The global landscape of online dementia resources

The global landscape of online dementia resources | 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 Article The global landscape of online dementia resources Irina Kinchin, Charlèss Dupont, Inbal Mayan, Yaohua Chen, Iracema Leroi, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8080114/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract This multi-country study provides the first systematic assessment of publicly accessible online dementia resources across 17 countries spanning diverse income levels and geographic regions. We mapped 124 online resources and evaluated their alignment with carer information needs using an evidence-based taxonomy covering disease knowledge, healthcare navigation, information sources, financial/legal support, and self-care. Our findings reveal disparities in resource availability and quality, with a "digital threshold effect" where countries with limited internet infrastructure had no identifiable online dementia resources. NGO-led provision dominated (68%), but quality varied widely, with mean domain coverage ranging from 47% to 96% across countries. Higher-scoring resources were associated with clear governance, dedicated funding, and systematic content maintenance. Technical accessibility assessments against WCAG 2.1 Level AA standards showed variable compliance. We identified adaptable delivery models including digital integration, multi-channel communication, cultural and linguistic tailoring, and community-based approaches. The study establishes a baseline for monitoring equity in online dementia support and offers policy recommendations for minimum standards, health system integration, hybrid delivery in low-connectivity contexts, and sustainable resourcing to address the growing global dementia burden through accessible digital resources. Health sciences/Health care Humanities/Health humanities Scientific community and society/Scientific community INTRODUCTION Dementia affects over 55 million people globally, a figure projected to triple by 2050, placing substantial demands on unpaid care partners, most often family and friends (1). As populations age, the need for timely, comprehensive, and accessible information and support becomes a core health-systems concern, particularly in settings with limited specialist services. Online resources, including public websites, articles, videos, and moderated forums, are increasingly used to overcome barriers of geography, clinic capacity, and time (2). When evidence-based and well designed, they can support disease understanding, care skills, navigation of services, and peer connection. In rural contexts, such supports have been reported to reduce experiences of isolation among spouse care partners (3). Yet quality, accuracy, comprehensiveness, and accessibility vary widely (4, 5). Critically, there is little comparative evidence on whether public-facing online resources meet carers’ needs across cultural and health-system contexts and income settings. Most prior assessments are single-country or regional (6-8). Despite 60% of people with dementia living in low-, middle-income countries (LMICs), where in-person services and specialist guidance are often scarce, there has been no systematic, multi-country appraisal of the availability, quality, and accessibility of online dementia support across LMICs and high-income countries (9). Building on a taxonomy of carer information needs (disease knowledge; healthcare navigation; information sources; financial/legal; self-care) (10), this study examines whether publicly accessible, non-social media web resources align with carers’ needs and are accessible to diverse users, including those with constrained connectivity. Because public web properties are amenable to government and NGO policy levers (standards, procurement, funding, regulation), understanding their coverage and accessibility has direct implications for equity. Objectives: Map the distribution and characteristics of publicly accessible online dementia resources across 17 countries spanning World Bank income groups and regions. Assess alignment with carer information needs and evaluate content comprehensiveness using an evidence-based taxonomy. Evaluate technical accessibility against WCAG 2.1 (Level AA) to appraise usability and inclusion. Analyse patterns by country-level indicators (e.g., internet penetration, health expenditure, universal health care coverage, national dementia plans) and identify adaptable delivery models. Derive policy-relevant recommendations. RESULTS Demographic and healthcare system characteristics of included countries The study included 17 countries across five continents (Table 2). Population sizes ranged from 1.3 million (Cyprus) to 1.4 billion (India), with varying proportions of older populations (2.8% in DRC to 23.5% in Bulgaria) (11). Life expectancy ranged from 62.1 years (DRC) to 84.1 years (Australia) (12). The OECD dementia prevalence indicator (definition in Table 2) was available for 12 out of 17 countries, ranged from 4.9% (India) to 24.1% (Greece) (13). Notably, 14 of 17 countries had implemented National Dementia Plans (14). Internet penetration rates varied dramatically from 16.7% in Kenya to 97.6% in Australia (15), while health expenditure ranged from 3.7% of GDP in Indonesia to 13.8% in Cuba (16). Physician density ranged from 0.2 per 1,000 in Kenya to 6.3 in Greece (17). Universal health coverage status was present in 13/17 countries (18) (Table 2). Online dementia resources meeting eligibility criteria were identified in 15/17 countries; no eligible resources were found for Cuba and the DRC at time of search (Table 3). The number of eligible websites per country varied widely, ranging from 1 (Kenya) to 20 (Russia), with a median of 5 websites per country. Australia, Russia, Belgium, and UK (Scotland) had the most resources (18, 20, 16, and 15, respectively). Non-governmental organizations (NGOs), including charities, were the most common providers ( n =84/124, 67.7%), followed by government/public sector ( n =17/124, 13.7%) and private companies ( n =14/124, 11.3%). In terms of geographical coverage, 11 countries had nationally focused resources, 8 had regional coverage, and 4 had relevant local resources. Quality of online resources The top-performing resource in each country by overall score is shown in Table 4. The Israel Alzheimer’s Association resource achieved the highest information coverage across the five carer-need domains (mean domain coverage 96%), followed by Dementia Australia (91%) and Aidons les nôtres (France, 91%). Kenya’s highest-scoring resource covered 47% of domains comprehensively. Country-level mean comprehensiveness scores ranged from 3.0 (Cyprus) to 5.0 (Australia, UK (Scotland) on a 1–5 scale; mean accessibility scores ranged from 2.5 to 4.5 (Australia, UK (Scotland). Across all resources, self-care content was most consistently addressed (mean coverage 97%), followed by healthcare-related navigation (81%) and disease-specific information (69%). Financial and legal support content was least covered (49%), with minimal content in Cyprus, Greece, and Kenya. Provider performance varied, with national NGOs in Australia and Scotland (UK) achieved the highest combined comprehensiveness and accessibility. Bulgaria and Cyprus relied primarily on EU-funded projects and academic sites, respectively. France illustrated a hybrid model with NGO/private sector partnerships. Influence of country-specific factors Digital infrastructure emerged as a prerequisite for resource availability. Countries with relatively limited internet penetration (Cuba 50.1%, DRC 29.5%) (15) had no eligible resources, whereas those above 75% penetration typically had multiple resources. Countries with substantial health expenditure (>10% GDP) demonstrated comprehensive resource development, Australia (10.5% GDP, 5.0 score) and France (12.8% GDP, 4.5 score), compared with lower-spend contexts such as Indonesia (3.7% GDP, 3.5 score), India (3.8% GDP, 4.0 score). These relationships are descriptive and not adjusted for confounding. In relation to healthcare system structure, universal healthcare systems demonstrated more balanced provider ecosystems. For example, Australia combined substantial government provision (7 resources) with NGO resources (6 resources). In contrast, mixed public-private systems, for example India, Indonesia, relied predominantly on NGO. Demography and fiscal capacity both appeared relevant. Countries with larger older-population shares (Belgium 19.4%; France 21.9%; Greece 22.8%) tended to host more comprehensive resources. However, Bulgaria (23.5% aged ≥65) had only four moderate-quality resources, suggesting economic and institutional constraints may limit response to need. Equity-driven innovations for