Cultural Adaptation of the World Health Organization’s iSupport Dementia Program for Family Carers of People Living with Dementia in Vietnam

Cultural Adaptation of the World Health Organization’s iSupport Dementia Program for Family Carers of People Living with Dementia in Vietnam | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Cultural Adaptation of the World Health Organization’s iSupport Dementia Program for Family Carers of People Living with Dementia in Vietnam Thanh Binh Nguyen, Thanh Binh Nguyen, Trung Anh Nguyen, Ngoc Anh Nguyen, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6988335/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Supporting carers is a key priority in the Global Action Plan on Dementia. The World Health Organization (WHO) developed iSupport, an online education and support program for family carers of people with dementia that can be adapted for use in different contexts. This study aimed to adapt iSupport for Vietnamese dementia carers. Methods : The adaptation process followed the WHO iSupport Adaptation and Implementation Guidelines in two stages. Stage 1 involved forward translation, expert panel review, backward translation, and harmonization, followed by researcher-led adjustments to align the content with Vietnamese cultural and healthcare contexts. Stage 2 consisted of Focus Group Discussions (FGDs) with family carers and healthcare professionals (HCPs) to gather feedback on the program’s content and its delivery via videos and an online virtual assistant platform. Results : Results of stage 1 involved refining professional translation to align with Vietnamese medical terminology, cultural norms, and caregiving practices. Unfamiliar activities were replaced with culturally relevant ones and medical advice was adjusted to local standards. Vietnamese proverbs, idioms, and localized names were incorporated to enhance cultural resonance. Stage 2 generated valuable feedback through FGDs. Participants called for simplified, jargon-free language and practical, context-specific advice. Digital delivery, especially through short multimedia videos with real actors, was preferred due to convenience and accessibility. Conclusion : Participants valued iSupport’s trustworthy, well-curated content, contrasting it with the overwhelming and often unreliable online resources. However, key barriers included limited time availability and the need for stage-specific guidance as dementia progresses. Suggested improvements included interactive features like update notifications. iSupport shows strong potential to improve dementia care in Vietnam by offering culturally tailored, accessible digital support to carers. cultural adaptation dementia family carers digital health intervention iSupport Vietnam Figures Figure 1 INTRODUCTION Vietnam is experiencing a rapidly aging population, with projections indicating that over 25% of the population will be aged 60 or older by 2049 [ 1 ]. This demographic shift is anticipated to intensify issues related to aging, including a significant rise in degenerative diseases such as dementia, a leading cause of disability and dependency among the old adults [ 2 ]. Consequently, demands on care for people living with dementia (PLWD) and their family carers are expected to grow, affecting social, health, and economic systems [ 3 ]. Vietnamese family carers face significant challenges, including time constraints, income loss, increased social isolation, poor physical health, and emotional distress [ 4 ]. The need for diverse support options for carers in Vietnam is evident [ 5 ]. Effective support for family carers often involves multimodal interventions, combining education, skill building to manage changed behavior, stress reduction, and referral to community resources [ 6 ]. One example is the REACH model (Resources for Enhancing Alzheimer's Caregivers Health) [ 7 ], which has been adapted by the Vietnam National Geriatric Hospital as REACH VN, showing significant improvements in mental health and caregiving burden for carers [ 8 ]. However, face-to-face REACH VN is resource-intensive, requiring home visits by interventionists, which can strain the healthcare system. While face-to-face interventions improve carers’ mental health, many carers are unable to attend due to limited transport, finances or inability to leave their relative with dementia [ 9 ]. Online or app-based carers interventions could address these accessibility barriers effectively [ 10 ]. Internet-based solutions are well-received by carers, offering flexible access and low costs [ 11 , 12 , 13 ]. Emerging online training and support programs have shown promise in improving the mental health of dementia carers and hold significant potential for wider adoption [ 13 ]. To address barriers in accessibility for carers who struggle to attend in-person support programs, the World Health Organization (WHO) developed “iSupport for Dementia.” This online, self-guided skills training program provides carers of PLWD with essential knowledge and skills, using evidence-based methods such as cognitive-behavioural therapy and problem-solving techniques [ 14 ]. The program comprises five modules with a total of 23 lessons (Fig. 1 ): (1) What is dementia; (2) Being a carer; (3) Self-care; (4) Providing care; and (5) Dealing with behavior changes. Each lesson includes interactive exercises for learners, offering immediate feedback on their responses to the exercises. Upon completing each lesson, learners receive a certificate of completion, validating their training [ 15 ]. iSupport has been culturally and linguistically adapted in several countries like India, New Zealand, Spain, Portugal, Brazil, though not in Vietnam [ 16 ]. Despite the global adoption of iSupport, there is a notable gap in its adaptation to meet the unique cultural and linguistic needs of Vietnamese carers, highlighting the need for further research. This paper addresses this gap, detailing the adaptation of iSupport for dementia family carers in Vietnam as part of the e-DiVA project (empowering Dementia Carers with an iSupport Virtual Assistant) [ 17 ]. The e-DiVA project aims to enhance the WHO iSupport program by developing an iSupport Virtual Assistant to assist family carers across four countries: Australia, New Zealand, Indonesia, and Vietnam. Through conversational interaction options and video tutorials, the virtual assistant will provide real-time guidance, making the program more accessible, user-friendly and easier to navigate. METHODS The adaptation of iSupport in Vietnam involved two stages, following a multi-step cultural adaptation process informed by established frameworks commonly employed in global health [ 18 ] and principles of community-based participatory research [ 19 ]. These stages were: 1) Translation and content adjustment by researchers, and 2) Cultural adaptation of the translated iSupport program through focus group discussions (FGDs) with family carers and healthcare professionals (HCPs). Stage 1 – Translation and adjustment of the content of the iSupport program. The translation and adjustment procedure (Table 1 ) was based on the WHO “iSupport Adaptation and Implementation Guide version 1.0 [ 20 ]. Table 1 The procedure of Translation and Adjustment of iSupport in Vietnam Steps Implementers Outcomes 1. Forward translation • iSupport English (ENG) Version 1 was translated into Vietnamese (VN) Version 1 by an authorized professional translator. • VN Version 1 was reviewed by a bilingual neurologist researcher (TBN 1,2 ) VN Version 1 2. Backward translation • VN Version 1 was back translated into English (TBN 1 ) ENG Version 2 3. Comparison and reconciliation • ENG Version 1 and ENG Version 2 were compared by researchers (TAN 1,3 , NAN, TNL) and feedback was provided to the professional translator to revise the VN Version 1 VN Version 2 4. Content adjustment by researchers • VN Version 2 was adjusted following the adaptation form (TBN 1 , TTBN, NAN, MPH, MVT, TNL) • Personal names, links, resources were changed. • Cultural norms, customs were adapted VN Version 3 5. Expert panel review • VN Version 3 was reviewed by representatives from Vietnam Alzheimer’s Association and the Principal Investigators (TP and TAN 1,3 ) VN Version 4 6. Fidelity check • A list of all proposed changes was compiled to submit to WHO. WHO feedback was incorporated to produce VN Version 5 VN Version 5 Stage 2 - Culturally adapt the iSupport program via focus group discussions with family carers and healthcare professionals. Two FGDs were conducted, one with family carers of PLWD and the other with HCPs working in the dementia care field. The FGDs aimed to seek feedback from participants to adapt the iSupport program to suit the cultural and linguistic context of Vietnam. Participants were allotted two weeks to review the Vietnamese-translated version of the iSupport manual (VN Version 5) and document their feedback on aspects of the content requiring attention before participating in the group discussion. The FGDs lasted approximately 2 hours and were audio recorded. Participant recruitment A purposive sampling technique was adopted for participant recruitment. Carers were recruited if they were ≥ 18 years old, were a primary family carer (i.e., providing the most day-to-day care) of a community-dwelling person with dementia (having a formal diagnosis of dementia), provided dementia care for at least 6 months, and regularly used smart devices with internet connection. Healthcare professionals were recruited if they had worked in the fields related to the care of PLWD (geriatrics, neurology, psychiatry, rehabilitation, social work) for at least 5 years to ensure adequate expertise [ 21 ]. Procedure Written consent and socio-demographic information were obtained from participants before undertaking the FGDs. A researcher (NAN), who is experienced in working with PLWD and their family carers, and trained in qualitative research methods ran the FGDs in Vietnamese, using an interview guide (see Supplementary Table S1 ). Notes were taken by two researchers (TNL, HYL). Data analysis Audio recordings of the FGDs were transcribed verbatim by two researchers (TBN 1 and QPN) and analysed thematically. First, transcripts were read and re-read to develop an overall sense of the data and identify meaningful segments. Second, initial codes were generated. Interesting features across the dataset were systematically coded and segments of data that are relevant to the research question were labelled, creating initial codes that formed the basis of later themes. Third, related codes were grouped together to identify broader themes that represent significant patterns within the data. Fourth, the themes were reviewed and refined to ensure that they accurately represented the data, both in relation to the coded data extracts (Level 1) and the overall dataset (Level 2). Fifth, each theme was further refined and clearly defined by identifying the narrative conveyed by the theme and capturing its essence through an appropriate name. Finally, vivid and compelling data extracts were selected, and these selected excerpts underwent a final analysis by linking the themes back to the research question and literature [ 22 , 23 ]. The NVIVO 14.23.2 software was used for data management and coding. Two researchers (TBN 1 and QPN) independently developed the original codes. After that, the list of generated codes was reviewed, compared, and contrasted to finalize the coding scheme with discrepancy resolved by discussion. A third researcher (TPAN) reviewed the final codes for accuracy and grouped them into themes. RESULTS The adaptation of the iSupport program for dementia carers in Vietnam involved two key stages: (1) the translation and researcher adjustment of the iSupport content, and (2) the cultural adaptation of the program through focus group discussions. Stage 1 - Translate and adjust the iSupport program content. Alignment with Vietnamese medical terminologies Although professional translation was conducted, further refinements to the Vietnamese translations of certain English medical terminologies were necessary to align with terminology commonly used in Vietnam. For enhanced accuracy, specific terms were adjusted across various versions of the Vietnamese translation. For example, in Vietnamese, the term “sa sút trí