the observation that caregivers prioritized care recipients over themselves with ward nurses and CHT members. Second was to explore the consensus level among ward nurses and CHT members on the feasibility and potential usefulness of aspects of the conceptualized multicomponent intervention.
4.1. Ward Nurses
Ward nurses agreed that caregivers will benefit from a one-stop digital resource containing localized information, as well as mobile applications and websites as potential platforms for digital resources. These findings suggest that the conceptualized mobile application can address caregivers’ informational needs. Singaporean caregivers have long highlighted their informational needs [18, 19, 46] and frustrations with locating relevant and trusted information [47]. The time-consuming nature of caregiving adds another layer of difficulty, with only 16% of caregivers in one study spending more than 1 hour for caregiver education [48], leading to suggestions of using online platforms to increase accessibility [49]. Both ward nurses’ consensus and previous literature confirmed caregivers’ informational needs, along with the potential usefulness of the mobile application in addressing it. The next step should be a study on caregivers’ views on the application’s usability and usefulness as a trusted information repository. Additionally, the study could explore if using the application reduces caregivers’ time spent searching for information and potential benefits, such as reduced feelings of burden and overwhelm.
Ward nurses also agreed on the challenging nature of caregiver training, such as difficulties in providing continuous and consistent training, along with the need to organize multiple training sessions. The mobile application’s resources such as videos on caregiving skills to address caregivers’ training needs could potentially supplement ward nurses’ caregiver training. A Singaporean hospital’s use of videos to supplement caregivers’ nasogastric tube feeding training led to improved knowledge and decreased the number of training sessions needed [50]. Other caregiving skills videos on the mobile application could potentially lead to the same benefits as well.
4.2. CHT
CHT members agreed that caregivers do not receive adequate support from sources outside their immediate family, such as extended family, friends or neighbours. In hindsight, this finding should not be surprising, as some Singaporean caregivers communicated a preference for keeping things within their immediate family as they thought outsiders would not understand [51]. Perceived support refers to an individual’s assessment of support availability along with its quality [52], and such assessments had a moderate negative effect on caregivers’ burden [9]. Connecting caregivers with peers who would likely understand them better could increase caregivers’ perceived support and reduce burden, highlighting the potential usefulness of the conceptualized peer support program. The next step should be a pilot study examining if the peer support program does indeed increase perceived support and reduce burden. Further research should also compare caregivers receiving peer support with caregivers receiving nonpeer support to determine if peer support offers additional benefits. With caregivers reportedly facing difficulties reentering the labour market after the death of their dependents [53, 54], policymakers can consider employing this group of people to support new caregivers in their caregiving journey.
Consistent with previous literature [55], CHT members also agreed that caregivers struggled to manage care recipients at home. This could be partly alleviated by the conceptualized multicomponent intervention. For instance, caregivers’ coping strategies have been linked with the behaviour of older adults with dementia, with older adults of avoidant or disengaged caregivers showing more behavioural problems [56–58]. Thus, there have been calls to teach caregivers appropriate coping strategies [59], such as adopting an encouraging approach to improve the well-being of older adults with dementia [60]. Information and training videos of appropriate coping strategies can be incorporated as part of the mobile application’s personalized recommendations for caregivers, and future studies can evaluate the effectiveness of these resources in reducing care recipients’ difficult behaviours as well as caregivers’ stress.
The lack of relevant community resources for caregivers was also an area of consensus among CHT members. Caregivers have long highlighted the mismatch between their needs and community resources such as care services. Examples include transportation issues, long waiting lists, suitability of care services programs for older adults and the lack of immediate short-term care options [22, 46, 61, 62]. Some of these are systemic issues requiring significant policy changes and cannot be directly addressed by the multicomponent intervention, which target issues at the individual level to lighten caregivers’ challenges. Still, studies both abroad and in Singapore identified struggling caregivers as being more likely to utilize care services [63, 64]. Therefore, connecting caregivers with their peers for emotional and social support and imparting caregivers appropriate coping strategies to manage care recipients’ difficult behaviours could alleviate some of their struggles, which could reduce caregivers’ need to utilize community resources.