resource-constrained settings Several themes emerged through cross-country comparison (Table 5). Digital integration emerged as a leading theme, with virtual support systems like Ireland's Virtual Dementia Hub (a public-private partnership with technology company Fujitsu (https://virtualdementiahub.ie/) and Greece's video consultation platforms offering 24/7 availability (https://affidea.gr/en/myaffidea-2/). Multi-channel communication strategies were common, combining traditional media with digital platforms, for example Bulgaria's integration of radio programming with digital consultations and Russia's "School of Care" program featuring live broadcasts for remote regions (https://alzrus.ru/o-fonde). Cultural and linguistic adaptation was evident across several countries, reflecting diverse populations. For example, Israel's provision of resources in Hebrew, English, and Arabic, while Australia offers services in over 40 languages with specific programs for Aboriginal and Torres Strait Islander communities. Russia demonstrated cultural creativity through resources like "My Grandmother-Yaga" children's stories, adapting dementia education to local folklore and cultural contexts (https://memini.ru/skazki/). Community-based innovations included Belgium's "Ville Amie Démence" initiative (https://www.liguealzheimer.be/), Greece's dementia-friendly communities program (www.gerontology.gr), and the widespread adoption of Memory Cafés across multiple countries. METHODS Study design and country selection A cross-sectional content analysis was conducted across 17 pre-specified countries selected via purposive and convenience sampling to ensure representation by World Bank income group and global region from Western Europe (Belgium, France, Ireland, UK (Scotland)), Eastern Europe (Bulgaria, Greece, Russia), the Middle East (Cyprus, Israel), South Asia (India), Southeast Asia (Indonesia), Oceania (Australia), South America (Brazil, Chile), the Caribbean (Cuba), and Africa (Democratic Republic of Congo (DRC), Kenya), yielding a sample of diverse geographical regions, healthcare systems, and economic development levels. Search strategy and data collection The search strategy was developed in consultation with an experienced university research support librarian and broadly informed by the methodologies used in global studies of online resources in health (19-23). Searches (June 2023-December 2024; refreshed May 2025) followed a standard protocol and were not pre-registered. For each country, native-language search strings were developed (full strings in Table 1), and run on the country Google domain (e.g., google.co.uk), in incognito mode with VPN geolocation set to the target country. Structured operators (e.g., site:gov.xx, site:.org, AND dementia/Alzheimer, carer/caregiver synonyms) were applied. The first 10 pages (about 100 results) per query were screened based on prior evidence that yield drops substantially beyond this range; targeted site searches identified further government/NGO pages not surfaced by general queries. A native speaker researcher conducted primary screening and extraction. Abacus.AI Claude Sonnet 3.5 independently extracted against a standard prompt (refer to Supplementary materials). Discordant items were reconciled by consensus. Where no eligible resources were found, a negative search statement was recorded. Eligibility criteria and resource identification Publicly accessible, non-social media websites providing dementia‑specific information or services (e.g., national portals, NGO sites, health system pages) intended for patients, carers, or providers were included. This focus aligns with government and NGO policy levers (procurement, standards, funding, regulation) that primarily apply to institutionally governed web properties. Excluded a priori: Mobile apps, social media channels/platforms, and closed or login‑only resources, given differing governance, content dynamics, and access models from policy‑addressable web properties. General caregiving resources without dementia‑tailored information or guidance. Sites with obsolete or outdated content (e.g., training/events last updated >5 years ago without current materials), or resources primarily advertising commercial services without substantive informational content. Where a single organization operated multiple online resources, the primary national‑facing site/portal was assessed to avoid duplication and to reflect the principal policy‑relevant entry point for the public. Data extraction For each eligible website, the following information was extracted: organization type (NGO/charity, government/public sector, private company, other), geographical coverage (national, regional, local), resource quality, delivery models. Content assessment used the carer information needs taxonomy (10) across five domains (disease-specific, healthcare navigation, information sources, financial/legal, self-care). Comprehensiveness and technical accessibility were evaluated with a bespoke rubric adapted from established guidance and aligned to WCAG 2.1 Level AA (Perceivable, Operable, Understandable, Robust) (24). AI-based scoring (Abacus.AI Claude Sonnet 3.5; 1–5 anchored Likert prompts) was followed by human verification by a native-language researcher. Representative pages per site included the homepage, a navigation hub, a content article, a service directory entry, and a contact/intake form. To avoid construct overlap, accessibility contributed only to the accessibility score; the comprehensiveness score synthesized content breadth/depth and support features, but did not include technical accessibility. Comprehensiveness subscales: breadth, depth, range of services, user support features, resource quality (currency/evidence), and content accuracy/currency; each 1–5 (1=basic facts only to 5=comprehensive coverage), averaged and rounded to 0.5. Accessibility dimensions: navigation, search, readability/plain language, mobile responsiveness, assistive-technology compatibility/semantics, alternative text, colour contrast, keyboard navigation, form accessibility, multimedia captions/transcripts, language options, cultural/linguistic appropriateness; each 1–5 (e.g., navigation: 1=confusing layout to 5=clear intuitive navigation), averaged and rounded to 0.5. Because each website was assessed by a single native-language researcher, formal inter-rater reliability (e.g., kappa) could not be estimated. To promote consistency, all researchers completed a common calibration using standardized instructions, an anchor example, and structured Excel templates. A 10% cross-audit was then conducted whereby a second researcher spot-checked ratings for adherence to the rubric. Any discrepancies were resolved by consensus and the rubric was refined accordingly. Delivery models, adaptable approaches and best practices were catalogued for each country. These were extracted through thematic analysis of resource features, service delivery models, and unique approaches. Adaptive practices were defined as context-specific approaches to service delivery, innovative use of technology, cultural or linguistic tailoring, or comprehensive service integration that distinguished a country's resources from those commonly observed elsewhere in the sample. Country-level contextual analysis Country-level indicators (most recent year 2019–2024) were sourced from the World Bank, Organisation for Economic Co-operation and Development (OECD) and Alzheimer’s Disease International, covering demographic indicators (country income level (25), population size (11), percentage aged 65+(26)), health system characteristics (life expectancy (12), health expenditure as percentage of GDP (16), physician density (17) ), dementia prevalence (13, 27), digital infrastructure (internet penetration rates(15)), and policy context (presence of National Dementia Plans (14)). Analyses were descriptive and exploratory aimed at understanding contextual influences rather than establishing statistical relationships, not adjusted for confounding. Patterns were interpreted considering the complex interplay of multiple factors and the limitations of cross-national comparisons with varying data availability and quality. Outcomes included number of resources, provider mix, geographic coverage, and mean comprehensiveness/accessibility scores. DISCUSSION This multi-country analysis of publicly accessible online dementia resources reveals disparities in availability, quality, and innovation across income settings. The findings establish a baseline for monitoring equity in access to online support, inform minimum-standard setting for public-facing portals, and point to practical pathways, such as hybrid delivery, to extend reach while maintaining quality and accessibility. A central observation is a “digital threshold effect”. The absence of identifiable online resources in countries with limited internet infrastructure highlights the fundamental role of digital connectivity as a prerequisite for online health resource development. Even widely used, low-bandwidth platforms like WhatsApp require a minimum level of internet access and smartphone availability, which may not always be met in these settings. This “digital threshold effect” means that without basic technological infrastructure, online supports cannot take root. As a result, populations in resource-limited countries may face a compounded disadvantage: they often experience a higher burden of dementia while also having the least access to online information, support, and care services. Provision is predominantly NGO-led (68% of 124 resources), suggesting that civil society often fills gaps in the absence of systematic public provision. However, presence alone did not equate to adequacy. Quality varied widely (e.g., mean domain coverage from 47% in the lowest-scoring country exemplar to 96% in the highest). Countries with higher-scoring resources tended to exhibit features such as clear governance, dedicated funding, and scheduled content maintenance, patterns consistent with coordinated, rather than ad hoc, development. This analysis focused on official organizational websites, but it is notable that the wider landscape extends beyond formal platforms to social media groups, professional networks, and multimedia content. Kenya's dementia community actively engages through Facebook groups, while Brazil has developed WhatsApp-integrated support groups and specialized podcasts. While these alternative information sources provide valuable peer support and accessible content, they also present challenges for ensuring comprehensive, reliable information. The proliferation of diverse informal online resources may create information fragmentation that can overwhelm care partners already managing complex care responsibilities. This highlights the need for "one-stop shop" approaches that consolidate reliable information from multiple sources while maintaining quality standards. Contextual patterns were also apparent but not deterministic. Higher health expenditure (>10% GDP) and universal health coverage were generally seen with more comprehensive and higher-scoring resources, suggesting that national healthcare investment may facilitate digital health information. However, the success of countries like Israel (8.3% GDP, 96% coverage) indicates that strategic resource allocation and systematic service development may be more important than public spending. Lastly, the diversity of adaptable approaches identified across countries shows the importance of locally adapted solutions in dementia care. Brazil's integration of WhatsApp support groups exemplifies how successful interventions leverage existing communication preferences and technological familiarity within populations. Similarly, Russia's use of folklore-based educational materials illustrates how cultural adaptation can enhance accessibility and engagement across age groups and literacy levels. These themes reflect locally adapted strategies rather than single-solution approaches: digital integration (virtual support hubs; extended-hours teleconsultation), multi-channel communication (radio plus web; live-streamed education), cultural and linguistic tailoring (multilingual content; materials grounded in local narratives), and community models (dementia-friendly initiatives; Memory Cafés). Such approaches align with equity aims and can be implemented incrementally. Taken together, these findings suggest that national approaches to online dementia support may benefit from clearer standards, closer integration with health systems, and attention to linguistic and connectivity barriers. One pragmatic direction could be the development of accredited national portals that align content with core carer information needs and provide crisis pathways and entitlement navigation. Experience from countries such as Cyprus, where academic oversight has supported content accuracy, indicates that governance structures, such as named institutional stewardship and scheduled reviews, may help sustain quality over time. Similarly, aligning technical accessibility with established benchmarks (for example, WCAG 2.1 AA) and adopting mobile-first design principles appear consistent with improving usability for diverse users. Public reporting of periodic audits and user feedback could offer a feasible mechanism for transparency and iterative improvement. Greater integration with existing health services may also be warranted. In higher-resource settings, linking portals to primary care workflows and electronic systems may facilitate clinician referral to reliable information and services. In lower-resource settings, evidence from community-based programmes suggests that community health workers can help bridge digital access gaps by facilitating use of online materials during routine contacts and by feeding back commonly encountered information needs to inform content updates (28-30). Across settings, the connection of online information to helplines, social protection services, and local referral directories appears to make resources more actionable and easier to navigate. Sustainable resourcing emerges as a recurrent need. The predominance of NGO-led provision in our sample points to the value of civil society leadership. At the same time, recurrent funding and shared stewardship arrangements with public authorities may support continuity, maintenance, and reach. In some contexts, partnerships with telecommunications providers to reduce data costs or zero-rate access have been used to lower barriers, and targeted support for multilingual or low‑bandwidth features could improve inclusivity, particularly where connectivity is limited. In settings where internet access is limited, hybrid delivery models may offer a practical way forward. For example, pairing concise web content with community radio segments; supplementing with printed guidance shared via primary care and local organisations; and exploring interactive voice response or SMS menus for basic navigation. As infrastructure strengthens, lightweight mobile pages could provide a gradual pathway to richer functionality without sacrificing reach. Above all, it may help to match delivery modes to people’s real contexts, technological, linguistic, and cultural, while guarding against fragmented messaging or any slide in quality assurance. Finally, routine monitoring and shared learning may help consolidate progress. Maintaining public registries of national portals, tracking a small set of indicators, for example, coverage of core domains, accessibility compliance, language reach, and basic usage metrics, and disaggregating data by region and language could illuminate inequities and guide improvements. Incorporating digital dementia support within national dementia plans and broader universal health coverage monitoring frameworks may also provide a coherent locus for stewardship. Recognising and formalising the contributions of NGOs within such arrangements could help move from a patchwork of initiatives toward coordinated ecosystems that are responsive to users’ needs. While digital exclusion is only one dimension of inequity, the evidence here indicates that it can compound disadvantages in access to essential information and support; approaches that are standards‑aligned, integrated, and context‑sensitive may therefore offer a plausible route to more equitable provision. This study's strengths include its global scope, systematic methodology, and comprehensive assessment of resource availability and quality, based on an existing needs taxonomy, enhanced by dual human-AI verification. The diverse country inclusion offers insights into contextual influences on digital health. However, limitations exist. Convenience sampling may not fully represent global diversity. Search strategies, limited to the first 10 pages, might have missed less visible resources. The cross-sectional design provides only a snapshot of rapidly evolving digital content. Our focus on web-based resources excluded other vital digital platforms (e.g., mobile apps, social media groups, podcasts). While excluding social media may undercount informal support networks, this reflects our policy focus on sustainable, quality-assured resources. The AI-supported scoring, while consistent, may not fully capture cultural nuances or user perspectives. Finally, the applied needs taxonomy, though globally informed, did not incorporate data from all included countries, meaning some identified needs might be less relevant or some context-specific needs might be uncaptured. Future research should incorporate user testing (including assistive technology users), longitudinal