Providing training and support to Spanish dementia caregivers living in rural and urban areas: insights and results from the iSupport-Sp study.

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Learn more: PMC Disclaimer | PMC Copyright Notice Int J Equity Health . 2026 Mar 3;25:93. doi: 10.1186/s12939-026-02790-6 Search in PMC Search in PubMed View in NLM Catalog Add to search Show available content in en es Providing training and support to Spanish dementia caregivers living in rural and urban areas: insights and results from the iSupport-Sp study Mauricio Molinari-Ulate Mauricio Molinari-Ulate 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain 2 Escuela de Psicología, Universidad de Costa Rica, San José, Costa Rica Find articles by Mauricio Molinari-Ulate 1, 2 , José-Miguel Toribio-Guzmán José-Miguel Toribio-Guzmán 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain 3 Department of Personality, Psychological Assessment and Treatment, Faculty of Psychology, Universidad de Salamanca, Salamanca, Spain Find articles by José-Miguel Toribio-Guzmán 1, 3 , María Anciones-Polo María Anciones-Polo 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain 4 Department of Statistics, Universidad de Salamanca, Salamanca, Spain Find articles by María Anciones-Polo 1, 4 , Alfonso Bahillo Alfonso Bahillo 5 Blue Connecting Emotion S.L, Valladolid, Spain 6 Department of Signal and Communications Theory and Telematics Engineering, School of Telecommunications Engineering, Universidad de Valladolid, Valladolid, Spain Find articles by Alfonso Bahillo 5, 6 , Henriëtte G van der Roest Henriëtte G van der Roest 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain Find articles by Henriëtte G van der Roest 1 , Manuel Franco-Martín Manuel Franco-Martín 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain 3 Department of Personality, Psychological Assessment and Treatment, Faculty of Psychology, Universidad de Salamanca, Salamanca, Spain 7 Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain Find articles by Manuel Franco-Martín 1, 3, 7, ✉ Author information Article notes Copyright and License information 1 Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain 2 Escuela de Psicología, Universidad de Costa Rica, San José, Costa Rica 3 Department of Personality, Psychological Assessment and Treatment, Faculty of Psychology, Universidad de Salamanca, Salamanca, Spain 4 Department of Statistics, Universidad de Salamanca, Salamanca, Spain 5 Blue Connecting Emotion S.L, Valladolid, Spain 6 Department of Signal and Communications Theory and Telematics Engineering, School of Telecommunications Engineering, Universidad de Valladolid, Valladolid, Spain 7 Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain ✉ Corresponding author. Received 2025 Mar 18; Accepted 2026 Feb 14; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13067446  PMID: 41776605 Abstract Background Dementia care in rural areas is hindered by limited-service availability and long distances to urban-based facilities, exacerbating disparities in access to care services. This inequality is a major obstacle to ensuring universal timely diagnosis, treatment, and care. Technology-based interventions have emerged as a promising approach to improve access to caregiver support, yet evidence regarding their implementation in diverse geographical contexts remains limited. iSupport-Sp is a web-based platform designed to provide training and support for dementia caregivers. This study aimed to evaluate the usability, user experience, and preliminary effectiveness of iSupport-Sp among dementia caregivers residing in both rural and urban settings. Methods A single-phase mixed-methods study was conducted to explore the preliminary effectiveness of iSupport-Sp in enhancing dementia knowledge and alleviating caregiver burden, and to evaluate its usability and user experience among dementia caregivers from rural and urban areas. Results Participants reported high levels of acceptability, positive user experience, and ease of use. High levels of perceived satisfaction were reported at post-intervention, and dementia knowledge increased significantly following programme completion (W = -3.12; p = 0.002). No statistically significant effects were observed in self-perceived caregiver burden. Due to the limited sample size, statistical comparisons between rural and urban caregivers could not be conducted. Conclusions iSupport-Sp was perceived as a promising and valuable tool for delivering training and support to dementia caregivers in both rural and urban settings. Future research with larger samples and more robust study designs is needed to examine differential effects across caregiver groups and to evaluate long-term outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-026-02790-6. Keywords: Dementia, People living with dementia, Dementia caregivers, Dementia care, Rural caregivers, Health inequalities, Psychoeducation, Web-based interventions, e-Health, iSupport Resumen Antecedentes La atención de la demencia en zonas rurales se ve limitada por la escasez de servicios y la lejanía de los centros urbanos, ampliando la brecha en el acceso a los servicios de atención. Esta desigualdad representa un gran obstáculo para asegurar el diagnóstico, tratamiento y cuidado oportunos y universales. Las intervenciones basadas en tecnología han surgido como una estrategia prometedora para mejorar el acceso al apoyo a cuidadores, pero la evidencia sobre su implementación en en distintos contextos geográficos sigue siendo limitada. iSupport-Sp es una plataforma web diseñada para proporcionar capacitación y apoyo a cuidadores de personas con demencia. El objetivo de este estudio fue evaluar la usabilidad, la experiencia de usuario y la efectividad preliminar de iSupport-Sp en cuidadores de personas que viven con demencia residentes en entornos rurales y urbanos. Métodos Se realizó un estudio de métodos mixtos de fase única para explorar la efectividad preliminar de iSupport-Sp en la mejora del conocimiento sobre la demencia y la reducción de la sobrecarga del cuidador, así como para evaluar la usabilidad y la experiencia de usuario en cuidadores de personas que viven con demencia de áreas rurales y urbanas. Resultados Los participantes reportaron altos niveles de aceptabilidad, una experiencia de usuario positiva y facilidad de uso. Altos niveles de satisfacción percibida fueron reportados tras la intervención, y el conocimiento sobre la demencia aumentó significativamente después de completar el programa (W = -3.12; p = 0.002). No se identificaron efectos estadísticamente significativos en la autopercepción de la sobrecarga del cuidador. Debido al tamaño limitado de la muestra, no fue posible realizar comparaciones significativas entre cuidadores rurales y urbanos. Conclusiones iSupport-Sp fue percibida como una herramienta prometedora y valiosa para ofrecer capacitación y apoyo a cuidadores de personas que viven con demencia tanto en contextos rurales como urbanos. Futuras investigaciones con muestras más amplias y diseños de estudio más robustos son necesarias para examinar efectos diferenciales entre grupos de cuidadores y evaluar los resultados a largo plazo. Background Ageing is one of the main risk factors for developing dementia [ 1 ]. Due to global population ageing, the number of people living with dementia (PLwD) is expected to triple, reaching approximately 139 million worldwide by 2050 [ 2 ]. Dementia is a major contributor to care dependency and disability. For example, Alzheimer’s disease is among the 10 leading causes of death [ 2 ], and ranks 25th in disability-adjusted life years globally [ 3 ], indicating a high overall disease burden that combines premature mortality with years lived with disability. With an increasing number of PLwD, it is