International evidence on effective interventions to support carers: Are we looking for the right outcomes Gillian Parker Hilary Arksey Melissa Harden
Outline • Background to the review • Methods • Findings • Raising questions about appropriate outcomes to use in evaluation research
Background • National Strategy 2008 • DH and Standing Commission on Carers • Understanding of what we know about what are effective interventions to support carers • Commissioned to carry out a meta-review (review of reviews) to address this issue • NOT about ‘normal’ services
Methods for conducting meta-review • Followed a defined search strategy • Screened over 11,000 references • Appraised nearly 300 articles and reports for relevance and quality • Scope of the field based on 34 reviews (20 higher quality; 14 lower quality) • Detailed analysis for meta-review based on 20 higher quality reviews
Findings 1: Scope of field (higher and lower quality systematic reviews) Types of interventions reviewed: • Psychosocial, psycho-educational psychological • Respite care • Information, education, knowledge, communication • Health service interventions • Diverse mix
Scope of field (cont’d …) Target carer groups: • Carers of people with dementia/older people • Carers of: stroke survivors; people with kidney disease; heart patients; palliative and cancer carers; bipolar patients; people with COPD • Carers in general
Scope of field (cont’d …) Types of outcomes measured: • Carer burden, strain or stress • Psychological or mental health • Subjective well-being or QoL • Knowledge or caring ‘competence’ • Physical health • Satisfaction • Costs
Scope of field (cont’d …) Number of primary studies included in reviews • Ranged from 0 to over 150 • Overlap of primary studies International coverage • Majority of primary studies in systematic reviews from USA, followed by UK
Findings 2: Qualitative findings from higher quality systematic reviews
Why is there so little evidence of effectiveness? • Quality of the primary studies – small, poorly conducted, inadequate ‘control’ • Short-term follow-up • Difficulties of doing this sort of research • Gaps in groups covered: other than dementia, BME groups, rural carers, other relationships • Are we looking at the right outcomes?
How can we make intervention research better? • Lack of theory in designing interventions • Need ‘proof of principle’ work • Need efficacy trials before effectiveness trials • Need costs to be included • Finding better outcomes to include in studies • Is ‘carer intervention’ the right way forward, given what we know about the importance of ‘services’?
Contact details Gillian Parker: email@example.com Social Policy Research Unit University of York York YO10 5DD SPRU website address http://www.york.ac.uk/inst/spru/