audits, and evaluation of hybrid delivery models in low-connectivity environments. This first multi‑country analysis highlights both the promise and the unevenness of online dementia support. While provision varies widely, locally adapted models demonstrate that equitable access is achievable when content quality, accessibility, and delivery are systematically addressed. The predominance of NGO‑led provision highlights civil society’s role, but also the need for durable governance, financing, and maintenance beyond ad hoc initiatives. This work establishes a baseline for monitoring equity in online dementia support and offers a standardised approach to compare content comprehensiveness and technical accessibility across settings. Policy and practice priorities include: (1) minimum standards for public‑facing portals with named stewardship and scheduled reviews; (2) integration with health‑system workflows, helplines, and social protection; (3) hybrid delivery to extend reach in low‑connectivity contexts; and (4) sustainable resourcing, including partnerships to reduce data costs and expand multilingual, low‑bandwidth features. Taken together, as dementia prevalence grows, online resources should complement, not replace, offline services. Standards‑aligned, integrated, and context‑sensitive ecosystems, supported by stable financing and complementary offline channels, may offer a feasible pathway to more equitable support for people living with dementia and their care partners. Declarations DATA AVAILABILITY STATEMENT All data generated or analysed during this study are included in this published article. FUNDING This study was part of a research project funded by the Global Brain Health Institute, Alzheimer's Association, Alzheimer's Society (GBHI ALZ UK‐21‐714522). At the time of manuscript writing, Irina Kinchin was supported by the Applied Programme Grants (APRO) Award (Reference 9745). The funding sources had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. ACKNOWLEDGEMENTS The authors also wish to thank Caroline Stirling, Academic Support Librarian at the University of Edinburgh, who supported the development of the initial search strategy. We thank Fasihah Irfani Fitri for her valuable contribution to the data collection and verification process for Indonesia. AUTHOR CONTRIBUTIONS Irina Kinchin: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Software, Writing – Original Draft, Writing – Review & Editing Charlèss Dupont: Methodology, Formal Analysis, Investigation, Writing – Original Draft Inbal Mayan: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review & Editing Yaohua Chen: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review & Editing Iracema Leroi: Methodology, Writing – Review & Editing Arianna Almirall Sanchez: Investigation Emmanuel Epenge: Investigation Eliza Georgiou: Investigation, Writing – Review & Editing Petya Grigorova: Investigation, Writing – Review & Editing Aline Haas: Investigation, Writing – Review & Editing Wambūi Karanja: Investigation, Writing – Review & Editing Tomás León: Investigation, Writing – Review & Editing Rachel Milte: Investigation, Writing – Review & Editing Khyati Tripathi: Investigation, Writing – Review & Editing Emily R. Adrion: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review & Editing COMPETING INTERESTS The authors declare that there is no conflict of interest with respect to the research, authorship, and/or publication of this article. References Soong A, Au ST, Kyaw BM, Theng YL, Tudor Car L. Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: a scoping review. BMC Geriatrics. 2020;20(1):61. Teles S, Paúl C, Costa-Santos C, Ferreira A. Use of dementia and caregiving-related internet resources by informal caregivers: A cross-sectional study. Frontiers in Medicine. 2022;9. Blusi M, Kristiansen L, Jong M. Exploring the influence of Internet-based caregiver support on experiences of isolation for older spouse caregivers in rural areas: a qualitative interview study. International Journal of Older People Nursing. 2015;10(3):211-20. Fahy E, Hardikar R, Fox A, Mackay S. 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JMIR Mhealth Uhealth. 2023;11:e42023. Blondino CT, Knoepflmacher A, Johnson I, Fox C, Friedman L. The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers. BMC Public Health. 2024;24(1):650. Feroz AS, Khoja A, Saleem S. Equipping community health workers with digital tools for pandemic response in LMICs. Archives of Public Health. 2021;79(1):1. Tables Tables 1 to 5 are available in the Supplementary Files section Additional Declarations No competing interests reported. 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As populations age, the need for timely, comprehensive, and accessible information and support becomes a core health-systems concern, particularly in settings with limited specialist services.\u003c/p\u003e\n\u003cp\u003eOnline resources, including public websites, articles, videos, and moderated forums, are increasingly used to overcome barriers of geography, clinic capacity, and time (2). When evidence-based and well designed, they can support disease understanding, care skills, navigation of services, and peer connection. In rural contexts, such supports have been reported to reduce experiences of isolation among spouse care partners (3). Yet quality, accuracy, comprehensiveness, and accessibility vary widely (4, 5). Critically, there is little comparative evidence on whether public-facing online resources meet carers\u0026rsquo; needs across cultural and health-system contexts and income settings.\u003c/p\u003e\n\u003cp\u003eMost prior assessments are single-country or regional (6-8). Despite 60% of people with dementia living in low-, middle-income countries (LMICs), where in-person services and specialist guidance are often scarce, there has been no systematic, multi-country appraisal of the availability, quality, and accessibility of online dementia support across LMICs and high-income countries (9).\u003c/p\u003e\n\u003cp\u003eBuilding on a taxonomy of carer information needs (disease knowledge; healthcare navigation; information sources; financial/legal; self-care) (10), this study examines whether publicly accessible, non-social media web resources align with carers\u0026rsquo; needs and are accessible to diverse users, including those with constrained connectivity. Because public web properties are amenable to government and NGO policy levers (standards, procurement, funding, regulation), understanding their coverage and accessibility has direct implications for equity.\u003c/p\u003e\n\u003cp\u003eObjectives:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eMap the distribution and characteristics of publicly accessible online dementia resources across 17 countries spanning World Bank income groups and regions.\u003c/li\u003e\n \u003cli\u003eAssess alignment with carer information needs and evaluate content comprehensiveness using an evidence-based taxonomy.\u003c/li\u003e\n \u003cli\u003eEvaluate technical accessibility against WCAG 2.1 (Level AA) to appraise usability and inclusion.\u003c/li\u003e\n \u003cli\u003eAnalyse patterns by country-level indicators (e.g., internet penetration, health expenditure, universal health care coverage, national dementia plans) and identify adaptable delivery models.\u003c/li\u003e\n \u003cli\u003eDerive policy-relevant recommendations.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"RESULTS","content":"\u003ch3\u003e\u003cstrong\u003eDemographic and healthcare system characteristics of included countries\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe study included 17 countries across five continents (Table 2). Population sizes ranged from 1.3 million (Cyprus) to 1.4 billion (India), with varying proportions of older populations (2.8% in DRC to 23.5% in Bulgaria) (11). Life expectancy ranged from 62.1 years (DRC) to 84.1 years (Australia) (12). The OECD dementia prevalence indicator (definition in Table 2) was available for 12 out of 17 countries, ranged from 4.9% (India) to 24.1% (Greece) (13). Notably, 14 of 17 countries had implemented National Dementia Plans (14). Internet penetration rates varied dramatically from 16.7% in Kenya to 97.6% in Australia (15), while health expenditure ranged from 3.7% of GDP in Indonesia to 13.8% in Cuba (16). Physician density ranged from 0.2 per 1,000 in Kenya to 6.3 in Greece (17). Universal health coverage status was present in 13/17 countries (18) (Table 2).