also expected to raise the number of caregivers [ 4 ]. However, a shortage of formal care has resulted in a heavy reliance on informal care [ 2 ], with family members, friends or unpaid caregivers providing 80–83% of dementia care [ 5 , 6 ]. This informal care accounts for approximately half of the global costs associated with dementia [ 2 ]. The financial burden, coupled with social and psychological stressors, negatively impacts informal caregivers’ physical and mental health, which in turn affects the quality of care provided [ 2 ]. Therefore, there is a critical need for accessible training and support services to strengthen caregivers’ capabilities, enhance their well-being, and enable PLwD to remain in their communities for longer, ultimately reducing healthcare utilization [ 2 ]. Access to dementia care services is largely concentrated in urban areas, creating significant disparities between urban and rural communities [ 2 , 7 , 8 ]. Several barriers limit access to care in rural settings, including geographical distance, shortages of healthcare workforce, limited resources, and inadequate dementia-specific training for health and social care providers [ 2 , 8 ]. Additionally, demographic shifts, such as rural-to-urban migration and the decline of traditional family caregiving structures, have further exacerbated rural dementia care access challenges [ 5 , 6 , 8 ]. Existing research has identified notable differences between rural and urban dementia caregivers, partly driven by these disparities [ 9 ]. For instance, rural caregivers typically provide more hours of care per week, experience higher rates of mortality and hospitalization, report poorer general and mental health, rely more on nursing homes, and have lower utilization of home-based care services [ 9 , 10 ]. These gaps represent a major obstacle to ensuring universal accessibility to dementia care, timely diagnosis, and appropriate treatment for both PLwD and their caregivers. To address these challenges, technology-based solutions – such as telehealth, remote monitoring technologies, and web-based interventions – have gained increasing attention in recent years as a way for remotely delivering training and support to dementia caregivers [ 7 , 11 – 14 ]. Digital interventions can increase coverage and overcome transportation and geographical barriers, making them especially beneficial for those in remote areas [ 15 , 16 ]. Among the most effective approaches are multicomponent interventions that combine cognitive behavioural therapy, relaxation techniques, educational resources, and online support groups, delivered through hybrid models (e.g. web-based platforms combined with telephone support) [ 17 , 18 ]. Such interventions have demonstrated positive effects on self-efficacy, anxiety, depression, goal setting, and dementia knowledge [ 17 ]. However, evidence in their implementation and impact in rural dementia caregivers is lacking [ 7 ]. Meanwhile, the excitement around digital health interventions has led to a lack of rigorous evaluation regarding their effectiveness for end-users and integration into healthcare systems [ 19 ]. Moreover, several challenges have been identified in the design, usability, and user experience of technology-based solutions for informal caregivers [ 20 ]. Usability refers to how effectively, efficiently and satisfactorily a product, service or system enables users to achieve a specific goal, while user experience encompasses users’ perceptions and overall responses to using a system or product [ 21 ]. Negative experiences while using digital interventions could lead to suboptimal use of the intervention or attrition, and consequently lower effectiveness [ 22 – 25 ]. These challenges may be further amplified in rural settings, where inadequate infrastructure, limited internet access and suboptimal connectivity could further hinder engagement and sustained utilization [ 12 , 26 – 28 ]. One existing digital intervention addressing these challenges is iSupport, a self-help training programme designed by the World Health Organization (WHO) to provide dementia caregiving information, reduce the mental and physical health consequences of caregiving, and improve the caregivers’ quality of life [ 29 ]. Although primarily targeted at informal caregivers (e.g. family members, relatives), it can also be used by health and social care professionals, non-governmental organizations, and private-sector stakeholders involved in dementia care [ 30 ]. The programme incorporates evidence-based psychoeducation, relaxation techniques, behavioural activation, cognitive reframing, and problem-solving strategies [ 15 , 30 ]. iSupport has been translated and culturally adapted in multiple countries [ 31 – 36 ], including a specialized version for young informal carers under 18 [ 37 ]. This study reports on the Spanish adaptation of iSupport (iSupport-Sp), previously developed and described in detail [ 36 ], which involved linguistic translation, cultural adaptation, and a co-design process with caregivers, professionals, and experts to ensure relevance to the Spanish context. The adapted programme is delivered via a dedicated digital platform and was designed to address caregiving challenges in Spain, particularly those related to rural depopulation, population ageing, and limited healthcare service delivery in remote areas [ 36 ]. The present study therefore reports on a pilot evaluation of iSupport-Sp, examining its usability, user experience, and preliminary effectiveness in improving dementia knowledge and reducing caregiver burden among rural and urban dementia caregivers. Methods Study design A mixed-methods study was conducted between February and December 2023. A pre- and post-test (T0 and T1) pilot study was used to evaluate the effectiveness of iSupport-Sp on dementia knowledge and caregiver burden through online questionnaires. T0 refers to the time point immediately prior to initiating the programme, while T1 corresponds to the time point at which participants completed all programme content (e.g., all modules and lessons). The programme was delivered in a self-paced online format, with no fixed intervention period; participants were allowed up to 60 days to complete the programme content. Usability was assessed post-test using the Computer System Usability Questionnaire (CSUQ), while user-experience was explored through a self-administered open-ended online questionnaire. Both questionnaires were embedded within the iSupport-Sp platform for the purpose of this study and were accessible to participants upon completion of all programme content. Ethics approval was granted by the Research Ethics Committee of Zamora Healthcare Complex (reference 583). Participants Participants were recruited from INTRAS Foundation Memory Clinic, Spanish Alzheimer’s Associations, the State Reference Center for the Care of People with Alzheimer’s Disease and Other Dementias (CREA) in Salamanca, Spain, and the Zamora Residence Network. Additionally, recruitment was carried out through six seminars supported by the Zamora Provincial Council (Diputación de Zamora), which were held in six rural municipalities in the province of Zamora, Castilla y León, Spain. These seminars aimed to introduce informal caregivers of PLwD to the iSupport-Sp programme [ 38 ]. The seminars also contributed to the training of formal caregivers of PLwD in rural areas who were involved in the ‘Silver Companions’ project – a professional care programme that integrates in-person care with technology interventions to enhance the quality of life for older adults in rural areas. The trained ‘Silver Companions’ caregivers were encouraged to share iSupport-Sp with other informal caregivers of PLwD living in rural areas. Participants were eligible if they: (a) were 18 