Search

Background: Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). Methods: This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. Discussion: This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed. [ABSTRACT FROM AUTHOR]

Objectives Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. Methods Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March and July 2022. Data were translated into English and thematically analyzed. Results Family carers and providers unanimously agreed that people with dementia should be respected and cared for. Concurrently, they perceived people with dementia as being "like a kid" and used the analogy of a parent–child relationship to understand their care responsibilities. This analogy informed how ethical principles such as personhood and equality were reframed in the relationships between family carers and people with dementia, as well as how carers and providers maintained the safety but undermined the autonomy of people with dementia through restricting their movements inside and outside the home. Discussion There can be relational solidarity in dementia care at home in urban India but also contradictions in the interpretations and applications of the ethical principles of autonomy, equality, dignity, and personhood. As such, a more organic, grassroots model of ethical practice is needed to frame care and provide material support to families in India. [ABSTRACT FROM AUTHOR]

Objectives: In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long‐term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India. Methods: We conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers for people with dementia and 25 professionals, collected in 2022, exploring attitudes to LTC; and (b) The Longitudinal Ageing Study in India (LASI) 2017–2018, cross‐sectional survey of a randomised probability sample of Indian adults aged 45+ living in private households. Results: We identified three themes from qualitative data: (1) LTC as a last resort, describes how LTC could be acceptable if care at home was "impossible" due to the person's medical condition or unavailability of the family carer, for example, if family members lived overseas or interstate. (2) Social expectations of care at home from family members and paid carers and; (3) Limited availability of LTC facilities in India, especially in rural localities, and the financial barriers to their use. Of 73,396 LASI participants, 40 were considering moving to LTC; 18,281 had a parent alive, of whom 9 reported that their father, and 16 that their mother, lived in LTC. LTC use was rare. While a third of participants with a living parent lived in urban areas, 14/24 of those with a parent in LTC lived in an urban area, supporting our qualitative findings that LTC is mainly accessed in urban areas. Conclusions: Preference for intergenerational community care combined with limited availability and societal stigma contribute to low rates of LTC use among Indian families. Future social policies should consider how to plan for greater equity in strengthening care at home and in the community, and bolstering respite and LTC services as a last resort. Key points: In India, the demand for long‐term care (LTC) facilities is low, with only a small number of people residing or considering residing in one. Most people prefer intergenerational community care at home.Contrary to the population as a while, more people who had a parent living in LTC were residing in urban versus rural areas; in qualitative interviews, family carers and healthcare professionals of people with dementia reported having less access to LTC in rural areas, which may be linked to increased financial challenges and limited resources for more specialised care.Given the strong preference for care at home over LTC, initiatives are needed to increase community resources for family carers of older adults with unrecognised and undiagnosed conditions such as dementia. Additionally, there should be improved access to LTC for those with fewer financial resources. [ABSTRACT FROM AUTHOR]

Introduction: Social workers constitute a significant task force that serves diverse populations experiencing psychosocial challenges in their daily lives. Lack of suicide prevention content/training in the Master of Social Work program may affect the student's self-esteem/ability to intervene when they come across a person with suicidality in the field. Developing a suicide prevention training module for social work students would be a suitable measure for upbringing their skills in dealing with individuals with suicidality. Method: The purpose of the present study was to develop a suicide prevention training module for social work students at the postgraduate level. The researcher conducted two Focused Group Discussions (FGD) each with social work students (n = 13) and social work educators (n = 15) on an online platform. Notes were taken during the discussion, and the contents were videotaped. The videotaped content was transcribed, and content analysis was used to analyze the data. The content that emerged from the FGD with social work students and educators was discussed in later FGD with mental health experts (two psychiatrists, one psychologist, two psychiatric social workers, and two mental health nurses). The discussion with experts clarified what components to retain for the training program. Results: Five major themes and 22 sub-themes emerged from the two FGDs each with students and educators, and one FGD with mental health professionals are described. The five major themes were understanding of suicidality, understanding suicide education in the master of social work curriculum, experience with suicidality, training content suggestion, and suggestions for future implications. Conclusions: The present study identified the need for suicide prevention training in postgraduate-level social work students. Furthermore, a lack of suicide prevention training was observed indicating the incorporation of suicide education in the postgraduate curriculum. [ABSTRACT FROM AUTHOR]

Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap, this study aims to use digital media, which has had a massive technological uptake in India, to improve dementia care in India. Objective: The objective of this paper is to describe an intervention study design that examines the feasibility and acceptability of Moving Pictures India, a digital media resource to improve dementia care in India. Methods: This study employs a mixed methods design and is divided into 4 phases: (1) video interviews with Indian caregivers and health professionals; (2) coproduction of resources; (3) pilot randomized controlled trial (RCT); and (4) dissemination and analytics. The pilot RCT will follow an experimental parallel group design with 2 arms aiming to assess the impact, feasibility, and acceptability of the developed resources. The primary outcome measures for the pilot RCT will be feasibility and acceptability, while the secondary outcome measures will be caregiver burden, mood, and quality of life. Results: This study received funding from the Alzheimer's Association in the United States in July 2021. In 2023, we will enroll 60 dementia caregivers (40 caregivers in the intervention arm and 20 in the control) for the pilot RCT. The study has been approved by the National Institute of Mental Health and Neuro Sciences Ethics Committee (26th IEC (BEH.SC.DIV.)/2020-21 dated November 11, 2020); the Health Ministry's Screening Committee, India (proposal ID 2020-10137); the Curtin University Human Research Ethics Committee (approval number HRE2020-0735); and the NARI Research Governance Office (site-specific approval dated March 17, 2021). Conclusions: This protocol is designed to deliver unique, coproduced, and evidence-based media resources to support caregivers of persons with dementia in India and other countries aiming to utilize digital media for dementia care. If the intervention is found feasible and acceptable, postpiloting analytics and qualitative feedback will be used to develop an implementation trial to evaluate the effectiveness of the potential low-risk high-benefit intervention in practice. [ABSTRACT FROM AUTHOR]

