Internet-delivered self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a mixed-methods process evaluation of reach and recruitment

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 intervention with minimal therapist support for family carers of people with dementia. The study examined the reach of the intervention and factors influencing recruitment to inform equitable implementation.Methods Demographic data from 565 screened carers and interviews with 30 referrers across UK health services were analysed.Results The screened sample was predominantly aged 50–79 years (82.5%), female (77%), and White (91.7%). Five themes were identified: referrers’ coordinated referrals, mutual motivation, and community outreach supported engagement; referrers’ trust-building, tailored communication, and timely approaches facilitated participation; carers’ time constraints and referrers’ assumptions about older carers’ digital skills influenced recruitment; proactive outreach was important for engaging ethnic minority carers; and cultural perceptions of mental health created barriers to participation.Conclusions The sample was broadly comparable with previous estimates of the UK dementia carer population. For the equitable implementation of interventions such as iACT4CARERS, coordinated recruitment across health, social care, and voluntary organisations, alongside centralised intervention delivery, may be critical. Outreach can be further strengthened by enhancing referrers’ communication and empowerment skills, including challenging assumptions about older carers’ digital abilities.