years or older; (b) were either informal caregivers (family members, friends or others who do not receive a salary for caregiving) or formal caregivers (health professionals or trained professional caregivers who provide paid care for PLwD); (c) provided care for a person with a formal diagnosis of mild cognitive impairment or dementia; (d) were able to read, write and speak Spanish; and (e) did not have sensory impairments that would significantly hinder their ability to use electronic devices. Participant registration, assessment, programme completion, and attrition are summarised in Fig. 1 . Fig. 1. Open in a new tab Flowchart of participant registration, assessment, and programme completion Intervention iSupport-Sp was developed by culturally adapting the WHO’s original iSupport programme [ 30 , 36 ]. It maintains the same structure as the original version, comprising 23 lessons divided into five modules: (1) introduction to dementia (1 lesson); (2) being a carer (4 lessons); (3) caring for me (3 lessons); (4) providing everyday care (5 lessons); and (5) dealing with behaviour changes (10 lessons). iSupport-Sp is delivered through a web-based platform that presents content in a slide-based format. It includes interactive questions, activities, and exercises, along with videos and audio elements to enhance comprehension and support self-paced learning [ 36 ]. The platform is multiplatform-compatible, accessible via computers, tablets and mobile phones. Further details on the technical development of the platform can be found in the cultural adaptation publication study [ 36 ]. Additionally, Fig. 2 provides an overview of the platform’s slides, videos, and interactive exercises. Fig. 2. Open in a new tab Overview of the iSupport-Sp platform, slides, videos, exercises and certificate of completion Procedure All participants accessed iSupport-Sp via a QR code or web link, where they registered by creating a username and password. During registration, they were presented with the project information sheet and an electronic informed consent form, followed by a socio-demographic questionnaire, all integrated into the platform. Upon consenting to participate, the platform enabled two initial assessments: dementia knowledge was assessed using the Dementia Knowledge Assessment Tool 2 – Spanish version (DKAT2-Sp), selected for its established validity and suitability for measuring changes in dementia-related knowledge in Spanish-speaking populations; caregiver burden was assessed using the Zarit Caregiver Burden Interview, a widely used and validated instrument for quantifying self-perceived caregiver burden among caregivers of people living with dementia. Once these questionnaires were completed, participants could freely navigate through iSupport-Sp modules and lessons. After completing all content, the platform re-enabled the DKAT-2 and Zarit Caregiver Burden Interview, along with the usability assessment (CSUQ) and user experience self-administered open-ended online questionnaire. Participants who completed the entire programme received a certificate of completion, which they could download from the platform. To gather feedback from those who dropped out, two follow-up emails were sent, encouraging them to complete the CSUQ and three short questions about their experience (“What do you think of the content of the iSupport-Sp platform?”; “What did you like the least and the most?”; and “Please write down any suggestions you would like to make on how to make the site easier to use”). Materials and measures Primary outcome measures included usability, user experience, dementia knowledge, and self-perceived caregiver burden. The following instruments were used to measure these outcomes: Sociodemographic questionnaire: the following sociodemographic data were collected: (a) gender; (b) age range; (c) type of municipality of residence; (d) type of relationship with the person being cared for; (e) length of time as caregiver; (f) level of education; and (g) frequency of technology usage (e.g., computers, tablets, mobile phones, internet). Dementia Knowledge Assessment Tool 2 – Spanish version (DKAT2-Sp): this questionnaire measures knowledge about dementia in the Spanish-speaking population. It consists of 21 items, each with three response options: “Yes”, “No” and “Do not know”. A higher score indicates greater knowledge about dementia. The internal consistency of the scale was acceptable (Cronbach’s α = 0.76) [ 39 , 40 ]. Zarit Caregiver Burden Interview – Spanish version: this instrument quantifies the degree of burden experienced by informal caregivers of dependent individuals. It consists of 22 items with five response options: “Never”, “Rarely”, “Sometimes”, “Quite frequently” and “Nearly always”. Higher total scores indicate greater perceived caregiver burden. The scale demonstrates high internal consistency (Cronbach’s α = 0.91) and excellent test–retest reliability ( r = 0.96) [ 41 , 42 ]. Computer System Usability Questionnaire (CSUQ) Version 3 – Spanish version: this 16-item questionnaire uses a Likert scale ranging from 1 to 7 (1 = strongly disagree; 7 = strongly agree). Lower scores indicate greater satisfaction. The CSUQ produces four scores: a general score and three subscales related to system quality, information quality and interface quality. The questionnaire demonstrated high internal consistency (Cronbach’s α = 0.96) [ 43 , 44 ]. Open-ended online questionnaire on user experience: user experience was assessed through a self-administered online questionnaire embedded within the iSupport-Sp platform. The questionnaire consisted of ten open-ended questions exploring participants’ expectations, perceived usability, content quality, design, perceived benefits and limitations, and suggestions for improvement (Additional File 1 ). Data analysis A descriptive analysis was conducted to characterise the sample and to summarise mean scores on the DKAT2-Sp, ZARIT, and CSUQ questionnaires. Pre- and post-test comparisons were performed using paired statistical tests, including Student’s t-tests or Wilcoxon signed-rank tests, as appropriate, based on data distribution. Between-group comparisons between caregivers who completed and those who did not complete the programme were conducted using the Mann-Whitney U test for continuous variables and chi-square tests for categorical variables. Non-parametric tests were selected due to small sample sizes and deviations from normality. The W statistics reported in the Results correspond to the Wilcoxon signed-rank test as generated by SPSS. A p-value of < 0.05 was considered statistically significant. All analyses was performed using IBM SPSS Statistics version 28. Responses to the self-administered open-ended online questionnaire were collected through the platform and exported verbatim for qualitative analysis. The analysis was conducted by JMT and MMU using NVivo version 1.7.1 (QRS International). An inductive thematic analysis was performed, in which codes and themes were generated directly from the data without pre-defined categories, allowing the patterns of meaning to emerge from participants’ perspectives. The analysis followed the six-phase approach described by Braun and Clarke [ 45 ]: (1) familiarisation with the data; (2) generation of initial codes, (3) searching for themes; (4) reviewing themes; (5) defining and naming themes; and (6) producing the report [ 45 ]. To enhance reflexivity and credibility, the coding process was conducted independently by two researchers, and emerging codes and themes were compared and discussed until consensus was reached. Ongoing analytic discussions withing the research team supported reflexive engagement with the data. A descriptive count of their occurrence was also conducted to provide contextual information