BBusiness Models of eHealth Interventions to Support Informal Caregivers of People with Dementia in the Netherlands: Case Study Analysis (Preprint)

BACKGROUND In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented into practice and much can be learned from their counterparts (from commercial, governmental, or other origins) that are already being used in practice. OBJECTIVE This study aimed to (1.) examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia, that are currently used in the Netherlands; (2.) investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions, and (3.) apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. METHODS In step one, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: (1.) delivered via the internet, (2.) suitable for informal caregivers of people with dementia, (3.) accessible in the Netherlands, either in Dutch or in English, and (4.) used in practice. The contacted experts were academics working on dementia and/or psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organisations, and people with dementia and their caregivers. In step two, contact persons from the suggested eHealth interventions participated in a semi-structured telephone interview. The results were analysed using multiple-case study methodology. RESULTS Twenty-one eHealth interventions for caregivers of people with dementia were suggested by experts. Nine of these 21 interventions met all four criteria and were included in the sample for case study analysis. Four cases were found to have developed sustainable business models. Five cases were implemented in a more exploratory manner and relied on research grants to varying extents, though some had also developed preliminary business models. CONCLUSIONS These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology (ICT) services externally, and offering fixed, low-level pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modelling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice.