Open Online Courses for Informal Carers: Systematic Integrative Review.

Background: Informal carers, people providing unpaid support to relatives or close others with an illness, disability, or advanced age-related care needs, are key stakeholders in health care systems. Carers have their own health and well-being challenges; however, their needs and care pathways are often overlooked by health care providers. Open online courses offer opportunities to address the information and support needs of large numbers of carers. However, our collective understanding of the design and outcomes of courses and learner experiences is limited. Objective: This systematic integrative review aimed to map the characteristics of open online courses for informal carers, explore learner experiences, and identify barriers and enablers to participation to inform the design of future courses. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we systematically searched 4 electronic databases (APA PsycINFO, CINAHL, EMBASE, and MEDLINE) for papers published from inception to January 30, 2025. Included papers were peer-reviewed, in the English language, and reported on the development, delivery, or outcomes of open online courses for informal carers aged more than 16 years. Excluded papers had no carer focus or were conference abstracts. Two reviewers independently screened titles and abstracts for eligibility. Backward and forward citation searches were conducted. Due to study heterogeneity, data on paper methodology, course characteristics, and course evaluations were extracted and synthesized narratively. Quality assessments of quantitative papers and the quantitative components of mixed methods papers used the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Qualitative components within mixed methods papers were appraised using the Critical Appraisal Skills Program (CASP) toolkit. Results: Searches identified 201 papers, of which 10 (6 quantitative and 4 mixed methods) met the inclusion criteria. No qualitative papers were identified. All included courses were massive open online courses. Sample sizes ranged from 3 to 17,591 participants, primarily targeting carers of older individuals (n=4). Completion rates ranged from 42% to 67% (n=5). Five papers reported improved carer knowledge and application of skills. Key enablers to learning included course accessibility and flexibility. Key barriers to learning included limited peer interaction, technical difficulties, time constraints, language challenges, and online privacy challenges. Most papers were of weak quality, except for 1 strong quantitative RCT. Conclusions: The evidence was limited by moderate-to-weak study quality, inconsistent measures, and exclusion of gray literature. Despite these limitations, findings suggest that open online courses may improve carers' knowledge and skills and enable accessible, flexible learning. However, barriers to learning, including limited learner-to-learner interaction within and external to the course, time constraints, and digital or language barriers, highlight the need for more inclusive and interactive course designs. Further high-quality research is needed to standardize outcomes.