tuệ” is officially recognised phrase for “dementia”, effectively conveying its full meaning and associated symptoms. It was used to replace the originally translated term “chứng mất trí nhớ” in VN Version 1. Other examples include the terms "lo lắng, thờ ơ" (meaning worried, indifferent) in the title of lesson 4, module 5, VN Version 1.0, which were changed to "lo âu" (anxiety) and "vô cảm" (apathy) in VN Version 2.0, reflecting more precise the emotional disorders. Similarly, "giai đoạn đầu/giai đoạn cuối" (beginning/end stages of dementia) in VN Version 1.0 were revised to "giai đoạn sớm/giai đoạn muộn" (early/late stages of dementia), and "không thể kiểm soát đại tiểu tiện" (unable to control urination) in lesson 3, module 4 was refined to "đại tiểu tiện không tự chủ" (incontinence) in VN Version 2.0, enhancing clarity and alignment with medical terminology. Adjustment of semantic expression Some English words and expressions have different or multiple meanings when translated into Vietnamese language, so careful selection and adjustments were undertaken to ensure accurate translation in context. For example, the word “tip” in the educational context was literally translated into “mẹo” but then was adjusted to “phương pháp [method]” for better understanding. Another example is “Ups and downs”, which literally means in Vietnamese as “lên và xuống”. However, “Having a lot of ups and downs” in the context of mood swings means unstable emotional state so it was translated as “Tính khí rất thất thường” [Very erratic temperament]. Similarly, “Interesting activities”, which was literally translated as “Hoạt đông thú vị” and then adjusted to “Hoạt động giải trí” [Entertainment activities]. In addition, some borrowed words commonly used in education and training were utilized for simplicity, an example being the word "module" in English, which was transliterated into Vietnamese as "mô-đun”. Finally, to capture the nuances of proverbs and idioms, Vietnamese equivalents were used in translating English expressions rather than direct, word-for-word translations. For example, the Vietnamese proverb "Có công mài sắt, có ngày nên kim" was chosen as an equivalent to "Practice makes perfect," in example 2, lesson 3, module 3, effectively conveying the original expression’s meaning in culturally familiar terms. Adjustment of personal names In total, 96 Western names used in the iSupport manual were converted into Vietnamese names. Recognising the cultural significance of personal names, the research team consulted cultural resources and figurative language references to guide translation and adjustment decisions. Given the subjective nature of this process, multiple strategies were applied. The primary approach involved selecting Vietnamese names with similar initials, considering both the original name’s first letter and gender. For instance, Manuel was changed to Mạnh, Maria to Mai, Mary to Mến, and Chrissy to Chi. In cases the first letter of the original names is not commonly used in Vietnamese names, a letter with a similar pronunciation was chosen. For example, Jonathan was adapted to Đức, John to Dũng, and Jacob to Dương. Other approaches include selecting Vietnamese names with similar meaning of the original names. For instance, the name “Hugo” is of Germanic origin, derived from the word "hug" meaning "mind" or "intellect" so it was converted into “Tâm” (in “Tâm trí” [Mind]). Additionally, to align with Vietnamese customs, honorifics such as “Mr” or “Ms” were added before personal names to convey a greater level of respect. For example, Maria was addressed as Ms Mai in Vietnamese, even in casual settings. Adjustment of resources, links and guidance to ensure relevance and align with Vietnam’s standard medical practices All original website links in the iSupport manual were from Alzheimer's Disease International pages. Fourteen of these links were replaced with websites from Vietnamese organizations providing similar information, such as the Vietnamese Alzheimer Disease & Neurocognitive Disorders Association ( http://www.alzvietnam.org ) and the Vietnam National Geriatric Hospital ( http://benhvienlaokhoa.vn ). Adjustment was also made to the guidance on accessing health and social services in the Vietnamese context to ensure relevance. For example, the suggestion to “consult the general practitioner to identify loose teeth, ulcers or infections” was revised to “consult a dentist” to align with standard medical practices in Vietnam. Another example is that the suggestion to “call a medical doctor's office and make an appointment” in cases of suspicion that a relative or friend may have dementia was replaced with "go to the nearest medical facility and see a doctor"​. Adjustment of items to align with cultural habits and expression (traditions) Items or terminologies rarely used in Vietnam were replaced with more commonly used ones to improve comprehension. For example, "Bọt biển” [Sponge bath] in “wiping the body with a sponge” was changed to “khăn ẩm” [a damp towel] or “pyjamas” was replaced by “quần áo ngủ” [sleepwear]. In addition, activities like “Watching birds or animals”, or “Playing a musical instrument” are not typical leisure activities performed by middle-aged or older people in Vietnam. Therefore, they were replaced by more popular and culturally appropriate activities such as “Watching TV” or “Listening to the radio”. Finally, some generic activities such as “Personal care before breakfast” in the original text were changed to more specific activities like “brush teeth and wash face before breakfast” to enhance understanding. Fidelity check The WHO team accepted the majority of the proposed changes from the Vietnam team, with the exception of two. The first was in the 'Introduction' section. The Vietnamese version suggested: “Dementia symptoms may include mild to severe memory and thinking disorders that make daily activities difficult without assistance. Dementia progresses through many stages, with symptoms varying at each stage and for each individual”. However, WHO recommended: “Dementia symptoms may include difficulties with memory, thinking, and the ability to perform daily activities. Symptoms usually worsen over time as dementia progresses. While dementia typically advances in stages, symptoms and progression differ from person to person”. The second change was in the “Dealing with Changing Behaviors” section. The Vietnamese team proposed replacing “I know that you feel bad, I do too. What we’re going through is really hard” with “Don't worry, it is okay”. However, according to the WHO team, the revision did not acknowledge the person's emotions. They emphasized the importance of emotional validation and suggested keeping “What we are going through is really hard” while potentially adding a phrase like “It is normal to feel this way”. Stage 2 - Culturally adapt the iSupport program via focus group discussions with family carers and HCPs Participants Twelve participants participated in the FGDs, including eight family carers and four HCPs (Table 2 ). Mean age of carers and HCPs were 49 and 43 years old, respectively. Half of carer participants (n = 4, 50%) were female, while all HCP participants were female (n = 4, 100%). The average number of years in dementia caring role was 6.4 and 8 years for carers and HCPs, respectively. Table 2 Participants’ characteristics Characteristics Carers Professionals Gender, n (%) Female 4 (50) 8 (100) Male 4 (50) Age, median (range) 49 (35–65) 43 (37–51) Education, n (%) Senior high school 1 (12.50) Undergraduate 1 (12.50) 2 (50) Postgraduate 6 (75) 2 (50) Marital status, n (%) Married 8 (100) 4 (100) Care experience (years of caring), median (range) 6.40 (3–12) 8 (5–10) Analysis of FGDs Three main themes emerged from the FGDs. A summary of the main themes, sub-themes, and finalized codes, as derived from the integration process, is provided in Supplementary Table S2 . Theme 1: iSupport empowering carers through knowledge and practical guidance The iSupport program is widely recognised as a valuable resource for carers providing them with essential knowledge and practical guidance. Many carers noted that the material helped them understand dementia and approach caregiving more effectively. "Before reading this, I thought my mother’s forgetfulness was just normal aeging. Now, I understand that dementia has specific causes and symptoms, which helps me be more patient with her" (37, nurse-caring for her mother). Similarly, (65, retired) mentioned that recognising her mother’s condition as vascular dementia rather than typical forgetfulness allowed her to adjust her expectations, making interactions with her mother much less frustrating: "When I realised my mother’s condition was due to vascular dementia, not just old age, it changed my perspective. Now I know why she repeats questions and forgets recent events" . The program also addresses behavioural challenges that carers frequently encounter. Carer participants acknowledged that the iSupport program helped them in cognitive reframing when dealing with behavioural and psychological symptoms of dementia. A nurse participant said "My mother doesn’t cooperate when I try to help her eat or bathe. Before, I got frustrated, but now I understand that her reactions are part of the disease. I’ve learned to approach her differently" (37, nurse). Beyond understanding the disease itself, carers also found guidance in handling behavioural changes, (37, office staff), who has been caring for his father for a decade, noted that the iSupport program provided explanations for why his father sometimes became disoriented. He admitted that "at first, I didn’t understand why my father would forget his own neighborhood, but now I know this is part of dementia’s progression." This knowledge, he added, allowed him to plan better and ensure his father’s safety. However, despite the wealth of information in iSupport, some carers felt that its format was not always practical for real-life situations. A carer (64, caring for his wife) emphasized that "the book is useful, but when my wife suddenly refuses to eat or becomes anxious, I don’t have time to read long sections. A quick reference guide would make a big difference." Others emphasized that the document was a good foundation but should be supplemented with practical tools. "This book is a great starting point, but real caregiving situations are unpredictable. It would help if we had more real-life case studies and step-by-step approaches" (39, caring for her mother). Theme 2: The Need for Simplification and Adaptation of iSupport While the content of iSupport was seen as valuable, carers repeatedly emphasized the need for simpler language and a structure that better suits Vietnamese readers. One of the participants, (43, caring for her father) pointed out that "some sentences feel unnatural in Vietnamese, and I had to read them multiple times to understand." Another carer (49, caring for his father) had a similar experience, saying that while the information was useful, it took him several reads to fully grasp certain concepts. The use of medical terminology was another concern. One carer noted that non-medical carers might struggle with terms like "Alzheimer’s disease progression" , which could be replaced with more relatable language. Another carer agreed, stating that "some parts sound like they were written for doctors, not for regular people." Without clear definitions, carers might not fully understand the advice being given. Another issue raised was inconsistency in terminology. A psychiatrist participant, pointed out that "some terms, such as ‘hourly carer’ are translated differently in different sections, which can cause confusion." Additionally, carers suggested improvements in formatting, such as adding clear section headings and making examples more identifiable. A rehabilitation technician participant proposed that "each case study should have a title, so if carers need to revisit a topic, they can quickly find the relevant section." Finally, there was strong support for adapting the content to fit Vietnamese caregiving realities. A nurse highlighted that in Vietnam, caregiving is often a family responsibility rather than an individual effort. "Most elderly people live with their children here, so the guidance should reflect how multiple family