\u003c/p\u003e\n\u003cp\u003eOnline dementia resources meeting eligibility criteria were identified in 15/17 countries; no eligible resources were found for Cuba and the DRC at time of search (Table 3). The number of eligible websites per country varied widely, ranging from 1 (Kenya) to 20 (Russia), with a median of 5 websites per country. Australia, Russia, Belgium, and UK (Scotland) had the most resources (18, 20, 16, and 15, respectively). Non-governmental organizations (NGOs), including charities, were the most common providers (\u003cem\u003en\u003c/em\u003e=84/124, 67.7%), followed by government/public sector (\u003cem\u003en\u003c/em\u003e=17/124, 13.7%) and private companies (\u003cem\u003en\u003c/em\u003e=14/124, 11.3%). In terms of geographical coverage, 11 countries had nationally focused resources, 8 had regional coverage, and 4 had relevant local resources.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eQuality of online resources\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe top-performing resource in each country by overall score is shown in Table 4. The Israel Alzheimer\u0026rsquo;s Association resource achieved the highest information coverage across the five carer-need domains (mean domain coverage 96%), followed by Dementia Australia (91%) and Aidons les n\u0026ocirc;tres (France, 91%). Kenya\u0026rsquo;s highest-scoring resource covered 47% of domains comprehensively. Country-level mean comprehensiveness scores ranged from 3.0 (Cyprus) to 5.0 (Australia, UK (Scotland) on a 1\u0026ndash;5 scale; mean accessibility scores ranged from 2.5 to 4.5 (Australia, UK (Scotland).\u003c/p\u003e\n\u003cp\u003eAcross all resources, self-care content was most consistently addressed (mean coverage 97%), followed by healthcare-related navigation (81%) and disease-specific information (69%). Financial and legal support content was least covered (49%), with minimal content in Cyprus, Greece, and Kenya.\u003c/p\u003e\n\u003cp\u003eProvider performance varied, with national NGOs in Australia and Scotland (UK) achieved the highest combined comprehensiveness and accessibility. Bulgaria and Cyprus relied primarily on EU-funded projects and academic sites, respectively. France illustrated a hybrid model with NGO/private sector partnerships.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eInfluence of country-specific factors\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eDigital infrastructure emerged as a prerequisite for resource availability. Countries with relatively limited internet penetration (Cuba 50.1%, DRC 29.5%) (15) had no eligible resources, whereas those above 75% penetration typically had multiple resources. Countries with substantial health expenditure (\u0026gt;10% GDP) demonstrated comprehensive resource development, Australia (10.5% GDP, 5.0 score) and France (12.8% GDP, 4.5 score), compared with lower-spend contexts such as Indonesia (3.7% GDP, 3.5 score), India (3.8% GDP, 4.0 score). These relationships are descriptive and not adjusted for confounding.\u003c/p\u003e\n\u003cp\u003eIn relation to healthcare system structure, universal healthcare systems demonstrated more balanced provider ecosystems. For example, Australia combined substantial government provision (7 resources) with NGO resources (6 resources). In contrast, mixed public-private systems, for example India, Indonesia, relied predominantly on NGO.\u003c/p\u003e\n\u003cp\u003eDemography and fiscal capacity both appeared relevant. Countries with larger older-population shares (Belgium 19.4%; France 21.9%; Greece 22.8%) tended to host more comprehensive resources. However, Bulgaria (23.5% aged \u0026ge;65) had only four moderate-quality resources, suggesting economic and institutional constraints may limit response to need.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEquity-driven innovations for resource-constrained settings\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eSeveral themes emerged through cross-country comparison (Table 5). Digital integration emerged as a leading theme, with virtual support systems like Ireland\u0026apos;s Virtual Dementia Hub (a public-private partnership with technology company Fujitsu (https://virtualdementiahub.ie/) and Greece\u0026apos;s video consultation platforms offering 24/7 availability (https://affidea.gr/en/myaffidea-2/). Multi-channel communication strategies were common, combining traditional media with digital platforms, for example Bulgaria\u0026apos;s integration of radio programming with digital consultations and Russia\u0026apos;s \u0026quot;School of Care\u0026quot; program featuring live broadcasts for remote regions (https://alzrus.ru/o-fonde).\u003c/p\u003e\n\u003cp\u003eCultural and linguistic adaptation was evident across several countries, reflecting diverse populations. For example, Israel\u0026apos;s provision of resources in Hebrew, English, and Arabic, while Australia offers services in over 40 languages with specific programs for Aboriginal and Torres Strait Islander communities. Russia demonstrated cultural creativity through resources like \u0026quot;My Grandmother-Yaga\u0026quot; children\u0026apos;s stories, adapting dementia education to local folklore and cultural contexts (https://memini.ru/skazki/).\u003c/p\u003e\n\u003cp\u003eCommunity-based innovations included Belgium\u0026apos;s \u0026quot;Ville Amie D\u0026eacute;mence\u0026quot; initiative (https://www.liguealzheimer.be/), Greece\u0026apos;s dementia-friendly communities program (www.gerontology.gr), and the widespread adoption of Memory Caf\u0026eacute;s across multiple countries.\u0026nbsp;\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design and country selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional content analysis was conducted across 17 pre-specified countries selected via purposive and convenience sampling to ensure representation by World Bank income group and global region from Western Europe (Belgium, France, Ireland, UK (Scotland)), Eastern Europe (Bulgaria, Greece, Russia), the Middle East (Cyprus, Israel), South Asia (India), Southeast Asia (Indonesia), Oceania (Australia), South America (Brazil, Chile), the Caribbean (Cuba), and Africa (Democratic Republic of Congo (DRC), Kenya), yielding a sample of diverse geographical regions, healthcare systems, and economic development levels.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eSearch strategy and data collection\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe search strategy was developed in consultation with an experienced university research support librarian and broadly informed by the methodologies used in global studies of online resources in health (19-23).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSearches (June 2023-December 2024; refreshed May 2025) followed a standard protocol and were not pre-registered. For each country, native-language search strings were developed (full strings in Table 1), and run on the country Google domain (e.g., google.co.uk), in incognito mode with VPN geolocation set to the target country. Structured operators (e.g., site:gov.xx, site:.org, AND dementia/Alzheimer, carer/caregiver synonyms) were applied. The first 10 pages (about 100 results) per query were screened based on prior evidence that yield drops substantially beyond this range; targeted site searches identified further government/NGO pages not surfaced by general queries. A native speaker researcher conducted primary screening and extraction. Abacus.AI Claude Sonnet 3.5 independently extracted against a standard prompt (refer to Supplementary materials). Discordant items were reconciled by consensus. Where no eligible resources were found, a negative search statement was recorded.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEligibility criteria and resource identification\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003ePublicly accessible, non-social media websites providing dementia‑specific information or services (e.g., national portals, NGO sites, health system pages) intended for patients, carers, or providers were included. This focus aligns with government and NGO policy levers (procurement, standards, funding, regulation) that primarily apply to institutionally governed web properties.\u003c/p\u003e\n\u003cp\u003eExcluded a priori:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eMobile apps, social media channels/platforms, and closed or login‑only resources, given differing governance, content dynamics, and access models from policy‑addressable web properties.\u003c/li\u003e\n \u003cli\u003eGeneral caregiving resources without dementia‑tailored information or guidance.\u003c/li\u003e\n \u003cli\u003eSites with obsolete or outdated content (e.g., training/events last updated \u0026gt;5 years ago without current materials), or resources primarily advertising commercial services without substantive informational content.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWhere a single organization operated multiple online resources, the primary national‑facing site/portal was assessed to avoid duplication and to reflect the principal policy‑relevant entry point for the public.