about the prevalence of identified patterns, in line with qualitative reporting guidance [ 46 ]. Results Description of study participants A total of 119 user profiles were registered in the iSupport-Sp. The sample predominantly consisted of females (84.9%). In terms of age distribution, 32.8% of participants were between 50 and 60 years old, followed by 26.1% aged 40 to 50 years. Most participants were highly educated, with 54.6% having completed professional or university training/degree. Additionally, 90.8% reported frequent use of technology, including computers, tablets, smartphones or the internet. Regarding geographical distribution, 58.8% resided in municipalities with over 30,000 inhabitants or provincial capital, 27.7% in small rural municipalities (fewer than 5,000 inhabitants), and 13.4% in large rural municipalities (regions between 5,000 and 30,000 inhabitants). Caregiver roles revealed that 58.8% were family caregivers, followed by 31.1% healthcare professionals and 10.1% friends or other close relatives. This indicates that 68.9% were informal caregivers, while 31.1% were formal caregivers. The duration of caregiving varied, with 46.2% providing care for less than one year, 26.1% for one to three years, and 27.7% for more than three years. Dementia knowledge was assessed in 91 participants (76.5%) using the DKAT2-Sp questionnaire, yielding a mean score of 15.43 (SD = 2.94). The Zarit Caregiver Burden Interview was completed by 82 participants (68.9%) with a median score of 37.07 (SD = 14.04). Due to the limited sample size, statistical comparisons between rural and urban caregivers regarding changes in dementia knowledge and caregiver burden were not conducted. Completed and non-completed profiles The mean completion level of the platform content was below 35% ( m = 33.95; SD = 43.33). Of the 119 registered profiles, 33 participants (27.7%) completed the entire programme, while 59 (49.6%) completed 3.33% or less of the content (equivalent to no more than one module), including 27.7% who only registered but did not engage with the material. Among those who completed the course, 81.8% were female, 54.5% resided in rural areas, and the age distribution was relatively even between 30 and 60 years. Additionally, 66.7% identified as informal caregivers, with 60.6% having less than one year of caregiving experience. Regarding education, 48.5% completed university or vocational training, followed by 21.2% with a high school education. The mean time spent completing the course was 10.27 h (SD = 8.01), with a median of 6.89 h. For participants who did not complete the programme, similar distributions were observed by gender (86% female), caregiving type (69.8% informal caregivers), and education level (57% university or vocational training). However, a higher proportion were urban residents (64%), had more than three years of caregiving experience (31.4%), and were aged 50 to 60 years (36%). No statistically significant differences were found between those who completed and did not complete the course across these variables (see Table 1 ). Table 1. Sociodemographic description of caregivers who completed and did not complete the programme Sociodemographics Completed the programme (n=33) Did not complete the programme (n=86) (p value) Gender: 0.33 (p = 0.56) Male 6 (18.2%) 12 (14.0%) Female 27 (81.8%) 74 (86.0%) Residence: 3.37 (p = 0.07) Urban 15 (45,5%) 55 (64.0%) Rural 18 (54.5%) 31 (36.0%) Age range: 8.00 (p = 0.09) < 30 years 7 (21.2%) 13 (15.1%) 30 - 40 years 9 (27.3%) 11 (12.8%) 40 - 50 years 9 (27.3%) 22 (25.6%) 50 – 60 years 8 (24.2%) 31 (36.0%) 60 – 75 years 0 (0.0%) 9 (10.5%) Type of caregiver: 0.11 (p = 0.74) Informal 22 (66.7%) 60 (69.8%) Formal 11 (33.3) 26 (30.2%) Time as caregiver: 3.96 (p = 0.14) < 1 year 20 (60.6%) 35 (40.7%) 1 – 3 years 7 (21.2%) 24 (27.9%) > 3 or more years 6 (18.2%) 27 (31.4%) Education:* 0.72 (p = 0.72) No education 2 (6.1%) 4 (4.7%) Incomplete elementary school 0 (0.0%) 1 (1.2%) Complete elementary school 1 (3.0%) 4 (4.7%) Complete high school 2 (6.1%) 1 (1.2%) Incomplete high school 7 (21.2%) 18 (20.9%) Incomplete vocational training or university 5 (15.2%) 9 (10.5%) Complete vocational training or university 16 (48.5%) 49 (57.0%) Use of technology: 2.10 (p = 0.15) Sometimes 1 (3.0%) 10 (11.6%) Often 32 (97.0%) 76 (88.4%) Open in a new tab *Education level corresponds to the Spanish education system At baseline (T0), self-perceived caregiver burden was lower among those who completed the programme ( n = 33; m = 34.30; SD = 14.79) compared to those who did not but completed the Zarit Caregiver Burden Interview ( n = 49; m = 38.4; SD = 13.34). Dementia knowledge scores were similar between completers ( n = 33; m = 15.30; SD = 3.32) and not completers who responded to the DKAT2-Sp ( n = 49; m = 15.50; SD = 2.73). Pre- and post- test scores of caregiver burden and dementia knowledge Within the subgroup of participants who completed the training modules and lessons ( n = 33), dementia knowledge significantly improved from baseline to post-test (Wilcoxon signed-rank test, p = 0.002). In contrast, no statistically significant change was observed in caregiver burden (paired t-test, p = 0.386) (see Table 2 ). Table 2. Pre- and post-test scores among programme completers ( n = 33) Outcome T0 Median (Range) or Mean (SD) T1 Median (Range) or Mean (SD) Test p -value Dementia knowledge (DKAT2-Sp) M = 16 (3–20) M = 17 (13–21) Wilcoxon signed-rank test (W = -3.12) 0.002 Caregiver burden (Zarit) m = 34.30 (14.78) m = 33.88 (14.08) Paired t-test (t = 0.29) 0.386 Open in a new tab Note: Only participants with complete pre–post data were included. Normality was assessed using the Shapiro–Wilk test; non-parametric tests were applied when assumptions were violated. m = mean; M = median Usability The usability of iSupport-Sp was assessed using the CSUQ, completed by all 33 participants who finished the programme and six of the 86 who did not. For overall usability (Table 3 ), participants who completed the programme reported higher satisfaction (lower scores indicate greater satisfaction) with the platform ( M = 1.31) compared to non-completers ( M = 2.28) (Mann Whitney, U = 21.50, p = 0.002). Similar trends were observed across the three subscales: (a) System quality was rated higher by completers ( M = 1.17) than non-completers ( M = 2.42) (Mann Whitney, U = 25, p = 0.003); (b) Information quality received higher scores from those who completed the course ( M = 1.5) compared to non-completers ( M = 2.25) (Mann Whitney, U = 29.50, p = 0.006); and (c) Interface quality satisfaction was also greater among completers ( M = 1) than non-completers ( M = 2.78) (Mann Whitney, U = 23, p = 0.002). Table 3. CSUQ Scale and Subscales scores of caregivers who completed and did not complete the programme Scales and Overall Completed the programme ( n = 33) Median Did not complete the programme ( n = 6) Median U ( p value) System Quality (Items 1–6) 1.17 2.42 25.00 ( p = 0.003) Information Quality (Items 7–12) 1.50 2.25 29.50 ( p = 0.006) Interface Quality (Items 13–15) 1.00 2.78 23.00 ( p = 0.002) Overall (Items 1–16) 1.31 2.28 21.50 ( p = 0 0.002) Open in a new tab Note: Lower scores correspond to higher degrees of satisfaction User experience User experience was analysed using an inductive thematic analysis of data from a self-administered open-ended online questionnaire in the platform. Results are presented for the 33 participants who completed the programme. Additionally, three of the 86 non-completers answered three interview questions, and their responses are also included in this section. To differentiate between groups, “C” denotes caregivers who completed the course, while “CN” refers to those who did not. For caregivers who completed the programme (C), brief descriptors (e.g., rural/urban and caregiver type) are provided; this information could not be specified for non-completers (CN) due to anonymous data collection. The final themes are summarised in Additional File 2 , including the number of coding references for each theme and subtheme. Additional File 2 provides an overview of key ideas expressed by participants. Representative quotes are included to illustrate their perspectives. Acceptability (perceived usefulness, recommended use) All 33 participants who completed the programme found the platform useful. In the category of perceived usefulness, the most frequently mentioned aspects were related to the knowledge gained, which facilitated a better understanding of dementia. For example: C3 (urban informal caregiver): “On this website you can learn a lot about these pathologies and how to face the challenge of caring for people with dementia”; C12 (urban informal caregiver): “… I have learned many new things to be able to handle different situations with users and relatives” . The platform was also valued for its role in resolving doubts and providing care solutions. As C4 (rural formal caregiver) expressed, “…for me the information has been a great help” , and C24 (rural formal caregiver) added, “…it is fantastic and we learn a lot , it helps us to solve many doubts” . Participants further emphasized the importance and applicability of the information provided. Specific responses included C15 (rural formal caregiver): “…provides useful tools to face certain situations ”, and C29 (rural informal caregiver): “…very useful information…”. Additionally, the positive experience led some participants to recommend the platform to others in similar situations. As C13 (urban informal caregiver) shared, “I have recommended it to people in a situation similar to mine”. Perceived usefulness was one of the categories with the highest number of coding references ( n = 40). User experience (accessibility, effectiveness, expectations, reliability, interaction, satisfaction) Participants expressed high satisfaction with the platform, describing their experience as positive, good or satisfactory. This category received the highest number of references within this topic. For example, C4 (rural formal caregiver) stated, “Positive experience and very helpful…” , C14 (rural informal caregiver) described it as “Fabulous” , C17 (rural informal caregiver) remarked, “Yes , it was great” , and C19 (rural informal caregiver) simply stated, “Very good” . Notably, none of the participants reported a negative experience. All participants also indicated that their expectations were met. Specific responses included C13 (urban informal caregiver): “Expectations have been met and exceeded” , C20 (rural informal caregiver): “Yes , it has really helped me a lot” , and C32 (rural informal caregiver): “…Yes , expectations have been met” . Accessibility and interaction were also highlighted as key strengths. As C6 (urban formal caregiver) noted, the platform was “accessible , understandable and informative” , while C2 (rural informal caregiver) shared, “…I felt very comfortable , and I think it will be great to be able to use it together with other caregivers and family members” . Although other categories received fewer comments, reliability was briefly mentioned. For instance, C2 (rural informal caregiver) stated, “…it has never given me any problems” . User interface (design, structure of the information, intuitiveness, navigation, simplicity, visually appealing) Regarding the user interface, participants’ comments primarily focused on design. Overall, the website was considered well-designed, with remarks such as C4 (rural formal caregiver): “It is very well designed” , C22 (rural informal caregiver): “…it is very well done” , and C30 (rural formal caregiver): “A well thought out and worked design” . However, one participant (C28, urban informal caregiver) expressed a contrasting view, stating, “Design a bit basic” . Some participants also found the interface visually appealing. For example, C2 (rural informal caregiver) remarked, “I really liked the website” , while C15 (rural formal caregiver) appreciated that “…the colours on the screen do not hurt the eyes” . Conversely, C26 (urban informal caregiver) noted, " I did not find it too attractive…” . Simplicity and intuitiveness were also highlighted as positive aspects. Comment included C13 (urban informal caregiver): “…simple and agile design” , C23 (urban formal caregiver): “…intuitive design and complete contents” , and C9 (rural informal caregiver): “…intuitive and with simple language” . Regarding website navigation, C2 (rural informal caregiver) specifically mentioned, “The ease of finding the modules and accessing from one to another from the internal pages” . Usability (learning, user control, ease of use, technical problems) Participants found iSupport-Sp easy to learn, with most requiring minimal time to understand its functionality – ranging from a few hours to one day. For example, C13 (urban informal caregiver) stated, " Learning was instantaneous because it is very easy to use” , C15 (rural formal caregiver) noted, " I learned in just one day” , and C28 (urban informal caregiver) echoed, “…learning how to use it in just one day” . However, one participant (C24, rural formal caregiver) reported a different experience, stating, “…it took quite a long time , until I could see how everything worked” . The platform was also perceived as easy to use. Comments included C18 (urban informal caregiver): “Quite practical and easy to use” , C25 (urban formal caregiver): “…easy to understand and use” , and C33: “Within the reach of people with no computer knowledge” . Despite the positive feedback, some participants who completed the programme highlighted technical issues related to audio and video quality. For instance, C4 (rural formal caregiver) mentioned, “…the quality of the audio in some slides is not very clear” , while C28 (urban informal caregiver) noted, “…the sound in general needs to be improved , the audio of the videos is very bad , as well as the audio of the text” . Additionally, non-completers reported difficulties with saving responses and through lessons. CN1 stated, “I did not like the fact that it did not record the answers well and I had to repeat it several times” , and CN2 mentioned, “I finished a topic and gave it to me as completed but then if I wanted to continue I had to do it again”. Content (interesting, realistic, understandable, useful, clarity, suitable, structured, complete) Most participants considered the content of the iSupport-Sp lessons and modules to be comprehensive, well structured, and easy to understand. Representative comments included C2 (rural informal caregiver): “…I found it very complete and easy to understand” , C12 (urban informal caregiver): “It is very well structured” , C4 (rural formal caregiver): “The content is clear and very helpful” , C16 (urban formal caregiver): “…gives information clearly and dynamically” , C13 (urban informal caregiver): “A lot of training with explanations and examples that are easy to understand…” , C19 (rural informal caregiver): “Very easy to understand” , and C22 (rural informal caregiver): “…it is very well understood and everything is very well explained…” . Participants also found the content engaging, appropriate, and realistic. C3 (urban informal caregiver) stated, “I find the website very interesting” , C26 (urban informal caregiver) remarked, “…in general I found the website interesting and very realistic” , C1(urban informal caregiver) described it as “Adequate” , and C13 (urban informal caregiver) noted, “…the topics are presented in a very coherent way…” . A similar perception was reported by caregivers who did not complete the programme, with CN1 