members share caregiving duties". In Module 3, a 60-year-old carer proposed adding familiar activities for relaxation: “For example, calling a friend or going out to a neighbor's house.” In Module 4, lesson 1, a nurse suggested breaking daily water intake into smaller portions using 500 ml bottles to ensure hydration: “Provide the easiest way for people to drink enough, such as dividing their intake into manageable portion using two or three 500ml bottles”. This approach simplifies tracking, promotes consistent hydration, and makes the goal feel achievable throughout the day. Additionally, a rehabilitation technician recommended consulting specialists instead of relying on unavailable products like stir-in thickeners: “Commercial stir-in thickeners are not available in Vietnam, so it should be replaced by consulting a rehabilitation specialist for advice on feeding.” For safety, a nurse proposed using modern solutions like navigation watches or embroidered contact information: “Carrying identification is challenging; alternatives like navigation watches are more practical.” Theme 3: Opinion on the implementation of the iSupport program Many carers and healthcare professionals emphasized the importance of using video and voice-over to make iSupport content more accessible. A nurse noted that “watching instructional videos is much easier to absorb because not everyone has time to read an entire book.” Similarly, a rehabilitation technician, highlighted the convenience of accessing information through digital devices: “Nowadays, people use their phones a lot, so having online support content would make it much easier to look up information.” These insights reflect a growing preference for multimedia learning tools that enhance engagement and comprehension. When discussing preferred video formats, participants expressed varied preferences. Some favored animation, believing it could simplify complex caregiving concepts, while others preferred real actors to make scenarios feel more relatable. A 37-year-old carer suggested: “Videos should last about 3 to 5 minutes… keep them short so they easily capture attention and convey as much information as possible.” Another carer supported the use of real-life demonstrations, explaining: “If real people act out the caregiving scenarios in the videos, I think it would be easier to empathize and apply the lessons in real life.” This suggests that videos should be concise, engaging, and tailored to real caregiving situations. Participants also identified both facilitators and barriers to effectively using the iSupport program. A key facilitator is the widespread use of smartphones, which allows carers to easily access digital resources. A 43-year-old carer, pointed out: “The use of phones and the internet is now widespread, everyone has a device now, so looking it up is very convenient.” Additionally, real-time assistance through a virtual assistant was highly favored. A psychiatrist participant noted: “Whatever word you type, the virtual assistant will respond.” These factors indicate that a digital platform with on-demand, AI-powered support could be a valuable tool for carers. Time constraints and the need for stage-specific information pose significant challenges for carers engaging in structured online learning. Many struggle to find dedicated time, making on-demand access essential. One carer noted: “ There are some things I can no longer apply because my wife’s disease has progressed to another stage .” This highlights the importance of tailored guidance that aligns with the evolving needs of carers. Despite their willingness to participate, many find it difficult to integrate learning into their daily routines. A 65-year-old carer, shared: “ I can only use the program at night or in the weekends when I’m done with caregiving duties .” Another participant echoed this: “ I’ll probably read it in the evening when I have free time .” These insights underscore the need for flexible access, allowing carers to engage at their convenience. To enhance the program’s effectiveness, carers proposed several key improvements. One widely supported suggestion was the introduction of interactive notifications, allowing carers to receive alerts when new information becomes available. A 43-year-old carer explained: “If there is new information, it would be popped up on the phone”. This feature would prevent carers from missing out on important updates without requiring them to manually check the platform​. Another critical improvement was the integration of real-time support tools, such as an AI-powered virtual assistant. Many carers believed that having immediate, personalised advice could significantly reduce stress and confusion. A participant emphasized the benefit of AI-driven assistance: “Whatever word you type, the virtual assistant will respond” This feature would enable carers to receive instant, situation-specific guidance, making caregiving less overwhelming​. Participants shared opinions on the value of multimedia learning tools, particularly short instructional videos and visual illustrations. A carer noted that videos should be “short and easy to understand” , ideally lasting between “three to five minutes” to maintain attention and enhance retention. He added that “some sentences need to be read multiple times to fully understand, so illustrations would help”. Other carer noted that “personally, I like visuals; if there were more images, it would be better” . Both agreed that “animated videos are easier to understand than live-action videos” since they simplify complex caregiving concepts and make content more engaging. While multimedia tools were seen as valuable, some carers highlighted challenges related to “internet access and digital literacy” , particularly for older carers. To address this, a nurse proposed making videos “easy to watch on mobile devices without requiring a computer” to enhance accessibility. DISCUSSION The adaptation of digital carer support programs, such as iSupport, requires careful cultural and contextual modifications to ensure their relevance and usability. This study focused on adapting iSupport for dementia carers in Vietnam, aligning with previous adaptation efforts in other countries while incorporating unique elements tailored to the Vietnamese caregiving context. The findings highlight key areas of adaptation, including content structure, multimedia preferences, accessibility, and linguistic modifications. Multimedia Learning Tools and Visual Preferences One of the primary modifications involved integrating short instructional videos and visual illustrations to facilitate learning. Similar adaptations have been observed in India, Portugal and Spain [ 24 , 25 , 26 ] where multimedia formats were prioritized to make information more digestible for carers. In Greece [ 27 ], video-based content was also emphasized, particularly in response to increased digital learning needs during the COVID-19 pandemic. Stage-Specific Caregiving Information Dementia progresses through multiple stages, each requiring different caregiving strategies. Adapting content to reflect this progression has been a common consideration in multiple iSupport implementations. In Indonesia [ 28 ], carers expressed the need for a dynamic structure that presents stage-specific information rather than a one-size-fits-all approach. Similarly, in China [ 29 ] implemented a structured learning flow based on the progression of dementia symptoms. The Vietnamese adaptation further emphasized real-time, stage-specific guidance, proposing the integration of AI-powered interactive support to assist carers with tailored recommendations. This feature was not emphasized in other adaptations, indicating that interactive digital elements may be an emerging consideration in newer adaptations of carer support programs. Accessibility and Technological Considerations Ensuring accessibility is a critical component of digital intervention adaptation, particularly in countries where internet connectivity and digital literacy vary across regions. Studies in India [ 30 ] and Spain [ 25 ] identified digital literacy as a barrier to engagement, prompting the integration of simplified navigation and offline access options. Vietnamese carers demonstrated a preference for mobile-optimized content, aligning with findings from Indonesia [ 28 ] and China [ 29 ] where mobile phone penetration is high. This suggests that mobile-first designs should be prioritized when adapting digital carer programs in regions with similar technological usage patterns. Linguistic and Cultural Adaptations Linguistic modifications are essential to ensure that carer programs are not only accurately translated but also contextually appropriate. In Portugal [ 26 ] and Russia [ 31 ], adaptations included simplifying medical terminology and replacing complex healthcare-related expressions with more commonly understood phrases. In Vietnam, similar adjustments were made by replacing technical dementia-related terms with everyday language, ensuring clarity for carers with varying educational backgrounds. Cultural adaptations extended beyond language, incorporating localized caregiving scenarios to enhance relevance. For example, the Vietnamese version replaced Western examples such as car trips with motorbike travel, a common mode of transportation in Vietnam. This practice mirrors adaptations in Indonesia [ 28 ], where caregiving examples were revised to align with multigenerational family structures. Time Constraints and Adaptation for Carers' Schedules Carers often face significant time constraints, making it essential for digital interventions to provide flexible access. Similar challenges were reported in Portugal [ 26 ], New Zealand [ 32 ] and Switzerland [ 33 ], where carers found it difficult to allocate time for structured learning. Limitations Few limitations of the study need to be recognised. First, all participants of the focus group discussions live in Hanoi, the capital city of Vietnam, majority of whom have university-level education and are middle-aged, so they do not represent a diverse group of users living across Vietnam including those in rural areas and those who are at a younger or older age groups. Second, despite our efforts to encourage participants to contribute to the discussion, there was still uneven engagement of all carers. Finally, although we divided the iSupport content to smaller, more manageable sections and sent them to focus group discussion participants in advance, some of the participants, especially family carers, had not reviewed fully the section assigned to them prior to attending the discussion. That might be a reason for the uneven engagement and contribution to the discussion among participants. CONCLUSION The adaptation of iSupport for Vietnam aligns with global efforts to modify digital carer interventions to meet the needs of diverse populations. While many findings are consistent with previous adaptations, such as the importance of multimedia learning, linguistic simplifications, and mobile optimization, the Vietnamese adaptation introduces notable advancements, including animated visual content and AI-powered stage-specific guidance. Comparing with adaptation strategies across multiple countries, this study proposes the most advanced adaptation for future implementations. Key recommendations include refining mobile-first approaches, developing interactive features, and incorporating long-term engagement strategies. Further research should evaluate the sustained impact of these adaptations on carer burden and well-being, ensuring that digital carer support programs continue to evolve in response to real-world needs. Abbreviations WHO World Health Organization FGDs Focus Group Discussions HCPs Health Care Professionals PLWD People Living with Dementia REACH Resources for Enhancing Alzheimer's Caregivers Health e-DiVA empowering Dementia Carers with an iSupport Virtual Assistant ENG English VN Vietnamese Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Vietnam National Geriatrics Hospital, Hanoi, Vietnam (approval No 1066/QD-BVLKTW signed 28/09/2022). All participants provided informed consent prior to enrollement. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Consent for publications Not applicable Availability of data and material The dataset used and analyzed during the current study are availabe from the corresponding author on reasonable request. Competing interests The authors declared no potential conflict of interest with respect to the research, authorship, and publication of this article. Funding The study disclosed receipt of financial support for the research, authorship and/or publication of this article: This work was support by Ministry of Science and Technology of Vietnam (e-ASIA JRP). Authors’ contributions Designed and obtain funding for the study: TAN 4,5,7 , TP and TAN 1,3 . Perform the study: TP, TAN 1,3 , TBN 1,2 , TBN 1 , NAN, TTBN, MPH, TNL, TPAN . Prepared the ethics application: TPAN, MHL, MVT. Conducted the focus group discussion: NAN, TNL, HYL. Contributed materials/analysis tools: NHN, VHH, TTL. Analysis the FGDs: TBN1, QPN, TPAN . Wrote the manuscript: TBN 1,2 , TBN 1 , UB, THD, TAN 4,5,7 . Undertook the quality appraisal: TP, TAN 1,3 , TBN 1,2 . All authors reviewed manuscript draft for critical intellectual content and approved the final manuscript. Acknowledgments The authors thank all carers and professional participants for their time and precious contribution to this work. The authors also wish to acknowledge the support provided by the members of Vietnam National Geriatrics Hospital, Vietnam Geriatrics Association, The Ministry of Science and Technology and collaborators for the realization of this project. The authors used OpenAI's ChatGPT (version GPT-4, accessed via ChatGPT, June 2025) to assist with language refinement and clarity during manuscript preparation. Final decisions and critical interpretation were made by the human authors. References Handong L, Hongngoc N, Tianmin Z. Vietnam’s Population Projections and Aging Trends from 2010 to 2049. J Popul Ageing. 2021;14(2):165–82. https://doi.org/10.1007/s12062-019-09257-3 . Wahl D, Solon-Biet SM, Cogger VC, Fontana L, Simpson SJ, Le Couteur DG, Ribeiro RV. Aging, lifestyle and dementia. Neurobiol Dis. 2019;130:104481. https://doi.org/10.1016/j.nbd.2019.104481 . Alzheimer’s Disease International. (n.d.). World Alzheimer Report 2022 – Life after diagnosis: Navigating treatment, care and support . Alzheimer’s Disease International. Nguyen TT. I am not a good enough caregiver, and it is my fault’: The complex self-concept of Vietnamese female caregivers in dementia care. Dement (London England). 2021;20(7):2340–61. https://doi.org/10.1177/1471301221994359 . Nguyen H, Nguyen T, Tran D, Hinton L. It’s extremely hard but it’s not a burden: A qualitative study of family caregiving for people living with dementia in Vietnam. PLoS ONE. 2021;16(11):e0259788. https://doi.org/10.1371/journal.pone.0259788 . Walter E, Pinquart M. How Effective Are Dementia Caregiver Interventions? An Updated Comprehensive Meta-Analysis. Gerontologist. 2020;60(8):609–19. https://doi.org/10.1093/geront/gnz118 . Nguyen TA, Nguyen H, Pham T, Nguyen TH, Hinton L. A cluster randomized controlled trial to test the feasibility and preliminary effectiveness of a family dementia caregiver intervention in Vietnam: The REACH VN study protocol. Medicine. 2018;97(42):e12553. https://doi.org/10.1097/MD.0000000000012553 . Hinton L, Nguyen H, Nguyen HT, Harvey DJ, Nichols L, Martindale-Adams J, Nguyen BT, Nguyen BTT, Nguyen AN, Nguyen CH, Nguyen TTH, Nguyen TL, Nguyen ATP, Nguyen NB, Tiet QQ, Nguyen TA, Nguyen PQ, Nguyen TA, Pham T. Advancing family dementia caregiver interventions in low and middle income countries: A pilot cluster randomized controlled trial of Resources for Advancing Alzheimer’s Caregiver Health in Vietnam (REACH VN). Alzheimer’s Dementia: Translational Res Clin Interventions. 2021;6(1):e12063. https://doi.org/10.1002/trc2.12063 . Prina AM, Mayston R, Wu Y-T, Prince M. A review of the 10/66 dementia research group. Soc Psychiatry Psychiatr Epidemiol. 2019;54(1):1–10. https://doi.org/10.1007/s00127-018-1626-7 . Hopwood J, Walker N, McDonagh L, Rait G, Walters K, Iliffe S, Ross J, Davies N. Internet-Based Interventions Aimed at Supporting Family Caregivers of People with Dementia: Systematic Review. J Med Internet Res. 2018;20(6):e216. https://doi.org/10.2196/jmir.9548 . Egan KJ, Pinto-Bruno ÁC, Bighelli I, Berg-Weger M, van Straten A, Albanese E, Pot A-M. Online Training and Support Programs Designed to Improve Mental Health and Reduce Burden Among Caregivers of People with Dementia: A Systematic Review. J Am Med Dir Assoc. 2018;19(3):200–e2061. https://doi.org/10.1016/j.jamda.2017.10.023 . Goodridge D, Reis N, Neiser J, Haubrich T, Westberg B, Erickson-Lumb L, Storozinski J, Gonzales C, Michael J, Cammer A, Osgood N. An App-Based Mindfulness-Based Self-compassion Program to Support Caregivers of People with Dementia: Participatory Feasibility Study. JMIR Aging. 2021;4(4):e28652. https://doi.org/10.2196/28652 . Leng M, Zhao Y, Xiao H, Li C, Wang Z. Internet-Based Supportive Interventions for Family Caregivers of People with Dementia: Systematic Review and Meta-Analysis. J Med Internet Res. 2020;22(9):e19468. https://doi.org/10.2196/19468 . Pot AM, Gallagher-Thompson D, Xiao LD, Willemse BM, Rosier I, Mehta KM, Zandi D, Dua T. iSupport: A WHO global online intervention for informal caregivers of people with dementia. World Psychiatry: Official J World Psychiatric Association (WPA). 2019;18(3):365–6. https://doi.org/10.1002/wps.20684 . & iSupport development team World Health Organization. (n.d.). iSupport for dementia: Training and support manual for carers of people with dementia. Retrieved 2. November 2024, from https://www.who.int/europe/publications/i/item/9789241515863 Nguyen, T. A., McCalmont, D., Kosowicz, L., Sinclair, R., Sani, T. P., Cullum, S.J., Turana, Y., Oliveira, D., Hamad, H. A., Chandran, M., Xiao, L. D., Brodaty, H.,Andrade, A., Esterman, A., Kurrle, S., Crotty, M., Schofield, P., Bhar, S., Wickramasinghe,N., … Brijnath, B. (2023). The cultural adaptation of iSupport program: Experiences from Australia, Brazil, Indonesia, New Zealand and Qatar. Alzheimer’s & Dementia, 19(S19), e074977. https://doi.org/10.1002/alz.074977 Nguyen, T. A., Tran, K., Esterman, A., Brijnath, B., Xiao, L. D., Schofield, P., Bhar,S., Wickramasinghe, N., Sinclair, R., Dang, T. H., Cullum, S., Turana, Y., Hinton,L., Seeher, K., Andrade, A. Q., Crotty, M., Kurrle, S., Freel, S., Pham, T., … Brodaty,H. (2021). Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA)in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial. JMIR Research Protocols, 10(11), e33572. https://doi.org/10.2196/33572. Escoffery C, Lebow-Skelley E, Udelson H, Wood EA, Fernandez R, M. E., Mullen PD. A scoping study of frameworks for adapting public health evidence-based interventions. Translational Behav Med. 2019;9(1):1–10. https://doi.org/10.1093/tbm/ibx067 . Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity. Am J Public Health. 2010;100(Suppl 1):S40–46. https://doi.org/10.2105/AJPH.2009.184036 . Suppl 1 . WHO. (n.d.). iSupport version 1.0. Adaptation and Implementation Guide . Petty S, Dening T, Griffiths A, Coleston DM. Importance of personal and professional experience for hospital staff in person-centred dementia care: a cross-sectional interview study using free listing in a UK hospital ward. BMJ open. 2019;9(4):e025655. https://doi.org/10.1136/bmjopen-2018-025655 . Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa . DeSantis L, Ugarriza DN. The concept of theme as used in qualitative nursing research. West J Nurs Res. 2000;22(3):351–72. https://doi.org/10.1177/019394590002200308 . Baruah U, Loganathan S, Shivakumar P, Pot AM, Mehta KM, Gallagher-Thompson D, Dua T, Varghese M. Adaptation of an online training and support program for caregivers of people with dementia to Indian cultural setting. Asian J Psychiatry. 2021;59:102624. https://doi.org/10.1016/j.ajp.2021.102624 . Molinari-Ulate M, Guirado-Sánchez Y, Platón L, van der Roest HG, Bahillo A, Franco-Martín M. Cultural adaptation of the iSupport online training and support programme for caregivers of people with dementia in Castilla y León, Spain. Dement (London England). 2023;22(5):1010–26. https://doi.org/10.1177/14713012231165578 . Teles S, Napolskij MS, Paúl C, Ferreira A, Seeher K. Training and support for caregivers of people with dementia: The process of culturally adapting the World Health Organization iSupport programme to Portugal. Dement (London England). 2021;20(2):672–97. https://doi.org/10.1177/1471301220910333 . Efthymiou A, Karpathiou N, Dimakopoulou E, Zoi P, Karagianni C, Lavdas M, Mastroyiannakis A, Sioti E, Zampetakis I, Sakka P. Cultural Adaptation and Piloting of iSupport Dementia in Greece. Stud Health Technol Inform. 2022;289:184–7. https://doi.org/10.3233/SHTI210890 . Turana Y, Kristian K, Suswanti I, Sani TP, Handajani YS, Tran K, Nguyen TA. Adapting the World Health Organization iSupport Dementia program to the Indonesian socio-cultural context. Front Public Health. 2023;11:1050760. https://doi.org/10.3389/fpubh.2023.1050760 . Wang H, Xiao LD, Wang J, Chang CC, Kwok T, Zhu M. Chinese caregivers’ experiences in an iSupport intervention program in Australia and China. International Psychogeriatrics. (2023);35:58–9. https://www.intpsychogeriatrics.org/article/S1041-6102(24)06125-8/fulltext Baruah U, Shivakumar P, Loganathan S, Pot AM, Mehta KM, Gallagher-Thompson D, Dua T, Varghese M. Perspectives on Components of an Online Training and Support Program for Dementia Family Caregivers in India: A Focus Group Study. Clin Gerontologist. 2020;43(5):518–32. https://doi.org/10.1080/07317115.2020.1725703 . Safronova K, Rusakova N, Pavlenko M. Digital technologies in ISupport implementation in Russia. Int Psychogeriatr. 2023;35(S1):59–60. 10.1017/S1041610224000164 . Sani TP, Cheung G, Peri K, Yates S, Whaanga H, Cullum SJ. Carers’ perspective on adapting the iSupport in New Zealand. Alzheimer’s Dement. 2023;19(S19):e077812. https://doi.org/10.1002/alz.077812 . Messina A, Amati R, Annoni AM, Bano B, Albanese E, Fiordelli M. Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People with Dementia (iSupport): Community-Based Participatory Approach. JMIR Formative Res. 2024;8:e46941. https://doi.org/10.2196/46941 . Additional Declarations No competing interests reported. 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11:21:21","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15101,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTableS2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6988335/v1/c85974aef63b06f1bf294cdd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Cultural Adaptation of the World Health Organization’s iSupport Dementia Program for Family Carers of People Living with Dementia in Vietnam","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eVietnam is experiencing a rapidly aging population, with projections indicating that over 25% of the population will be aged 60 or older by 2049 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This demographic shift is anticipated to intensify issues related to aging, including a significant rise in degenerative diseases such as dementia, a leading cause of disability and dependency among the old adults [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, demands on care for people living with dementia (PLWD) and their family carers are expected to grow, affecting social, health, and economic systems [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eVietnamese family carers face significant challenges, including time constraints, income loss, increased social isolation, poor physical health, and emotional distress [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The need for diverse support options for carers in Vietnam is evident [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Effective support for family carers often involves multimodal interventions, combining education, skill building to manage changed behavior, stress reduction, and referral to community resources [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. One example is the REACH model (Resources for Enhancing Alzheimer's Caregivers Health) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which has been adapted by the Vietnam National Geriatric Hospital as REACH VN, showing significant improvements in mental health and caregiving burden for carers [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, face-to-face REACH VN is resource-intensive, requiring home visits by interventionists, which can strain the healthcare system.