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eData extraction\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eFor each eligible website, the following information was extracted: organization type (NGO/charity, government/public sector, private company, other), geographical coverage (national, regional, local), resource quality, delivery models.\u003c/p\u003e\n\u003cp\u003eContent assessment used the carer information needs taxonomy (10) across five domains (disease-specific, healthcare navigation, information sources, financial/legal, self-care). Comprehensiveness and technical accessibility were evaluated with a bespoke rubric adapted from established guidance and aligned to WCAG 2.1 Level AA (Perceivable, Operable, Understandable, Robust) (24). AI-based scoring (Abacus.AI Claude Sonnet 3.5; 1–5 anchored Likert prompts) was followed by human verification by a native-language researcher. Representative pages per site included the homepage, a navigation hub, a content article, a service directory entry, and a contact/intake form.\u003c/p\u003e\n\u003cp\u003eTo avoid construct overlap, accessibility contributed only to the accessibility score; the comprehensiveness score synthesized content breadth/depth and support features, but did not include technical accessibility. Comprehensiveness subscales: breadth, depth, range of services, user support features, resource quality (currency/evidence), and content accuracy/currency; each 1–5 (1=basic facts only to 5=comprehensive coverage), averaged and rounded to 0.5. Accessibility dimensions: navigation, search, readability/plain language, mobile responsiveness, assistive-technology compatibility/semantics, alternative text, colour contrast, keyboard navigation, form accessibility, multimedia captions/transcripts, language options, cultural/linguistic appropriateness; each 1–5 (e.g., navigation: 1=confusing layout to 5=clear intuitive navigation), averaged and rounded to 0.5.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBecause each website was assessed by a single native-language researcher, formal inter-rater reliability (e.g., kappa) could not be estimated. To promote consistency, all researchers completed a common calibration using standardized instructions, an anchor example, and structured Excel templates. A 10% cross-audit was then conducted whereby a second researcher spot-checked ratings for adherence to the rubric. Any discrepancies were resolved by consensus and the rubric was refined accordingly.\u003c/p\u003e\n\u003cp\u003eDelivery models, adaptable approaches and best practices were catalogued for each country. These were extracted through thematic analysis of resource features, service delivery models, and unique approaches. Adaptive practices were defined as context-specific approaches to service delivery, innovative use of technology, cultural or linguistic tailoring, or comprehensive service integration that distinguished a country's resources from those commonly observed elsewhere in the sample.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCountry-level contextual analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCountry-level indicators (most recent year 2019–2024) were sourced from the World Bank, Organisation for Economic Co-operation and Development (OECD) and Alzheimer’s Disease International, covering demographic indicators (country income level (25), population size (11), percentage aged 65+(26)), health system characteristics (life expectancy (12), health expenditure as percentage of GDP (16), physician density (17) ), dementia prevalence (13, 27), digital infrastructure (internet penetration rates(15)), and policy context (presence of National Dementia Plans (14)).\u003c/p\u003e\n\u003cp\u003eAnalyses were descriptive and exploratory aimed at understanding contextual influences rather than establishing statistical relationships, not adjusted for confounding. Patterns were interpreted considering the complex interplay of multiple factors and the limitations of cross-national comparisons with varying data availability and quality. Outcomes included number of resources, provider mix, geographic coverage, and mean comprehensiveness/accessibility scores.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis multi-country analysis of publicly accessible online dementia resources reveals disparities in availability, quality, and innovation across income settings. The findings establish a baseline for monitoring equity in access to online support, inform minimum-standard setting for public-facing portals, and point to practical pathways, such as hybrid delivery, to extend reach while maintaining quality and accessibility.\u003c/p\u003e\n\u003cp\u003eA central observation is a “digital threshold effect”. The absence of identifiable online resources in countries with limited internet infrastructure highlights the fundamental role of digital connectivity as a prerequisite for online health resource development. Even widely used, low-bandwidth platforms like WhatsApp require a minimum level of internet access and smartphone availability, which may not always be met in these settings. This “digital threshold effect” means that without basic technological infrastructure, online supports cannot take root. As a result, populations in resource-limited countries may face a compounded disadvantage: they often experience a higher burden of dementia while also having the least access to online information, support, and care services.\u003c/p\u003e\n\u003cp\u003eProvision is predominantly NGO-led (68% of 124 resources), suggesting that civil society often fills gaps in the absence of systematic public provision. However, presence alone did not equate to adequacy. Quality varied widely (e.g., mean domain coverage from 47% in the lowest-scoring country exemplar to 96% in the highest). Countries with higher-scoring resources tended to exhibit features such as clear governance, dedicated funding, and scheduled content maintenance, patterns consistent with coordinated, rather than ad hoc, development.\u003c/p\u003e\n\u003cp\u003eThis analysis focused on official organizational websites, but it is notable that the wider landscape extends beyond formal platforms to social media groups, professional networks, and multimedia content. Kenya's dementia community actively engages through Facebook groups, while Brazil has developed WhatsApp-integrated support groups and specialized podcasts. While these alternative information sources provide valuable peer support and accessible content, they also present challenges for ensuring comprehensive, reliable information. The proliferation of diverse informal online resources may create information fragmentation that can overwhelm care partners already managing complex care responsibilities. This highlights the need for \"one-stop shop\" approaches that consolidate reliable information from multiple sources while maintaining quality standards.\u003c/p\u003e\n\u003cp\u003eContextual patterns were also apparent but not deterministic. Higher health expenditure (\u0026gt;10% GDP) and universal health coverage were generally seen with more comprehensive and higher-scoring resources, suggesting that national healthcare investment may facilitate digital health information. However, the success of countries like Israel (8.3% GDP, 96% coverage) indicates that strategic resource allocation and systematic service development may be more important than public spending.\u003c/p\u003e\n\u003cp\u003eLastly, the diversity of adaptable approaches identified across countries shows the importance of locally adapted solutions in dementia care. Brazil's integration of WhatsApp support groups exemplifies how successful interventions leverage existing communication preferences and technological familiarity within populations. Similarly, Russia's use of folklore-based educational materials illustrates how cultural adaptation can enhance accessibility and engagement across age groups and literacy levels. These themes reflect locally adapted strategies rather than single-solution approaches: digital integration (virtual support hubs; extended-hours teleconsultation), multi-channel communication (radio plus web; live-streamed education), cultural and linguistic tailoring (multilingual content; materials grounded in local narratives), and community models (dementia-friendly initiatives; Memory Cafés). Such approaches align with equity aims and can be implemented incrementally.