Bianca Brijnath is a Professor of Health Communication in Society at La Trobe University, Melbourne, Australia.
More than 55 million people worldwide live with dementia, and the global cost of care now exceeds US$1.3 trillion each year. Around half of this cost reflects unpaid care provided by family members and friends. Most of it delivered at home, often with little or no formal support. As populations age, the pressure on family carers continues to grow.
Digital tools are frequently promoted to make support more accessible and inclusive. In response to these pressures, the World Health Organization (WHO) developed iSupport, a comprehensive online self-help and skills-training program designed to reduce carers’ mental and physical health problems and improve quality of life. Evaluations of iSupport in countries such as India and Australia showed that carers valued the program, but many offered a consistent message: it was too long. They wanted shorter, more practical resources that could help them address immediate problems in real time.
That feedback, combined with the disruption of many community-based dementia services during the COVID-19 pandemic, led the WHO to create iSupport Lite. This is a streamlined version of the program consisting of six short messages focused on seeking support, self-care, care continuity, responding to change, flexibility, and communication.
Although iSupport has now been adapted and implemented in more than 40 countries, iSupport Lite has received far less attention. In particular, there has been limited work on culturally adapting its messages for carers from ethnically diverse communities, or on evaluating whether such adaptations make a meaningful difference.
From iSupport Lite to Draw-Care
To address this gap, we developed Draw-Care, a culturally adapted version of iSupport Lite for multilingual dementia carers in Australia. Using a co-designed process, we transformed the six messages into short, animated films and accompanying tip sheets, hosted on a bespoke website and translated into ten languages most commonly spoken by older Australians.
We then evaluated Draw-Care in a randomised clinical trial, examining its effects on carer burden (primary outcome), as well as mood, quality of life, and daily functioning (secondary outcomes) over six- and twelve-week follow-up periods.
What the trial showed and what stood out
This was the first trial to evaluate a multilingual adaptation of iSupport Lite specifically with dementia carers. Like several other iSupport trials conducted in India, Portugal, and the United Kingdom, our trial showed that Draw-Care did not lead to significant reductions in carer burden or significant improvements in carers’ mood. In that sense, our findings align with a growing international evidence base suggesting that iSupport, on its own, may not reliably shift these outcomes.
However, one finding stood out. Carers who accessed Draw-Care reported a significant improvement in care-related quality of life, measured using the Care-related Quality of Life Visual Analogue Scale (CarerQoL-VAS). In simple terms, carers felt better about their overall quality of life in the caregiving role, even though their sense of burden or mood did not change.
Why these findings matter
Several factors may help explain this pattern. Participants’ baseline depression scores were already relatively low, with the mean just above the cut-off score for probable depression (out of a total possible score of 60). There was therefore not much scope for improvement, creating a likely ceiling effect. The intervention itself was intentionally brief at just under 17 minutes of content, which may be insufficient to shift outcomes designed for longer, more intensive programs.
More broadly, evidence suggests that iSupport-type interventions may be better at improving carers’ knowledge, coping skills and sense of self-efficacy than at reducing burden or depression directly. These findings also point to a wider issue in digital care research: many commonly used outcome measures were developed decades ago, well before online interventions existed, and may not capture the kinds of change produced by short, self-directed programs. This challenge is particularly acute for research conducted in languages other than English, where validated measurement options are limited. For example, the CarerQoL-VAS only applied to English, Spanish, and Italian speaking participants in the Draw Care trial, though the intervention itself was available in 10 languages.
Taken together, these findings suggest that both the logic model underpinning such programs and the outcomes we prioritise may need revisiting.
Looking ahead: inclusive digital care
The Draw-Care trial highlights that culturally adapted, in-language digital interventions are most effective when delivered as part of multicomponent support, alongside care coordination, peer support, and human interaction.
As dementia care research increasingly moves online, ensuring that interventions and the ways we evaluate them are inclusive of multilingual carers will be critical to advancing equitable and meaningful evidence.
Read the full article in Age and Ageing: Evaluating the effects of the World Health Organisation’s online intervention ‘iSupport lite’ to reduce burden in multilingual dementia carers: results from the Australian Draw-Care randomised clinical trial