\u003c/p\u003e\u003cp\u003eWhile face-to-face interventions improve carers’ mental health, many carers are unable to attend due to limited transport, finances or inability to leave their relative with dementia [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Online or app-based carers interventions could address these accessibility barriers effectively [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Internet-based solutions are well-received by carers, offering flexible access and low costs [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eEmerging online training and support programs have shown promise in improving the mental health of dementia carers and hold significant potential for wider adoption [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. To address barriers in accessibility for carers who struggle to attend in-person support programs, the World Health Organization (WHO) developed “iSupport for Dementia.” This online, self-guided skills training program provides carers of PLWD with essential knowledge and skills, using evidence-based methods such as cognitive-behavioural therapy and problem-solving techniques [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe program comprises five modules with a total of 23 lessons (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e): (1) What is dementia; (2) Being a carer; (3) Self-care; (4) Providing care; and (5) Dealing with behavior changes. Each lesson includes interactive exercises for learners, offering immediate feedback on their responses to the exercises. Upon completing each lesson, learners receive a certificate of completion, validating their training [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eiSupport has been culturally and linguistically adapted in several countries like India, New Zealand, Spain, Portugal, Brazil, though not in Vietnam [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Despite the global adoption of iSupport, there is a notable gap in its adaptation to meet the unique cultural and linguistic needs of Vietnamese carers, highlighting the need for further research. This paper addresses this gap, detailing the adaptation of iSupport for dementia family carers in Vietnam as part of the e-DiVA project (empowering Dementia Carers with an iSupport Virtual Assistant) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The e-DiVA project aims to enhance the WHO iSupport program by developing an iSupport Virtual Assistant to assist family carers across four countries: Australia, New Zealand, Indonesia, and Vietnam. Through conversational interaction options and video tutorials, the virtual assistant will provide real-time guidance, making the program more accessible, user-friendly and easier to navigate.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThe adaptation of iSupport in Vietnam involved two stages, following a multi-step cultural adaptation process informed by established frameworks commonly employed in global health [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and principles of community-based participatory research [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese stages were: 1) Translation and content adjustment by researchers, and 2) Cultural adaptation of the translated iSupport program through focus group discussions (FGDs) with family carers and healthcare professionals (HCPs).\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 1 – Translation and adjustment of the content of the iSupport program.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe translation and adjustment procedure (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) was based on the WHO “iSupport Adaptation and Implementation Guide version 1.0 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe procedure of Translation and Adjustment of iSupport in Vietnam\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSteps\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImplementers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Forward translation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• iSupport English (ENG) Version 1 was translated into Vietnamese (VN) Version 1 by an authorized professional translator.\u003c/p\u003e\u003cp\u003e• VN Version 1 was reviewed by a bilingual neurologist researcher (TBN\u003csup\u003e1,2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVN Version 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Backward translation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• VN Version 1 was back translated into English (TBN\u003csup\u003e1\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eENG Version 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Comparison and reconciliation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• ENG Version 1 and ENG Version 2 were compared by researchers (TAN\u003csup\u003e1,3\u003c/sup\u003e, NAN, TNL) and feedback was provided to the professional translator to revise the VN Version 1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVN Version 2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Content adjustment by researchers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• VN Version 2 was adjusted following the adaptation form (TBN\u003csup\u003e1\u003c/sup\u003e, TTBN, NAN, MPH, MVT, TNL)\u003c/p\u003e\u003cp\u003e• Personal names, links, resources were changed.\u003c/p\u003e\u003cp\u003e• Cultural norms, customs were adapted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVN Version 3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Expert panel review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• VN Version 3 was reviewed by representatives from Vietnam Alzheimer’s Association and the Principal Investigators (TP and TAN\u003csup\u003e1,3\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVN Version 4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Fidelity check\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e• A list of all proposed changes was compiled to submit to WHO. WHO feedback was incorporated to produce VN Version 5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVN Version 5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 2 - Culturally adapt the iSupport program via focus group discussions with family carers and healthcare professionals.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwo FGDs were conducted, one with family carers of PLWD and the other with HCPs working in the dementia care field. The FGDs aimed to seek feedback from participants to adapt the iSupport program to suit the cultural and linguistic context of Vietnam.\u003c/p\u003e\u003cp\u003eParticipants were allotted two weeks to review the Vietnamese-translated version of the iSupport manual (VN Version 5) and document their feedback on aspects of the content requiring attention before participating in the group discussion. The FGDs lasted approximately 2 hours and were audio recorded.\u003c/p\u003e\u003cp\u003e\u003cem\u003eParticipant recruitment\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA purposive sampling technique was adopted for participant recruitment. Carers were recruited if they were ≥ 18 years old, were a primary family carer (i.e., providing the most day-to-day care) of a community-dwelling person with dementia (having a formal diagnosis of dementia), provided dementia care for at least 6 months, and regularly used smart devices with internet connection.\u003c/p\u003e\u003cp\u003eHealthcare professionals were recruited if they had worked in the fields related to the care of PLWD (geriatrics, neurology, psychiatry, rehabilitation, social work) for at least 5 years to ensure adequate expertise [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003eProcedure\u003c/em\u003e\u003c/p\u003e\u003cp\u003e Written consent and socio-demographic information were obtained from participants before undertaking the FGDs. A researcher (NAN), who is experienced in working with PLWD and their family carers, and trained in qualitative research methods ran the FGDs in Vietnamese, using an interview guide (see Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e). Notes were taken by two researchers (TNL, HYL).\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eAudio recordings of the FGDs were transcribed verbatim by two researchers (TBN\u003csup\u003e1\u003c/sup\u003e and QPN) and analysed thematically. First, transcripts were read and re-read to develop an overall sense of the data and identify meaningful segments. Second, initial codes were generated. Interesting features across the dataset were systematically coded and segments of data that are relevant to the research question were labelled, creating initial codes that formed the basis of later themes. Third, related codes were grouped together to identify broader themes that represent significant patterns within the data. Fourth, the themes were reviewed and refined to ensure that they accurately represented the data, both in relation to the coded data extracts (Level 1) and the overall dataset (Level 2). Fifth, each theme was further refined and clearly defined by identifying the narrative conveyed by the theme and capturing its essence through an appropriate name. Finally, vivid and compelling data extracts were selected, and these selected excerpts underwent a final analysis by linking the themes back to the research question and literature [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The NVIVO 14.23.2 software was used for data management and coding. Two researchers (TBN\u003csup\u003e1\u003c/sup\u003e and QPN) independently developed the original codes. After that, the list of generated codes was reviewed, compared, and contrasted to finalize the coding scheme with discrepancy resolved by discussion. A third researcher (TPAN) reviewed the final codes for accuracy and grouped them into themes.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe adaptation of the iSupport program for dementia carers in Vietnam involved two key stages: (1) the translation and researcher adjustment of the iSupport content, and (2) the cultural adaptation of the program through focus group discussions.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 1 - Translate and adjust the iSupport program content.\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAlignment with Vietnamese medical terminologies\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAlthough professional translation was conducted, further refinements to the Vietnamese translations of certain English medical terminologies were necessary to align with terminology commonly used in Vietnam. For enhanced accuracy, specific terms were adjusted across various versions of the Vietnamese translation. For example, in Vietnamese, the term \u0026ldquo;sa s\u0026uacute;t tr\u0026iacute; tuệ\u0026rdquo; is officially recognised phrase for \u0026ldquo;dementia\u0026rdquo;, effectively conveying its full meaning and associated symptoms. It was used to replace the originally translated term \u0026ldquo;chứng mất tr\u0026iacute; nhớ\u0026rdquo; in VN Version 1. Other examples include the terms \"lo lắng, thờ ơ\" (meaning worried, indifferent) in the title of lesson 4, module 5, VN Version 1.0, which were changed to \"lo \u0026acirc;u\" (anxiety) and \"v\u0026ocirc; cảm\" (apathy) in VN Version 2.0, reflecting more precise the emotional disorders. Similarly, \"giai đoạn đầu/giai đoạn cuối\" (beginning/end stages of dementia) in VN Version 1.0 were revised to \"giai đoạn sớm/giai đoạn muộn\" (early/late stages of dementia), and \"kh\u0026ocirc;ng thể kiểm so\u0026aacute;t đại tiểu tiện\" (unable to control urination) in lesson 3, module 4 was refined to \"đại tiểu tiện kh\u0026ocirc;ng tự chủ\" (incontinence) in VN Version 2.0, enhancing clarity and alignment with medical terminology.