\u003c/p\u003e\n\u003cp\u003eTaken together, these findings suggest that national approaches to online dementia support may benefit from clearer standards, closer integration with health systems, and attention to linguistic and connectivity barriers. One pragmatic direction could be the development of accredited national portals that align content with core carer information needs and provide crisis pathways and entitlement navigation. Experience from countries such as Cyprus, where academic oversight has supported content accuracy, indicates that governance structures, such as named institutional stewardship and scheduled reviews, may help sustain quality over time. Similarly, aligning technical accessibility with established benchmarks (for example, WCAG 2.1 AA) and adopting mobile-first design principles appear consistent with improving usability for diverse users. Public reporting of periodic audits and user feedback could offer a feasible mechanism for transparency and iterative improvement.\u003c/p\u003e\n\u003cp\u003eGreater integration with existing health services may also be warranted. In higher-resource settings, linking portals to primary care workflows and electronic systems may facilitate clinician referral to reliable information and services. In lower-resource settings, evidence from community-based programmes suggests that community health workers can help bridge digital access gaps by facilitating use of online materials during routine contacts and by feeding back commonly encountered information needs to inform content updates (28-30). Across settings, the connection of online information to helplines, social protection services, and local referral directories appears to make resources more actionable and easier to navigate.\u003c/p\u003e\n\u003cp\u003eSustainable resourcing emerges as a recurrent need. The predominance of NGO-led provision in our sample points to the value of civil society leadership. At the same time, recurrent funding and shared stewardship arrangements with public authorities may support continuity, maintenance, and reach. In some contexts, partnerships with telecommunications providers to reduce data costs or zero-rate access have been used to lower barriers, and targeted support for multilingual or low‑bandwidth features could improve inclusivity, particularly where connectivity is limited.\u003c/p\u003e\n\u003cp\u003eIn settings where internet access is limited, hybrid delivery models may offer a practical way forward. For example, pairing concise web content with community radio segments; supplementing with printed guidance shared via primary care and local organisations; and exploring interactive voice response or SMS menus for basic navigation. As infrastructure strengthens, lightweight mobile pages could provide a gradual pathway to richer functionality without sacrificing reach. Above all, it may help to match delivery modes to people’s real contexts, technological, linguistic, and cultural, while guarding against fragmented messaging or any slide in quality assurance.\u003c/p\u003e\n\u003cp\u003eFinally, routine monitoring and shared learning may help consolidate progress. Maintaining public registries of national portals, tracking a small set of indicators, for example, coverage of core domains, accessibility compliance, language reach, and basic usage metrics, and disaggregating data by region and language could illuminate inequities and guide improvements. Incorporating digital dementia support within national dementia plans and broader universal health coverage monitoring frameworks may also provide a coherent locus for stewardship. Recognising and formalising the contributions of NGOs within such arrangements could help move from a patchwork of initiatives toward coordinated ecosystems that are responsive to users’ needs. While digital exclusion is only one dimension of inequity, the evidence here indicates that it can compound disadvantages in access to essential information and support; approaches that are standards‑aligned, integrated, and context‑sensitive may therefore offer a plausible route to more equitable provision.\u003c/p\u003e\n\u003cp\u003eThis study's strengths include its global scope, systematic methodology, and comprehensive assessment of resource availability and quality, based on an existing needs taxonomy, enhanced by dual human-AI verification. The diverse country inclusion offers insights into contextual influences on digital health. However, limitations exist. Convenience sampling may not fully represent global diversity. Search strategies, limited to the first 10 pages, might have missed less visible resources. The cross-sectional design provides only a snapshot of rapidly evolving digital content. Our focus on web-based resources excluded other vital digital platforms (e.g., mobile apps, social media groups, podcasts). While excluding social media may undercount informal support networks, this reflects our policy focus on sustainable, quality-assured resources. The AI-supported scoring, while consistent, may not fully capture cultural nuances or user perspectives. Finally, the applied needs taxonomy, though globally informed, did not incorporate data from all included countries, meaning some identified needs might be less relevant or some context-specific needs might be uncaptured. Future research should incorporate user testing (including assistive technology users), longitudinal audits, and evaluation of hybrid delivery models in low-connectivity environments.\u003c/p\u003e\n\u003cp\u003eThis first multi‑country analysis highlights both the promise and the unevenness of online dementia support. While provision varies widely, locally adapted models demonstrate that equitable access is achievable when content quality, accessibility, and delivery are systematically addressed. The predominance of NGO‑led provision highlights civil society’s role, but also the need for durable governance, financing, and maintenance beyond ad hoc initiatives.\u003c/p\u003e\n\u003cp\u003eThis work establishes a baseline for monitoring equity in online dementia support and offers a standardised approach to compare content comprehensiveness and technical accessibility across settings. Policy and practice priorities include: (1) minimum standards for public‑facing portals with named stewardship and scheduled reviews; (2) integration with health‑system workflows, helplines, and social protection; (3) hybrid delivery to extend reach in low‑connectivity contexts; and (4) sustainable resourcing, including partnerships to reduce data costs and expand multilingual, low‑bandwidth features.\u003c/p\u003e\n\u003cp\u003eTaken together, as dementia prevalence grows, online resources should complement, not replace, offline services. Standards‑aligned, integrated, and context‑sensitive ecosystems, supported by stable financing and complementary offline channels, may offer a feasible pathway to more equitable support for people living with dementia and their care partners.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDATA AVAILABILITY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analysed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was part of a research project funded by the Global Brain Health Institute, Alzheimer's Association, Alzheimer's Society (GBHI ALZ UK‐21‐714522). At the time of manuscript writing, Irina Kinchin was supported by the Applied Programme Grants (APRO) Award (Reference 9745). The funding sources had no involvement in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors also wish to thank Caroline Stirling, Academic Support Librarian at the University of Edinburgh, who supported the development of the initial search strategy. We thank Fasihah Irfani Fitri for her valuable contribution to the data collection and verification process for Indonesia.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIrina Kinchin: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Software, Writing – Original Draft, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eCharlèss Dupont: Methodology, Formal Analysis, Investigation, Writing – Original Draft\u003c/p\u003e\n\u003cp\u003eInbal Mayan: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eYaohua Chen: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eIracema Leroi: Methodology, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eArianna Almirall Sanchez: Investigation\u003c/p\u003e\n\u003cp\u003eEmmanuel Epenge: Investigation\u003c/p\u003e\n\u003cp\u003eEliza Georgiou: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003ePetya Grigorova: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eAline Haas: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eWambūi Karanja: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eTomás León: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eRachel Milte: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eKhyati Tripathi: Investigation, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003eEmily R. Adrion: Methodology, Investigation, Validation, Writing – Original Draft, Writing – Review \u0026amp; Editing\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest with respect to the research, authorship, and/or publication of this article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSoong A, Au ST, Kyaw BM, Theng YL, Tudor Car L. Information needs and information seeking behaviour of people with dementia and their non-professional caregivers: a scoping review. BMC Geriatrics. 