Authors
Hande Gencer, Emily Mena, Theresa Freund, Sebastian Budde, Hajo Zeeb, Benjamin Schüz, Tilman Brand
Published in
JMIR formative research. Volume 10. Pages e95268. Nov 11, 2026. Epub Nov 11, 2026.
Abstract
Informal caregivers play a central role in long-term care but experience elevated risks of stress, depressive symptoms, and caregiver burden, alongside barriers to accessing preventive support. Low-threshold digital public health interventions may offer scalable support; however, evidence on their feasibility, usability, and contextual fit remains limited, particularly for heterogeneous caregiver populations.
This study describes the development and implementation of PflegeBot, an intersectionality-informed WhatsApp-based chatbot intervention, and evaluates its feasibility, usability, and acceptability among informal caregivers in Germany.
A single-arm, nonrandomized feasibility study with pre-post assessments was conducted between December 2023 and March 2024. Informal caregivers aged 18 years and older were recruited via community-based, institutional, and online channels. PflegeBot was a co-designed, bilingual (German and Turkish) WhatsApp-based chatbot that delivered 84 scheduled messages over 12 weeks. Content included caregiving information, self-care, and cognitive behavioral therapy-informed self-help, plus optional frequently asked questions and question functions. Baseline and full follow-up assessments were administered online. Feasibility was assessed using indicators of recruitment, chatbot initiation and message delivery, opt-out, and provision of follow-up measures. Usability was assessed using the System Usability Scale (SUS), and acceptability was assessed using study-specific items. Exploratory outcomes included perceived stress (4-item Perceived Stress Scale [PSS-4]), caregiver burden (4-item Zarit Burden Interview [ZBI-4]), depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]), and loneliness (6-item De Jong Gierveld Loneliness Scale [DJGLS-6]). Analyses were descriptive; no hypothesis tests were conducted. Open-ended follow-up feedback was examined using a systematic inductive descriptive approach.
Of 102 participants included in the baseline analysis sample, 84 (82%) were women. According to chatbot log data, message delivery was initiated for 67 participants. Forty-nine participants provided at least one follow-up measure, and complete SUS data were available for 46 participants. The mean SUS score was 82.45 (SD 14.86, 95% CI 78.03-86.86; range 47.5-100), and 35 out of 46 (76%) participants scored at or above the benchmark of 68. Overall satisfaction with PflegeBot had a mean rating of 4.02 out of 5 (SD 0.98; n=46). Among participants responding to the relevant item, 1 out of 45 (2%) reported using the optional FAQ function. Mean changes were -0.57 (95% CI -1.24 to 0.10; n=35) for perceived stress, 0.81 (95% CI -0.02 to 1.63; n=36) for caregiver burden, -2.38 (95% CI -5.42 to 0.66; n=34) for depressive symptoms, and -0.39 (95% CI -0.90 to 0.12; n=36) for loneliness. Open-ended feedback highlighted needs for more flexible delivery, greater tailoring, and easier navigation.
PflegeBot could be delivered through WhatsApp, and participants providing follow-up data reported high usability and generally favorable satisfaction. Controlled evaluations with objective engagement data and assessment of differential reach and outcomes are warranted.
PMID:
43013871
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.
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