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdjustment of semantic expression\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Some English words and expressions have different or multiple meanings when translated into Vietnamese language, so careful selection and adjustments were undertaken to ensure accurate translation in context. For example, the word \u0026ldquo;tip\u0026rdquo; in the educational context was literally translated into \u0026ldquo;mẹo\u0026rdquo; but then was adjusted to \u0026ldquo;phương ph\u0026aacute;p [method]\u0026rdquo; for better understanding. Another example is \u0026ldquo;Ups and downs\u0026rdquo;, which literally means in Vietnamese as \u0026ldquo;l\u0026ecirc;n v\u0026agrave; xuống\u0026rdquo;. However, \u0026ldquo;Having a lot of ups and downs\u0026rdquo; in the context of mood swings means unstable emotional state so it was translated as \u0026ldquo;T\u0026iacute;nh kh\u0026iacute; rất thất thường\u0026rdquo; [Very erratic temperament]. Similarly, \u0026ldquo;Interesting activities\u0026rdquo;, which was literally translated as \u0026ldquo;Hoạt đ\u0026ocirc;ng th\u0026uacute; vị\u0026rdquo; and then adjusted to \u0026ldquo;Hoạt động giải tr\u0026iacute;\u0026rdquo; [Entertainment activities]. In addition, some borrowed words commonly used in education and training were utilized for simplicity, an example being the word \"module\" in English, which was transliterated into Vietnamese as \"m\u0026ocirc;-đun\u0026rdquo;. Finally, to capture the nuances of proverbs and idioms, Vietnamese equivalents were used in translating English expressions rather than direct, word-for-word translations. For example, the Vietnamese proverb \"C\u0026oacute; c\u0026ocirc;ng m\u0026agrave;i sắt, c\u0026oacute; ng\u0026agrave;y n\u0026ecirc;n kim\" was chosen as an equivalent to \"Practice makes perfect,\" in example 2, lesson 3, module 3, effectively conveying the original expression\u0026rsquo;s meaning in culturally familiar terms.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdjustment of personal names\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn total, 96 Western names used in the iSupport manual were converted into Vietnamese names. Recognising the cultural significance of personal names, the research team consulted cultural resources and figurative language references to guide translation and adjustment decisions. Given the subjective nature of this process, multiple strategies were applied. The primary approach involved selecting Vietnamese names with similar initials, considering both the original name\u0026rsquo;s first letter and gender. For instance, Manuel was changed to Mạnh, Maria to Mai, Mary to Mến, and Chrissy to Chi. In cases the first letter of the original names is not commonly used in Vietnamese names, a letter with a similar pronunciation was chosen. For example, Jonathan was adapted to Đức, John to Dũng, and Jacob to Dương. Other approaches include selecting Vietnamese names with similar meaning of the original names. For instance, the name \u0026ldquo;Hugo\u0026rdquo; is of Germanic origin, derived from the word \"hug\" meaning \"mind\" or \"intellect\" so it was converted into \u0026ldquo;T\u0026acirc;m\u0026rdquo; (in \u0026ldquo;T\u0026acirc;m tr\u0026iacute;\u0026rdquo; [Mind]).\u003c/p\u003e\u003cp\u003eAdditionally, to align with Vietnamese customs, honorifics such as \u0026ldquo;Mr\u0026rdquo; or \u0026ldquo;Ms\u0026rdquo; were added before personal names to convey a greater level of respect. For example, Maria was addressed as Ms Mai in Vietnamese, even in casual settings.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdjustment of resources, links and guidance to ensure relevance and align with Vietnam\u0026rsquo;s standard medical practices\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll original website links in the iSupport manual were from Alzheimer's Disease International pages. Fourteen of these links were replaced with websites from Vietnamese organizations providing similar information, such as the Vietnamese Alzheimer Disease \u0026amp; Neurocognitive Disorders Association (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.alzvietnam.org\u003c/span\u003e\u003cspan address=\"http://www.alzvietnam.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) and the Vietnam National Geriatric Hospital \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e(\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://benhvienlaokhoa.vn\u003c/span\u003e\u003cspan address=\"http://benhvienlaokhoa.vn\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAdjustment was also made to the guidance on accessing health and social services in the Vietnamese context to ensure relevance. For example, the suggestion to \u0026ldquo;consult the general practitioner to identify loose teeth, ulcers or infections\u0026rdquo; was revised to \u0026ldquo;consult a dentist\u0026rdquo; to align with standard medical practices in Vietnam. Another example is that the suggestion to \u0026ldquo;call a medical doctor's office and make an appointment\u0026rdquo; in cases of suspicion that a relative or friend may have dementia was replaced with \"go to the nearest medical facility and see a doctor\"​.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAdjustment of items to align with cultural habits and expression (traditions)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eItems or terminologies rarely used in Vietnam were replaced with more commonly used ones to improve comprehension. For example, \"Bọt biển\u0026rdquo; [Sponge bath] in \u0026ldquo;wiping the body with a sponge\u0026rdquo; was changed to \u0026ldquo;khăn ẩm\u0026rdquo; [a damp towel] or \u0026ldquo;pyjamas\u0026rdquo; was replaced by \u0026ldquo;quần \u0026aacute;o ngủ\u0026rdquo; [sleepwear]. In addition, activities like \u0026ldquo;Watching birds or animals\u0026rdquo;, or \u0026ldquo;Playing a musical instrument\u0026rdquo; are not typical leisure activities performed by middle-aged or older people in Vietnam. Therefore, they were replaced by more popular and culturally appropriate activities such as \u0026ldquo;Watching TV\u0026rdquo; or \u0026ldquo;Listening to the radio\u0026rdquo;. Finally, some generic activities such as \u0026ldquo;Personal care before breakfast\u0026rdquo; in the original text were changed to more specific activities like \u0026ldquo;brush teeth and wash face before breakfast\u0026rdquo; to enhance understanding.\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity check\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe WHO team accepted the majority of the proposed changes from the Vietnam team, with the exception of two. The first was in the 'Introduction' section. The Vietnamese version suggested: \u003cem\u003e\u0026ldquo;Dementia symptoms may include mild to severe memory and thinking disorders that make daily activities difficult without assistance. Dementia progresses through many stages, with symptoms varying at each stage and for each individual\u0026rdquo;.\u003c/em\u003e However, WHO recommended: \u003cem\u003e\u0026ldquo;Dementia symptoms may include difficulties with memory, thinking, and the ability to perform daily activities. Symptoms usually worsen over time as dementia progresses. While dementia typically advances in stages, symptoms and progression differ from person to person\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eThe second change was in the \u0026ldquo;Dealing with Changing Behaviors\u0026rdquo; section. The Vietnamese team proposed replacing \u003cem\u003e\u0026ldquo;I know that you feel bad, I do too. What we\u0026rsquo;re going through is really hard\u0026rdquo;\u003c/em\u003e with \u003cem\u003e\u0026ldquo;Don't worry, it is okay\u0026rdquo;.\u003c/em\u003e However, according to the WHO team, the revision did not acknowledge the person's emotions. They emphasized the importance of emotional validation and suggested keeping \u003cem\u003e\u0026ldquo;What we are going through is really hard\u0026rdquo;\u003c/em\u003e while potentially adding a phrase like \u003cem\u003e\u0026ldquo;It is normal to feel this way\u0026rdquo;.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage 2 - Culturally adapt the iSupport program via focus group discussions with family carers and HCPs\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTwelve participants participated in the FGDs, including eight family carers and four HCPs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Mean age of carers and HCPs were 49 and 43 years old, respectively. Half of carer participants (n\u0026thinsp;=\u0026thinsp;4, 50%) were female, while all HCP participants were female (n\u0026thinsp;=\u0026thinsp;4, 100%). The average number of years in dementia caring role was 6.4 and 8 years for carers and HCPs, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; characteristics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCarers\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProfessionals\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender, n (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge, median (range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49 (35\u0026ndash;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43 (37\u0026ndash;51)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenior high school\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (12.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUndergraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (12.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostgraduate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (50)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status, n (%)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (100)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eCare experience (years of caring), median (range)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.40 (3\u0026ndash;12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (5\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eAnalysis of FGDs\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThree main themes emerged from the FGDs. A summary of the main themes, sub-themes, and finalized codes, as derived from the integration process, is provided in Supplementary Table \u003cspan refid=\"MOESM2\" class=\"InternalRef\"\u003eS2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: iSupport empowering carers through knowledge and practical guidance\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe iSupport program is widely recognised as a valuable resource for carers providing them with essential knowledge and practical guidance. Many carers noted that the material helped them understand dementia and approach caregiving more effectively. \u003cem\u003e\"Before reading this, I thought my mother\u0026rsquo;s forgetfulness was just normal aeging. Now, I understand that dementia has specific causes and symptoms, which helps me be more patient with her\"\u003c/em\u003e (37, nurse-caring for her mother). Similarly, (65, retired) mentioned that recognising her mother\u0026rsquo;s condition as vascular dementia rather than typical forgetfulness allowed her to adjust her expectations, making interactions with her mother much less frustrating: \u003cem\u003e\"When I realised my mother\u0026rsquo;s condition was due to vascular dementia, not just old age, it changed my perspective. Now I know why she repeats questions and forgets recent events\"\u003c/em\u003e.\u003c/p\u003e\u003cp\u003eThe program also addresses behavioural challenges that carers frequently encounter. Carer participants acknowledged that the iSupport program helped them in cognitive reframing when dealing with behavioural and psychological symptoms of dementia. A nurse participant said \u003cem\u003e\"My mother doesn\u0026rsquo;t cooperate when I try to help her eat or bathe. Before, I got frustrated, but now I understand that her reactions are part of the disease. I\u0026rsquo;ve learned to approach her differently\"\u003c/em\u003e (37, nurse). Beyond understanding the disease itself, carers also found guidance in handling behavioural changes, (37, office staff), who has been caring for his father for a decade, noted that the iSupport program provided explanations for why his father sometimes became disoriented. He admitted that \u003cem\u003e\"at first, I didn\u0026rsquo;t understand why my father would forget his own neighborhood, but now I know this is part of dementia\u0026rsquo;s progression.\"\u003c/em\u003e This knowledge, he added, allowed him to plan better and ensure his father\u0026rsquo;s safety.