LAUSR

Approximately 42.1 million family caregivers provided care to an adult with limitations in daily activities at any given point in time in the US in 2009 (Feinberg et al., 2011). The economic value of caregivers' unpaid contributions was estimated to $450 billion (Feinberg et al., 2011). Younger care recipients most often suffer from mental illness (MI) while older care recipients' problems are commonly aging, chronic diseases, Alzheimer's, dementia/other mental confusion (National Alliance for Caregiving and AARP, 2004). There are approximately 1.3 million caregivers in Sweden who support someone regularly, of whom 900,000 are of working age and 140,000 have stopped or reduced their working hours due to the caregiving situation (Riksförbund, 2016). Many of the families with a person with MI experience such psychological distress that they require therapeutic intervention. Caregivers of people with other diseases, e.g. stroke (Rigby et al., 2009), dementia (Etters et al., 2008), cancer (Grunfeld et al., 2004), Parkinson's (Schrag et al., 2006), and brain tumors (Schubart et al., 2008) also experience caregiver burden. This entails both an objective and subjective burden, the latter referring to the psychological distress prompted by the illness (Lefley, 1989). It hence includes psychological, occupational and financial burdens, especially in times of illness deterioration (Grunfeld et al., 2004; Schubart et al., 2008). The experience of burden has been found to be enhanced in long-lasting relationships, when the caregiver and his/her relative live together and when the care is given daily and not appreciated (Östman and Hansson, 2004). Caregivers of older adults also report decreases in health due to caregiving (National Alliance for Caregiving and AARP, 2009). For example, role overload (Turcotte, 2013; Adelman et al., 2014) and caregiver burden can be the most important predictors of anxiety/depression (Rigby et al., 2009) and negative stress in caregivers (Turcotte, 2013; Adelman et al., 2014). Furthermore, caregivers report unmet needs such as finding own time, managing emotional and physical stress, and balancing work and family responsibilities (Longacre, 2013). It has been proposed that health professionals should include the management of caregiver distress to improve families' quality of life (QoL) (Schrag et al., 2006) and guide them towards effective interventions (Rigby et al., 2009; Adelman et al., 2014). Care duties, carers' fears and worries, and the patient's behavior (Cormac and Tihanyi, 2006) can have negative effects on caregivers' mental health (Schulz and Sherwood, 2008; Phillips et al., 2009; Smith et al., 2014). Family interventions can improve the family's emotional climate (Pharoah et al., 2010), with lower relapse rates, and enhanced outcomes and problem-solving capacities. Transportation issues, fatigue, lack of resources and stigma can be barriers to accessing help, which can be addressed by online solutions. Tailored online interventions that incorporate behavior change techniques such as stress management can have positive effects on caregivers' psychological well-being (Guay et al., 2017). Web-based mindfulness interventions (MBI) show promising results with beneficial health effects for healthy and clinical samples (de Vibe et al., 2012). A feasibility study and randomized controlled trial of the current online MBI showed positive significant results for families living with MI with enhanced levels of mindfulness and self-compassion, and decreased levels of caregiver burden and perceived stress (Stjernswärd and Hansson, 2016a; Stjernswärd and Hansson, 2017), combined with good usability and subjective value when using the program (Stjernswärd and Hansson, 2016b). Usability refers to the extent to which a specific user can use a specific product to reach specific goals, with purposefulness, effectiveness, and satisfaction, in a given context (ISO, 1998). Ease of access and flexibility of use were strong motivators for use (Stjernswärd and Hansson, 2016b). More studies are called for to verify the intervention's effectiveness for extended groups of caregivers.