5. Limitations
First, the criterion for consensus is subjective. Second, the Delphi statements were formulated in part using information gathered from caregivers participating in Project Carer Matters or engagement sessions organized by the study team. However, this meant that we only engaged caregivers who could leave their care recipients unattended for a few hours. It is possible that different statements would be formulated if we were able to reach out to caregivers who could not leave their care recipients unaccompanied. We tried to minimize this bias by tapping on relevant literature as well for statement development. Future research can use online or door-to-door surveys to reach out to this group of caregivers.
Third, although ward nurses and CHT members had extensive experience working with caregivers, there was a certain level of unexpected heterogeneity in the Delphi panels, making it difficult to achieve consensus. The variability inherent with caregiving experiences also added to the difficulty. For instance, ward nurses have standard procedures for tasks such as making a postdischarge phone call. However, discrepancies in the consistency of how tasks are performed or follow-through, along with differences in caregivers and care recipients’ profile meant that ward nurses could have diverse experiences interacting with caregivers. Similarly, CHT members aim to support caregivers and care recipients with the hospital-to-home transition, but their varied professional backgrounds likely interacted with each caregiving dyad’s unique experiences, leading to diverse perspectives among the members. Fourth, external constraints meant we could only conduct two rounds of the Delphi survey. Findings might differ if there was time for additional rounds to explore some participants’ comments.
6. Future Research
Statements on respite services not meeting caregivers’ needs came close to consensus, aligning with previous research [22, 61, 62]. While the conceptualized multicomponent intervention has the potential to alleviate some of the struggles experienced by caregivers and reduce their demand for such services, further research should still examine the possibility of reforming these services to address caregivers’ needs.
Although caregivers participating in Project Care Matters voiced their concerns of their care recipient falling, there was no consensus for statements exploring caregivers’ likelihood on subscribing to a fall detection and response service, or their interests in home modifications. Further studies should work with a larger sample of caregivers to examine the appeal and feasibility of these approaches.
Consistent with previous literature [65], the study team’s engagements with caregivers found that they often require clarifications on their care recipient’s medication and daily care needs. Caregivers also voiced difficulties in determining if care recipient’s symptoms required hospitalization or admission to an emergency department. To validate these findings, ward nurses were asked if caregivers required clarification or struggled to assess if their care recipient required hospitalization. These questions were considered appropriate for ward nurses as they conduct postdischarge calls and could have encountered caregivers facing these challenges. However, there was no consensus among ward nurses. A plausible reason is that ward nurses usually attempt one postdischarge call for each caregiver and will not call again for those who do not pickup. Hence, ward nurses could have limited contact with caregivers postdischarge, leading to difficulties in rating related statements. Further research can explore this hypothesis, or if there are other reasons for the discrepancy.
7. Conclusion
The purpose of this Delphi study is to tap into the experiences of ward nurses and CHT members to triangulate previously identified needs of caregivers, and to explore the feasibility and potential usefulness of aspects of the conceptualized multicomponent intervention. Findings suggest that the mobile application and peer support program were potentially feasible and useful, while further exploratory research is needed for the fall detection and response service. Implications for caregivers, practitioners and policymakers were identified, along with areas for future research.
Ethics Statement
This study was approved by the National Health Group Domain Specific Review Board in Singapore (NHG DSRB Reference Number: 2022/00610).
Disclosure
The funders had no role in this study.
Conflicts of Interest
The authors declare no conflicts of interest.
Funding
This work was supported by a grant from the National Medical Research Council (MOH-001068-01).
Supporting Information
List of all Delphi statements and rate of agreement.
Open Research
Data Availability Statement
Access restrictions apply to the data underlying the findings due to national data protection laws and restrictions imposed by the ethics committees to ensure the data privacy of the study participants. As such, they cannot be made freely available in the manuscript, the supporting files or a public repository. Request for the data may be sent to the principal investigator at [email protected].