\u003c/p\u003e\u003cp\u003eHowever, despite the wealth of information in iSupport, some carers felt that its format was not always practical for real-life situations. A carer (64, caring for his wife) emphasized that \u003cem\u003e\"the book is useful, but when my wife suddenly refuses to eat or becomes anxious, I don\u0026rsquo;t have time to read long sections. A quick reference guide would make a big difference.\"\u003c/em\u003e Others emphasized that the document was a good foundation but should be supplemented with practical tools. \u003cem\u003e\"This book is a great starting point, but real caregiving situations are unpredictable. It would help if we had more real-life case studies and step-by-step approaches\"\u003c/em\u003e (39, caring for her mother).\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: The Need for Simplification and Adaptation of iSupport\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWhile the content of \u003cem\u003eiSupport\u003c/em\u003e was seen as valuable, carers repeatedly emphasized the need for simpler language and a structure that better suits Vietnamese readers. One of the participants, (43, caring for her father) pointed out that \u003cem\u003e\"some sentences feel unnatural in Vietnamese, and I had to read them multiple times to understand.\"\u003c/em\u003e Another carer (49, caring for his father) had a similar experience, saying that while the information was useful, it took him several reads to fully grasp certain concepts.\u003c/p\u003e\u003cp\u003eThe use of medical terminology was another concern. One carer noted that non-medical carers might struggle with terms like \u003cem\u003e\"Alzheimer\u0026rsquo;s disease progression\"\u003c/em\u003e, which could be replaced with more relatable language. Another carer agreed, stating that \u003cem\u003e\"some parts sound like they were written for doctors, not for regular people.\"\u003c/em\u003e Without clear definitions, carers might not fully understand the advice being given.\u003c/p\u003e\u003cp\u003eAnother issue raised was inconsistency in terminology. A psychiatrist participant, pointed out that \u003cem\u003e\"some terms, such as \u0026lsquo;hourly carer\u0026rsquo; are translated differently in different sections, which can cause confusion.\"\u003c/em\u003e Additionally, carers suggested improvements in formatting, such as adding clear section headings and making examples more identifiable. A rehabilitation technician participant proposed that \u003cem\u003e\"each case study should have a title, so if carers need to revisit a topic, they can quickly find the relevant section.\"\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFinally, there was strong support for adapting the content to fit Vietnamese caregiving realities. A nurse highlighted that in Vietnam, caregiving is often a family responsibility rather than an individual effort. \u003cem\u003e\"Most elderly people live with their children here, so the guidance should reflect how multiple family members share caregiving duties\".\u003c/em\u003e In Module 3, a 60-year-old carer proposed adding familiar activities for relaxation: \u003cem\u003e\u0026ldquo;For example, calling a friend or going out to a neighbor's house.\u0026rdquo;\u003c/em\u003e In Module 4, lesson 1, a nurse suggested breaking daily water intake into smaller portions using 500 ml bottles to ensure hydration: \u003cem\u003e\u0026ldquo;Provide the easiest way for people to drink enough, such as dividing their intake into manageable portion using two or three 500ml bottles\u0026rdquo;.\u003c/em\u003e This approach simplifies tracking, promotes consistent hydration, and makes the goal feel achievable throughout the day. Additionally, a rehabilitation technician recommended consulting specialists instead of relying on unavailable products like stir-in thickeners: \u003cem\u003e\u0026ldquo;Commercial stir-in thickeners are not available in Vietnam, so it should be replaced by consulting a rehabilitation specialist for advice on feeding.\u0026rdquo;\u003c/em\u003e For safety, a nurse proposed using modern solutions like navigation watches or embroidered contact information: \u003cem\u003e\u0026ldquo;Carrying identification is challenging; alternatives like navigation watches are more practical.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 3: Opinion on the implementation of the iSupport program\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMany carers and healthcare professionals emphasized the importance of using video and voice-over to make iSupport content more accessible. A nurse noted that \u003cem\u003e\u0026ldquo;watching instructional videos is much easier to absorb because not everyone has time to read an entire book.\u0026rdquo;\u003c/em\u003e Similarly, a rehabilitation technician, highlighted the convenience of accessing information through digital devices: \u003cem\u003e\u0026ldquo;Nowadays, people use their phones a lot, so having online support content would make it much easier to look up information.\u0026rdquo;\u003c/em\u003e These insights reflect a growing preference for multimedia learning tools that enhance engagement and comprehension.\u003c/p\u003e\u003cp\u003eWhen discussing preferred video formats, participants expressed varied preferences. Some favored animation, believing it could simplify complex caregiving concepts, while others preferred real actors to make scenarios feel more relatable. A 37-year-old carer suggested: \u003cem\u003e\u0026ldquo;Videos should last about 3 to 5 minutes\u0026hellip; keep them short so they easily capture attention and convey as much information as possible.\u0026rdquo;\u003c/em\u003e Another carer supported the use of real-life demonstrations, explaining: \u003cem\u003e\u0026ldquo;If real people act out the caregiving scenarios in the videos, I think it would be easier to empathize and apply the lessons in real life.\u0026rdquo;\u003c/em\u003e This suggests that videos should be concise, engaging, and tailored to real caregiving situations.\u003c/p\u003e\u003cp\u003eParticipants also identified both facilitators and barriers to effectively using the iSupport program. A key facilitator is the widespread use of smartphones, which allows carers to easily access digital resources. A 43-year-old carer, pointed out: \u003cem\u003e\u0026ldquo;The use of phones and the internet is now widespread, everyone has a device now, so looking it up is very convenient.\u0026rdquo;\u003c/em\u003e Additionally, real-time assistance through a virtual assistant was highly favored. A psychiatrist participant noted: \u003cem\u003e\u0026ldquo;Whatever word you type, the virtual assistant will respond.\u0026rdquo;\u003c/em\u003e These factors indicate that a digital platform with on-demand, AI-powered support could be a valuable tool for carers.\u003c/p\u003e\u003cp\u003eTime constraints and the need for stage-specific information pose significant challenges for carers engaging in structured online learning. Many struggle to find dedicated time, making on-demand access essential. One carer noted: \u0026ldquo;\u003cem\u003eThere are some things I can no longer apply because my wife\u0026rsquo;s disease has progressed to another stage\u003c/em\u003e.\u0026rdquo; This highlights the importance of tailored guidance that aligns with the evolving needs of carers.\u003c/p\u003e\u003cp\u003eDespite their willingness to participate, many find it difficult to integrate learning into their daily routines. A 65-year-old carer, shared: \u0026ldquo;\u003cem\u003eI can only use the program at night or in the weekends when I\u0026rsquo;m done with caregiving duties\u003c/em\u003e.\u0026rdquo; Another participant echoed this: \u0026ldquo;\u003cem\u003eI\u0026rsquo;ll probably read it in the evening when I have free time\u003c/em\u003e.\u0026rdquo; These insights underscore the need for flexible access, allowing carers to engage at their convenience.\u003c/p\u003e\u003cp\u003eTo enhance the program\u0026rsquo;s effectiveness, carers proposed several key improvements. One widely supported suggestion was the introduction of interactive notifications, allowing carers to receive alerts when new information becomes available. A 43-year-old carer explained: \u003cem\u003e\u0026ldquo;If there is new information, it would be popped up on the phone\u0026rdquo;.\u003c/em\u003e This feature would prevent carers from missing out on important updates without requiring them to manually check the platform​.\u003c/p\u003e\u003cp\u003eAnother critical improvement was the integration of real-time support tools, such as an AI-powered virtual assistant. Many carers believed that having immediate, personalised advice could significantly reduce stress and confusion. A participant emphasized the benefit of AI-driven assistance: \u003cem\u003e\u0026ldquo;Whatever word you type, the virtual assistant will respond\u0026rdquo;\u003c/em\u003e This feature would enable carers to receive instant, situation-specific guidance, making caregiving less overwhelming​. Participants shared opinions on the value of multimedia learning tools, particularly short instructional videos and visual illustrations. A carer noted that videos should be \u003cem\u003e\u0026ldquo;short and easy to understand\u0026rdquo;\u003c/em\u003e, ideally lasting between \u003cem\u003e\u0026ldquo;three to five minutes\u0026rdquo;\u003c/em\u003e to maintain attention and enhance retention. He added that \u003cem\u003e\u0026ldquo;some sentences need to be read multiple times to fully understand, so illustrations would help\u0026rdquo;.\u003c/em\u003e Other carer noted that \u003cem\u003e\u0026ldquo;personally, I like visuals; if there were more images, it would be better\u0026rdquo;\u003c/em\u003e. Both agreed that \u003cem\u003e\u0026ldquo;animated videos are easier to understand than live-action videos\u0026rdquo;\u003c/em\u003e since they simplify complex caregiving concepts and make content more engaging.\u003c/p\u003e\u003cp\u003eWhile multimedia tools were seen as valuable, some carers highlighted challenges related to \u003cem\u003e\u0026ldquo;internet access and digital literacy\u0026rdquo;\u003c/em\u003e, particularly for older carers. To address this, a nurse proposed making videos \u003cem\u003e\u0026ldquo;easy to watch on mobile devices without requiring a computer\u0026rdquo;\u003c/em\u003e to enhance accessibility.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe adaptation of digital carer support programs, such as iSupport, requires careful cultural and contextual modifications to ensure their relevance and usability. This study focused on adapting iSupport for dementia carers in Vietnam, aligning with previous adaptation efforts in other countries while incorporating unique elements tailored to the Vietnamese caregiving context. The findings highlight key areas of adaptation, including content structure, multimedia preferences, accessibility, and linguistic modifications.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMultimedia Learning Tools and Visual Preferences\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOne of the primary modifications involved integrating short instructional videos and visual illustrations to facilitate learning. Similar adaptations have been observed in India, Portugal and Spain [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] where multimedia formats were prioritized to make information more digestible for carers. In Greece [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], video-based content was also emphasized, particularly in response to increased digital learning needs during the COVID-19 pandemic.\u003c/p\u003e\u003cp\u003e\u003cb\u003eStage-Specific Caregiving Information\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDementia progresses through multiple stages, each requiring different caregiving strategies. Adapting content to reflect this progression has been a common consideration in multiple iSupport implementations. In Indonesia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], carers expressed the need for a dynamic structure that presents stage-specific information rather than a one-size-fits-all approach. Similarly, in China [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] implemented a structured learning flow based on the progression of dementia symptoms.