stating, “Very interesting” , and CN2 agreeing, “The content has been very interesting”. The most valuable and useful platform features were the exercises, questionnaires, and practical examples. C4 (rural formal caregiver) highlighted, " most valuable the exercises with day-to-day situations and the possible options there are to solve them” , C6 (urban formal caregiver) noted, “…the examples and the knowledge application questions” , and C15 (rural formal caregiver) emphasised, “The examples contain practical situations that help to identify all possible solutions” . Similar feedback was provided by non-completers, with CN2 stating, “What I liked the most: the relaxation exercises and how to manage both my emotions and those of the user” , and CN3 noting, “the examples are very realistic”. Both platform usability and the practical tips provided in the programme content were positively rated. C28 (urban informal caregiver) commented, “…very effective tips” , referring to the practical guidance included in the programme, while C31 (rural formal caregiver) highlighted, “…the ease of use of the website” , reflecting the platform’s usability. Preferences (positive, negative) Regarding the most positive features of the iSupport-Sp, many participants expressed that they liked everything about the platform. For example, C7 (rural informal caregiver) stated, “There is nothing I did not like” , C20 (rural informal caregiver) mentioned, “…I liked everything , and I found it easy” , and C29 (rural informal caregiver) noted, “…I liked everything , I think everything is interesting” . However, they particularly preferred the content, examples, and exercises/questionnaires. For instance, regarding the content, C1 (urban informal caregiver) commented, “In general , I liked the content and the way it was presented” , C7 (rural informal caregiver) highlighted, “…what I liked most , the ease and clarity of the contents” , and C21 (urban informal caregiver) said, “What I liked most was all the content , which is very didactic” . As for the exercises and questionnaires, C28 (urban informal caregiver) stated, “… I liked the exercises intertwined with the theory” , and C4 (rural formal caregiver) noted, “What I liked most are the exercises with their possible options. They are situations that can happen to us” . For the examples provided in iSupport-Sp, C15 (rural formal caregiver) remarked, “What I most appreciated are the examples…” , C33 (urban formal caregiver) mentioned, “…I liked the number of practical examples” . On the other hand, participants identified the audio quality of the videos and text as the least favorable feature, particularly noting that the audio was difficult to hear. C8 (rural informal caregiver) commented, “…the videos were the least liked because they could not be understood very well” , C13 (urban informal caregiver) said, “the only thing that is not quite right is the audio in the videos , the words can be understood but they cannot be heard as well as they should” , and C16 (urban formal caregiver) noted, “I did not like the videos because they sounded very bad” . The length of the course and repetitive information were also mentioned by both completers and non-completers. For example, C11 (urban informal caregiver) said, “It is a bit long…” , C23 (urban formal caregiver) commented, “Maybe doing it can become tiresome for caregivers because of its length” , and C31 (rural formal caregiver) remarked, “The content is a bit repetitive at times” . Non-completers also reported issues with repetition: CN2 noted, “The thing I liked the least: I had to repeat many topics and it did not allow me to continue with the course” . Benefits Participants highlighted the knowledge gained and its usefulness as key benefits of the platform. For example, C4 (rural formal caregiver) noted, “You learn to understand the disease” , C8 (rural informal caregiver) mentioned, “You learn quickly how to act with the people you care for” , and C13 (urban informal caregiver) stated, “The information and advice to cope with dementia in our relatives” . They also emphasized the support provided in caregiving. C11 (urban informal caregiver) remarked, “It helps with caregiving” , and C18 (urban informal caregiver) shared, “It has helped me quite a lot… to face some situations with my relative with Alzheimer’s problems” . The usefulness and ease of use were again highlighted as beneficial. C20 (rural informal caregiver) commented, “I see it as very useful for people who are starting to learn about this disease by caring for someone in this situation” , C30 (rural formal caregiver) mentioned, “A useful way to remember techniques for the care of this type of patient…” , C25 (urban formal caregiver) said, “…easy to understand and use…” , and C9 (rural informal caregiver) noted, “…easy to use” . Inconveniences and disadvantages Most of the participants reported no disadvantages, with several stating: C8 (rural informal caregiver), " Sincerely none” , C10 (rural informal caregiver), “No disadvantages…” , and C15 (rural formal caregiver), " I don’t see any disadvantages” . However, some inconveniences were mentioned, notably related to the sound quality of the videos and audios. C4 (rural formal caregiver) stated, “…the audios were not good on some slides” , and C32 (rural informal caregiver) noted, “…the videos sounded very bad” . Accessibility issues were also raised, including C18 (urban informal caregiver) comment, “…it is not adapted for tablets” , and C29 (rural informal caregiver) remark, “…for people who are not computer literate is a barrier and places where internet coverage is null are also limited…the videos sound very bad” . Another concern was the volume of content. C21 (urban informal caregiver) remarked, “Many lessons (content)” . Suggestions and remarks Suggestions for making the website more user-friendly aligned with the drawbacks mentioned earlier. Most participants had no suggestions, as expressed by C1 (urban informal caregiver): “…I have no suggestions” , C8 (rural informal caregiver): " The way it is , is perfect” , and C13 (urban informal caregiver): “It is very easy to use. I wouldn’t change anything” . Some suggestions focused on accessibility, such as C20 (rural informal caregiver) recommendation: “…for those people who do not have ease with technology , more videos to make it easier to understand” , and C18 (urban informal caregiver) suggestion: “They should also adapt it for tablets” . Other suggestions addressed the audio quality, including C32 (rural informal caregiver) comment: “…I would revise the videos to make them easier to hear” . Regarding content, C12 (urban informal caregiver) suggested: “Simplify things that are repeated”; and C21 (urban informal caregiver) considered: “Reduce lessons (content) and group them” . One caregiver who did not complete the programme (CN1) suggested: “I think you need to improve the system to save answers and some videos that did not open well. For the rest I think it is a good tool”. Discussion This study examined the rural and urban caregivers’ perceptions of the iSupport-Sp, specifically its usability, user experience, and preliminary effectiveness in enhancing dementia knowledge and alleviating caregiver burden. Findings indicate positive feedback on acceptability, user experience, user interface and usability, although some technical constraints were highlighted. Participants reported high levels of perceived satisfaction at post-intervention and increased dementia knowledge after completing the programme, but no significant impact on caregiver burden. These results should be addressed carefully as more rigorous study methodologies must be implemented, including randomized controlled trials (RCTs). iSupport-Sp was developed to assist caregivers of PLwD in rural