Effects and mechanisms of a mobile-based intelligent recommender system for dementia care on the psychological health of family caregivers: A secondary analysis of a randomized clinical trial

Background Health recommender systems show promise in delivering remote support and improving coping among family caregivers of persons with dementia. Objective To evaluate the effectiveness of a mobile-based intelligent recommender system for dementia care (DCIRS) in enhancing psychological well-being among family caregivers and to explore the mechanisms underlying its effects. Methods Data from a randomized controlled trial (RCT) were used. Of the 250 eligible participants, 125 caregivers were randomly allocated to the intervention group (receiving DCIRS) and 125 to the waitlist control group. Outcomes, including benefit finding, depressive symptoms, self-efficacy, and coping styles, were assessed at baseline (T0), 6 weeks (T1), and 12 weeks (T2). Generalized estimating equations (GEE) was used to evaluate changes over time and between-group differences, while path analysis examined mediation pathways. Results At 12 weeks, the intervention group showed significant within-group improvements in coping, self-efficacy, and benefit finding (all p < 0.05 for group × time interaction). Between-group analyses revealed greater reductions in depressive symptoms at T1 and T2, though the group × time interaction was non-significant ( p = 0.393). Path analysis indicated that reduced depressive symptoms were mediated primarily by increased self-efficacy. Conclusions This DCIRS demonstrated the potential to reduce depressive symptoms and enhance benefit finding in caregivers of people with dementia. Strengthening self-efficacy and active coping styles should remain a core focus in digital health interventions, providing meaningful guidance to healthcare professionals in developing caregiver support program.