\u003c/p\u003e\u003cp\u003eThe Vietnamese adaptation further emphasized real-time, stage-specific guidance, proposing the integration of AI-powered interactive support to assist carers with tailored recommendations. This feature was not emphasized in other adaptations, indicating that interactive digital elements may be an emerging consideration in newer adaptations of carer support programs.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAccessibility and Technological Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eEnsuring accessibility is a critical component of digital intervention adaptation, particularly in countries where internet connectivity and digital literacy vary across regions. Studies in India [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] and Spain [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] identified digital literacy as a barrier to engagement, prompting the integration of simplified navigation and offline access options. Vietnamese carers demonstrated a preference for mobile-optimized content, aligning with findings from Indonesia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and China [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] where mobile phone penetration is high. This suggests that mobile-first designs should be prioritized when adapting digital carer programs in regions with similar technological usage patterns.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLinguistic and Cultural Adaptations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eLinguistic modifications are essential to ensure that carer programs are not only accurately translated but also contextually appropriate. In Portugal [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and Russia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], adaptations included simplifying medical terminology and replacing complex healthcare-related expressions with more commonly understood phrases. In Vietnam, similar adjustments were made by replacing technical dementia-related terms with everyday language, ensuring clarity for carers with varying educational backgrounds.\u003c/p\u003e\u003cp\u003eCultural adaptations extended beyond language, incorporating localized caregiving scenarios to enhance relevance. For example, the Vietnamese version replaced Western examples such as car trips with motorbike travel, a common mode of transportation in Vietnam. This practice mirrors adaptations in Indonesia [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], where caregiving examples were revised to align with multigenerational family structures.\u003c/p\u003e\u003cp\u003e\u003cb\u003eTime Constraints and Adaptation for Carers' Schedules\u003c/b\u003e\u003c/p\u003e\u003cp\u003eCarers often face significant time constraints, making it essential for digital interventions to provide flexible access. Similar challenges were reported in Portugal [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], New Zealand [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and Switzerland [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], where carers found it difficult to allocate time for structured learning.\u003c/p\u003e\u003cp\u003e\u003cb\u003eLimitations\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFew limitations of the study need to be recognised. First, all participants of the focus group discussions live in Hanoi, the capital city of Vietnam, majority of whom have university-level education and are middle-aged, so they do not represent a diverse group of users living across Vietnam including those in rural areas and those who are at a younger or older age groups. Second, despite our efforts to encourage participants to contribute to the discussion, there was still uneven engagement of all carers. Finally, although we divided the iSupport content to smaller, more manageable sections and sent them to focus group discussion participants in advance, some of the participants, especially family carers, had not reviewed fully the section assigned to them prior to attending the discussion. That might be a reason for the uneven engagement and contribution to the discussion among participants.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe adaptation of iSupport for Vietnam aligns with global efforts to modify digital carer interventions to meet the needs of diverse populations. While many findings are consistent with previous adaptations, such as the importance of multimedia learning, linguistic simplifications, and mobile optimization, the Vietnamese adaptation introduces notable advancements, including animated visual content and AI-powered stage-specific guidance.\u003c/p\u003e\u003cp\u003eComparing with adaptation strategies across multiple countries, this study proposes the most advanced adaptation for future implementations. Key recommendations include refining mobile-first approaches, developing interactive features, and incorporating long-term engagement strategies. Further research should evaluate the sustained impact of these adaptations on carer burden and well-being, ensuring that digital carer support programs continue to evolve in response to real-world needs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWHO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eWorld Health Organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFGDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eFocus Group Discussions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHCPs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eHealth Care Professionals\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePLWD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ePeople Living with Dementia\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eREACH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eResources for Enhancing Alzheimer's Caregivers Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003ee-DiVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eempowering Dementia Carers with an iSupport Virtual Assistant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eENG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eEnglish\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVietnamese\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Vietnam National Geriatrics Hospital, Hanoi, Vietnam (approval No\u0026nbsp;1066/QD-BVLKTW signed 28/09/2022).\u003cbr\u003eAll participants provided informed consent prior to enrollement. The study was conducted in accordance with the ethical principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset used and analyzed during the current study are availabe from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declared no potential conflict of interest with respect to the research, authorship, and publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study disclosed receipt of financial support for the research, authorship and/or publication of this article: This work was support by Ministry of Science and Technology of Vietnam (e-ASIA JRP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDesigned and obtain funding for the study: TAN\u003csup\u003e4,5,7\u003c/sup\u003e, TP and TAN\u003csup\u003e1,3\u003c/sup\u003e. \u0026nbsp;Perform the study: TP, TAN\u003csup\u003e1,3\u003c/sup\u003e, TBN\u003csup\u003e1,2\u003c/sup\u003e, TBN\u003csup\u003e1\u003c/sup\u003e, \u0026nbsp;NAN, TTBN, MPH, TNL, TPAN . Prepared the ethics application: TPAN, MHL, MVT. Conducted the focus group discussion: NAN, TNL, HYL. Contributed materials/analysis tools: NHN, VHH, TTL. \u0026nbsp;Analysis the FGDs: TBN1, QPN, TPAN . Wrote the manuscript: TBN\u003csup\u003e1,2\u003c/sup\u003e, TBN\u003csup\u003e1\u003c/sup\u003e, UB, THD, TAN\u003csup\u003e4,5,7\u003c/sup\u003e . Undertook the quality appraisal: TP, TAN\u003csup\u003e1,3\u003c/sup\u003e, TBN\u003csup\u003e1,2\u003c/sup\u003e . All authors reviewed manuscript draft for critical intellectual content and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank all carers and professional participants for their time and precious contribution to this work. The authors also wish to acknowledge the support provided by the members of Vietnam National Geriatrics Hospital, Vietnam Geriatrics Association, The Ministry of Science and Technology and collaborators for the realization of this project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors used OpenAI's ChatGPT (version GPT-4, accessed via ChatGPT, June 2025) to assist with language refinement and clarity during manuscript preparation. Final decisions and critical interpretation were made by the human authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHandong L, Hongngoc N, Tianmin Z. Vietnam\u0026rsquo;s Population Projections and Aging Trends from 2010 to 2049. 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Alzheimer\u0026rsquo;s Dement. 2023;19(S19):e077812. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/alz.077812\u003c/span\u003e\u003cspan address=\"10.1002/alz.077812\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMessina A, Amati R, Annoni AM, Bano B, Albanese E, Fiordelli M. Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People with Dementia (iSupport): Community-Based Participatory Approach. JMIR Formative Res. 2024;8:e46941. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/46941\u003c/span\u003e\u003cspan address=\"10.2196/46941\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cultural adaptation, dementia, family carers, digital health intervention, iSupport, Vietnam","lastPublishedDoi":"10.21203/rs.3.rs-6988335/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6988335/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Supporting carers is a key priority in the Global Action Plan on Dementia. The World Health Organization (WHO) developed iSupport, an online education and support program for family carers of people with dementia that can be adapted for use in different contexts. This study aimed to adapt iSupport for Vietnamese dementia carers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: The adaptation process followed the WHO iSupport Adaptation and Implementation Guidelines in two stages. Stage 1 involved forward translation, expert panel review, backward translation, and harmonization, followed by researcher-led adjustments to align the content with Vietnamese cultural and healthcare contexts. Stage 2 consisted of Focus Group Discussions (FGDs) with family carers and healthcare professionals (HCPs) to gather feedback on the program’s content and its delivery via videos and an online virtual assistant platform.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Results of stage 1 involved refining professional translation to align with Vietnamese medical terminology, cultural norms, and caregiving practices. Unfamiliar activities were replaced with culturally relevant ones and medical advice was adjusted to local standards. Vietnamese proverbs, idioms, and localized names were incorporated to enhance cultural resonance. Stage 2 generated valuable feedback through FGDs. Participants called for simplified, jargon-free language and practical, context-specific advice. Digital delivery, especially through short multimedia videos with real actors, was preferred due to convenience and accessibility.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Participants valued iSupport’s trustworthy, well-curated content, contrasting it with the overwhelming and often unreliable online resources. However, key barriers included limited time availability and the need for stage-specific guidance as dementia progresses. Suggested improvements included interactive features like update notifications. iSupport shows strong potential to improve dementia care in Vietnam by offering culturally tailored, accessible digital support to carers.\u003c/p\u003e","manuscriptTitle":"Cultural Adaptation of the World Health Organization’s iSupport Dementia Program for Family Carers of People Living with Dementia in Vietnam","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 10:57:17","doi":"10.21203/rs.3.rs-6988335/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"91d4b0a5-9a0d-4e74-ae80-6425337a79c3","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T09:23:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-01 10:57:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6988335","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6988335","identity":"rs-6988335","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}