Spain [ 36 ]. This study aimed to explore how rural dementia caregivers perceive iSupport-Sp and to identify potential differences in perceptions between rural and urban caregivers, given the well-documented inequities in access to dementia care. However, the sample size was insufficient to detect significant differences between these groups. Despite this limitation, we believe the study contributes to the limited scientific literature on delivering dementia care through technology to rural populations. In this regard, several assumptions warrant discussion. Major obstacles to delivering dementia care in rural regions include geographical accessibility, distance to urban services [ 28 ], limited resources, healthcare workforce shortages, and insufficient training [ 2 , 8 ]. Additionally, inadequate infrastructure – such as limited internet access and low digital literacy [ 12 , 14 , 47 ] – which further restricts healthcare services and increases costs due to transportation [ 14 , 28 ]. Given these challenges, this study’s methodology aimed to maximise available community resources for both participant recruitment and the delivery of iSupport-Sp in rural areas. To achieve this, the research team collaborated with the Zamora Provincial Council (Diputación de Zamora) to reach rural dementia caregivers through the ‘Silver Companions’ project. The Silver Companions – professional caregivers hired by the Council to provide care to older adults in rural areas – were trained and instructed to share iSupport-Sp with informal caregivers of PLwD in their respective regions. While we cannot conclude that this effort directly influenced rural participant recruitment, the study successfully provided iSupport-Sp to 49 rural dementia caregivers. Rural participants comprised 41% of registered users on the platform and represented the majority of those who completed the programme. Although the results do not differentiate between urban and rural participants due to the sample size limitations, they offer initial insights into the use of iSupport-Sp among dementia caregivers living in remote rural areas, contributing to the limited evidence on technology-based interventions for these populations [ 16 ]. One key finding is that iSupport-Sp appears to be a feasible web-based intervention for supporting dementia caregivers, including those living in rural settings, with respect to dementia knowledge. This positive effect aligns with previous findings [ 48 ], highlighting the potential for knowledge transfer to improve caregivers’ capacity on understanding PLwD behaviours and reduce self-blame, improving outcomes such as goal-setting, mastery, and self-efficacy [ 17 ]. Other reported benefits of iSupport, though not addressed in this study, include anxiety reduction, improved caregiver quality of life [ 49 ], mental health-related quality of life, self-efficacy in controlling upsetting thoughts and lower distress reactions to changed behaviours of PLwD [ 50 ]. However, consistent with prior iSupport studies [ 31 , 49 ] and meta-analyses [ 51 , 52 ], no significant effects on caregiver burden were observed. Additionally, a recent RCT showed null findings regarding the effectiveness of iSupport in reducing distress and depression in dementia caregivers [ 53 ]. It is important to note that most participants were highly educated and digitally literate, raising concerns about representativeness, as similar samples have been targeted in studies from Portugal and India [ 31 , 49 ]. The exclusion of less educated and digital illiterate participants could be a limitation of web-based interventions and may be linked to the association between education and internet use [ 49 ]. Despite the advantages of web-based interventions – such as increased coverage and the ability to overcome geographical and transportation barriers [ 15 , 16 ] – high attrition rates remain a challenge. In our study, the overall attrition rate was 44.6%, with 63% of rural participants failing to complete the programme. High dropout rates are consistently reported in web-based interventions, ranging from 18.4% to 62% [ 17 , 25 ]. Previous iSupport studies have documented dropout rates between 14.3% and 63.56% [ 31 , 49 , 50 , 53 ]. While reasons for dropout are often unreported [ 25 ], contributing factors may include interventions not fully addressing caregivers’ needs, lack of time or energy, perceived lack of usefulness, caregiver health decline, or nursing home placement of the PLwD [ 17 ]. These high attrition levels are concerning, as research suggests that withdrawal often occurs before the intervention can effectively address its target outcome [ 25 ]. We aimed to investigate the reasons for dropout from iSupport-Sp; however, response rates were very low, with only 3 out of 86 completing the questionnaire. Unlike Teles, Ferreira, et al. [ 49 ], we did not find statistically significant differences between dropouts and those who completed the programme. One possible reason for the high dropout rate is the absence of follow-up messages regarding participants’ progress. Our intention was to simulate a “real-life” engagement scenario, where caregivers were not prompted to continue, particularly to explore how rural participants engaged with the platform in the absence of formal care reminders. In contrast, Teles, Ferreira, et al. [ 49 ] found that weekly email reminders helped reduce attrition by encouraging participation. The frequency of reminders in their study may explain differences in dropout rates among iSupport-Portugal, iSupport-Sp, and the iSupport study in India. To the best of our knowledge, iSupport web-based versions do not include human contact features. To enhance engagement, future versions of iSupport – particularly iSupport-Sp – should consider incorporating elements such as supportive listening, peer support, and online guidance. These features could be enabled through social media, discussion forums and blogs [ 54 ]. Even minimal contact, such as troubleshooting assistance or answering user questions, has been associated with lower dropout rates; interventions lacking human interaction have shown dropout rates as high as 39.6% [ 25 ]. Additionally, interaction with healthcare professionals and peer support during self-help web-based interventions have been shown to improve outcomes related to stress, burden, and retention rates [ 31 , 55 ]. Notably, an RCT incorporating iSupport as part of a multicomponent programme – along with online carer support groups and access to need-based information and services – demonstrated the most prominent results associated with iSupport [ 50 ], until now. Dropout rates may also be influenced by the inclusion of interactive features and personalised strategies for different dementia types and stages [ 25 ]. However, tailoring these interventions is challenging due to the diverse needs of caregivers and their care recipients [ 25 ]. Web-based training and support programmes should be designed as flexible resources that caregivers can access as needed, rather than rigid, time-limited interventions. This flexibility could help assess effectiveness at various stages of the caregiving journey. While iSupport provides general content, efforts have been made to develop additional modules and adapt it for different populations [ 37 ]. This study is the first to explore its use in rural settings. Incorporating content tailored to specific caregiving populations (e.g., rural or young caregivers) and caregiving stages, along with human contact features, could improve retention, usability, and caregiver health outcomes. Automated assessments of caregivers’ profiles could further personalise content, and integrating new technologies like artificial intelligence could enhance this process. Both rural and urban