2020;20(1):61.\u003c/li\u003e\n\u003cli\u003eTeles S, Pa\u0026uacute;l C, Costa-Santos C, Ferreira A. Use of dementia and caregiving-related internet resources by informal caregivers: A cross-sectional study. Frontiers in Medicine. 2022;9.\u003c/li\u003e\n\u003cli\u003eBlusi M, Kristiansen L, Jong M. 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Dementia Caregivers\u0026rsquo; Responses to 2 Internet-Based Intervention Programs. American Journal of Alzheimer\u0026apos;s Disease \u0026amp; Other Dementias\u0026reg;. 2011;26(1):36-43.\u003c/li\u003e\n\u003cli\u003eYin Z, Stratton L, Song Q, Ni C, Song L, Commiskey P, et al. Perceptions and Utilization of Online Peer Support Among Informal Dementia Caregivers: Survey Study. JMIR Aging. 2024;7:e55169.\u003c/li\u003e\n\u003cli\u003eWorld Health Organisation. Dementia: WHO; 2025 [Available from: https://www.who.int/news-room/fact-sheets/detail/dementia.\u003c/li\u003e\n\u003cli\u003eKinchin I, Edwards L, Adrion E, Chen Y, Ashour A, Leroi I, et al. Care partner needs of people with neurodegenerative disorders: What are the needs, and how well do the current assessment tools capture these needs? A systematic meta-review. Int J Geriatr Psychiatry. 2022;37(7).\u003c/li\u003e\n\u003cli\u003eWorld Bank. Population size [Available from: https://data.worldbank.org/indicator/SP.POP.TOTL65.\u003c/li\u003e\n\u003cli\u003eWorld Bank. Life expectancy [Available from: https://data.worldbank.org/indicator/SP.DYN.LE00.IN \u003c/li\u003e\n\u003cli\u003eOECD. Health at a Glance 2023. OECD Indicators. Dementia [Available from: https://www.oecd.org/en/publications/2023/11/health-at-a-glance-2023_e04f8239/full-report/dementia_d36fa970.html#figure-d1e35171-cc708128ba.\u003c/li\u003e\n\u003cli\u003e(ADI) AsDI. Dementia plans [Available from: https://www.alzint.org/what-we-do/policy/dementia-plans/.\u003c/li\u003e\n\u003cli\u003eWorld Bank. Internet access [Available from: https://data.worldbank.org/indicator/IT.NET.USER.ZS \u003c/li\u003e\n\u003cli\u003eWorld Bank. Health expenditure as percentage of GDP [Available from: https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS \u003c/li\u003e\n\u003cli\u003eWorld Bank. Physician density [Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS \u003c/li\u003e\n\u003cli\u003eOECD. Health inequality and universal health coverage [Available from: https://www.oecd.org/en/topics/policy-issues/health-inequality-and-universal-health-coverage.html.\u003c/li\u003e\n\u003cli\u003eKeaver L, Huggins MD, Chonaill DN, O\u0026apos;Callaghan N. Online nutrition information for cancer survivors. Journal of Human Nutrition and Dietetics. 2023;36(2):415-33.\u003c/li\u003e\n\u003cli\u003eMatsieli ML, Sooryamoorthy R. Evaluation of E-Government Websites in Lesotho: An Empirical Study. African Journal of Governance and Development. 2021;10(1):80-97.\u003c/li\u003e\n\u003cli\u003eNahm E-S, Preece J, Resnick B, Mills ME. Usability of Health Web Sites for Older Adults: A Preliminary Study. CIN: Computers, Informatics, Nursing. 2004;22(6).\u003c/li\u003e\n\u003cli\u003eSaad M, Zia A, Raza M, Kundi M, Haleem M. A Comprehensive Analysis of Healthcare Websites Usability Features, Testing Techniques and Issues. IEEE Access. 2022;10:97701-18.\u003c/li\u003e\n\u003cli\u003eMtebe JSaK, A.W. Accessibility and Usability of Government Websites in Tanzania. The African Journal of Information Systems. 2017;9(4).\u003c/li\u003e\n\u003cli\u003eW3C. Web Content Accessibility Guidelines (WCAG) 2.1 2025 [Available from: https://www.w3.org/TR/WCAG21/.\u003c/li\u003e\n\u003cli\u003eWorld Bank. World Bank country classifications by income level for 2024-2025 2025 [\u003c/li\u003e\n\u003cli\u003eWorld Bank. Population size over 65 [Available from: https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS.\u003c/li\u003e\n\u003cli\u003eNichols E, Steinmetz JD, Vollset SE, Fukutaki K, Chalek J, Abd-Allah F, et al. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. The Lancet Public Health. 2022;7(2):e105-e25.\u003c/li\u003e\n\u003cli\u003eGreuel M, Sy F, B\u0026auml;rnighausen T, Adam M, Vandormael A, Gates J, et al. Community Health Worker Use of Smart Devices for Health Promotion: Scoping Review. JMIR Mhealth Uhealth. 2023;11:e42023.\u003c/li\u003e\n\u003cli\u003eBlondino CT, Knoepflmacher A, Johnson I, Fox C, Friedman L. The use and potential impact of digital health tools at the community level: results from a multi-country survey of community health workers. BMC Public Health. 2024;24(1):650.\u003c/li\u003e\n\u003cli\u003eFeroz AS, Khoja A, Saleem S. Equipping community health workers with digital tools for pandemic response in LMICs. Archives of Public Health. 2021;79(1):1.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 5 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"npj-dementia","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Dementia](https://www.nature.com/npjdementia/)","snPcode":"44400","submissionUrl":"https://submission.springernature.com/new-submission/44400/3","title":"npj Dementia","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8080114/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8080114/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis multi-country study provides the first systematic assessment of publicly accessible online dementia resources across 17 countries spanning diverse income levels and geographic regions. We mapped 124 online resources and evaluated their alignment with carer information needs using an evidence-based taxonomy covering disease knowledge, healthcare navigation, information sources, financial/legal support, and self-care. Our findings reveal disparities in resource availability and quality, with a \"digital threshold effect\" where countries with limited internet infrastructure had no identifiable online dementia resources. NGO-led provision dominated (68%), but quality varied widely, with mean domain coverage ranging from 47% to 96% across countries. Higher-scoring resources were associated with clear governance, dedicated funding, and systematic content maintenance. Technical accessibility assessments against WCAG 2.1 Level AA standards showed variable compliance. We identified adaptable delivery models including digital integration, multi-channel communication, cultural and linguistic tailoring, and community-based approaches. The study establishes a baseline for monitoring equity in online dementia support and offers policy recommendations for minimum standards, health system integration, hybrid delivery in low-connectivity contexts, and sustainable resourcing to address the growing global dementia burden through accessible digital resources.\u003c/p\u003e","manuscriptTitle":"The global landscape of online dementia resources","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-27 12:50:50","doi":"10.21203/rs.3.rs-8080114/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-07T21:34:35+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-07T12:26:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"321787641589528448121676980819222414623","date":"2025-11-27T17:19:36+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T19:12:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103614191856152240542261049090493589972","date":"2025-11-21T15:30:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-19T16:55:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-19T00:46:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-16T10:07:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"npj Dementia","date":"2025-11-10T19:12:03+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"npj-dementia","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [npj Dementia](https://www.nature.com/npjdementia/)","snPcode":"44400","submissionUrl":"https://submission.springernature.com/new-submission/44400/3","title":"npj Dementia","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"NPJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"af49891f-dcea-4e06-9349-a81c5a4675c0","owner":[],"postedDate":"November 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":58677946,"name":"Health sciences/Health care"},{"id":58677947,"name":"Humanities/Health humanities"},{"id":58677948,"name":"Scientific community and society/Scientific community"}],"tags":[],"updatedAt":"2026-01-28T01:53:10+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-27 12:50:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8080114","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8080114","identity":"rs-8080114","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}