caregivers generally found iSupport-Sp useful and reported high satisfaction with the platform. However, those who dropped out reported lower satisfaction, possibly due to technical issues such as saving progress or having to repeat lessons. iSupport-Sp currently lacks instructions or support for troubleshooting, which may impact retention and limit assistance for users facing technical problems. Including tutorials and step-by-step guidance could improve technology adoption and retention rates [ 24 ]. Additionally, increased promotion and awareness campaigns among caregivers and healthcare professionals could expand their reach and utilization. Moving forward, iSupport-Sp should focus on: (a) resolving identified technical issues, such as audio quality in slides and videos; (b) reducing course length and minimising repetitive content; (c) ensuring accessibility on devices like tablets and smartphones; (d) adding optional modules for different dementia caregivers, types and stages; (e) incorporating human contact features and progress reminders; (f) conducting RCTs to evaluate its effectiveness in rural populations and its impact on key health outcomes (e.g. quality of life, depression, dementia knowledge, anxiety, self-efficacy); and (g) integrating iSupport-Sp into the Spanish healthcare system and dementia associations, given its potential benefits for dementia knowledge and rural populations. Our findings suggest that dementia caregivers in rural areas accepted and used iSupport-Sp with high satisfaction, viewing it as a valuable alternative when no other support options were available. Of course, providing psychoeducation face to face is more effective and offers additional benefits, however many caregivers lack access to in-person programmes. For them, iSupport – specifically iSupport-Sp – represents an important opportunity to access useful information for providing better care and avoiding or reducing the risk of overburden and mental health issues. Strengths, limitations, and further research The main strength of this study lies in its methodology and sample. As previously discussed, we aimed to simulate a “real-life” engagement with the platform, allowing us to identify key factors affecting retention rates and technical challenges. While more structured approaches could potentially increase retention, they might also obscure the engagement difficulties we observed. The inclusion of a significant proportion of rural participants suggests that iSupport-Sp may be a valuable tool for these populations. However, the study also has limitations. We were unable to compare results between groups, such rural and urban populations or formal and informal caregivers. Future research should focus on identifying the specific characteristics of caregivers who benefit most from web-based training and support programmes. Due to small sample size, we could not effectively characterize these caregiver profiles. Certain caregiver profiles were underrepresented, leading to a biased sample. Most participants were highly educated, digitally literate, and had limited caregiving experience (with most having less than one year of experience). Future studies should ensure a more diverse sample and consider additional relevant variables, such as attitudes toward web-based platforms, caregiver relationship to the PLwD (e.g., spouse, daughter), type of dementia diagnosis, level of care recipient dependence, and availability of social support. The reported benefits of iSupport-Sp should be interpreted with caution. More robust methodologies, such as RCTs, are needed to determine its effectiveness. Additionally, larger sample sizes would allow for meaningful comparisons between groups and conditions, leading to statistically significant results. Future studies should also incorporate additional outcomes, such as depression, anxiety, quality of life, and self-efficacy, to provide a more comprehensive assessment of iSupport-Sp’s impact. Conclusions This study examined the usability, user experience, and preliminary effectiveness of iSupport-Sp, a web-based training and support programme for caregivers of people living with dementia, including those in rural and urban areas. The findings suggest that iSupport-Sp is a feasible and acceptable digital intervention, with positive feedback on usability and user experience from both rural and urban caregivers. Improvements were observed in dementia knowledge after programme completion. Technical challenges related to platform accessibility and multimedia quality, as well as the absence of direct human contact, were considered as areas for improvement. Considering the pilot nature of this study, the small sample sizes, and high attrition rates, results should be interpreted with caution. Future research using more rigorous study designs, such as RCTs, is needed to further evaluate the effectiveness and implementation of iSupport-Sp, particularly in undeserved rural settings. Supplementary Information Below is the link to the electronic supplementary material. Supplementary Material 1 (215.3KB, pdf) Acknowledgements Special thanks are due to AFA Zamora, INTRAS Foundation, CREA Imserso Salamanca, Diputación de Zamora, BLUE Connecting Emotions S.L., Cluster SIVI, and the residents and caregivers of the rural towns from Castilla y León who were engaged with this study. Abbreviations CSUQ Computer System Usability Questionnaire DKAT2-Sp Dementia Knowledge Assessment Tool 2. Spanish version PLwD People Living with Dementia RCT Randomised Controlled Trial WHO World Health Organization Author contributions MMU, the executive researcher of the project wrote the first draft of the manuscript. MMU, MFM, and JMTG substantially contributed to the conception of the study, the study design and the acquisition, analysis, and interpretation of data. MAP substantially contributed to the quantitative analysis. AB contributed to the development, improvement and troubleshooting of the iSupport web-based platform. MMU, HGvdR and MFM substantially contributed to writing the final draft of the manuscript. All authors contributed to the final revised version of the manuscript, approved the submitted version that involved the author’s contribution to the study and agreed on both to be personally accountable for the author’s own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Funding This work was supported by the European Union’s Horizon 2020, as part of the Marie Skłodowska Curie Actions - Innovative Training Network, H2020-MSCA-ITN [under grant agreement number 813196]; and the Spanish Ministry of Science and Innovation under the PeaceOfMind project [ref. PID2019- 105470RB-C31]. Data availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of the Zamora Healthcare Complex (reference 583). The study was conducted in accordance with the guidelines of the Declaration of Helsinki. Declarations of generative AI and AI-assisted technologies in the writing process During the preparation of this manuscript, the authors used ChatGPT (GPT-5.2 model) [56] to improve the readability and language of the document and to support the translation of the abstract. After using this tool, the authors reviewed and edited the content as necessary and take full responsibility for the content of the publication. Consent for publication Online informed consent to participate was obtained from all the participants in the study. Competing interests The authors declare no competing interests. Footnotes Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 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[ DOI ] [ PubMed ] Supplementary Materials Supplementary Material 1 (215.3KB, pdf) Data Availability Statement The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. 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