This article discusses a community-based public health initiative called "Stories against stigma: A walking tour of NIMHANS" conducted at the National Institute of Mental Health and Neurosciences in Bengaluru, India. The tour aimed to reduce stigma and discrimination towards persons with mental illness (PWMI) by providing in-person social contact and educational information. The study involved a baseline assessment of participants' attitudes and knowledge about mental illness before the tour, as well as a feedback form to assess the impact of the tour experience. The majority of participants reported a positive shift in their attitude towards mental health and appreciated the opportunity to address misconceptions about PWMI through direct interactions with professionals. The article suggests that walking tours like this could be organized at other mental health establishments to combat stigma and improve mental health literacy. [Extracted from the article]

Objectives: Internet‐based interventions involving elements of cognitive behavior therapy, psychoeducation, relaxation and skills training for caregivers of people with dementia have been found to be promising in Western countries. Given these outcomes, the adapted version of a multi‐component online caregiver skills training and support program of the World Health Organization, called iSupport, was tested for feasibility and preliminary effectiveness in India. Methods: One hundred fifty‐one caregivers of family members with a diagnosis of Alzheimer's disease or dementia were randomized to either the intervention arm (iSupport; n = 74) or to the control group (an education‐only e‐book program; n = 77). Participants were assessed using self‐rated measures of depression and perceived burden, which were the primary outcome measures, at baseline and 3‐month follow‐up. Person‐centered attitude, self‐efficacy, mastery and self‐rated health were also assessed. Results: Fifty‐five caregivers (29 in the iSupport group and 26 in the control condition) completed the study. The recruitment and retention rate of the study were 44.67% and 36.42% respectively. No significant differences were found between the two groups at 3‐month follow‐up on the primary outcomes. Among the secondary outcomes, significant improvement was only seen in caregivers' person‐centered attitude towards persons with dementia in the iSupport group (t = 2.228; p < 0.05). Conclusions: Despite efforts to recruit and retain participants to the online program, this study had a low recruitment and retention rate, which require closer attention and indicates a need for further adaptations of the Indian version of the iSupport program to improve its acceptability and accessibility. The lessons learned from this study will guide the further development of caregiver training and support interventions in India. The trial was registered with the Clinical Trials Registry‐India (Trial Registration No. CTRI/2017/02/007876). Key points: An online caregiver training and support program (iSupport) was tested for feasibility and preliminary effectiveness in IndiaFeasibility was measured in terms of recruitment rate and retention rate, both of which were low in the studyNo significant differences were found between the study and comparison group on the primary outcomesA significant improvement was seen in caregivers' person‐centered attitude in the iSupport groupThe findings indicate a need for further adaptations of the Indian version of the iSupport program to improve its acceptability and accessibility [ABSTRACT FROM AUTHOR]

There is a considerable need for support interventions for caregivers of people with dementia in developing countries, such as India. The purpose of the study was to identify the components and understand the acceptability of an online training and support program for dementia caregivers in India. Three focus group discussions were carried out with dementia caregivers (2) and health professionals (1) to understand the requirements of an online training and support program from their perspective. The commonly recurring themes were identified and defined using thematic content analysis. The expectations from an online training and support program were wide-ranging from information about identification and management of dementia to support caregiver well-being. Use of simple language, cultural relevance, and an interactive design were suggestions to facilitate the use of the support program. Lack of time, difficulty in accessing the internet, lack of awareness about the portal, difficulty in reaching the rural population were anticipated as challenges in using the program. The study highlights the requisite components of a first of its kind online training and support program in India by integrating the experiences, motivations, challenges, and expectations of caregivers and professionals involved in dementia care. The focus group discussions in the current study provide a road map for the development of an online caregiver training and support program underlying the perspectives of the stakeholders for the consolidation of an effective dementia care program for lower resourced settings. [ABSTRACT FROM AUTHOR]

The article informs about basic principles and techniques for family interventions in clinical practice guidelines. Topics discussed include integral in being part of the treatment and therapeutic process involving an individual with mental illness; salient features of broad principles for providing family interventions for the treating psychiatrist; and how to deal with the index person with the psychiatric illness.

Background: Poor awareness about mental health and illness is one of the causes for the large treatment gap for all mental disorders across India. Material: We used both qualitative and quantitative methods in devising a street play to enhance knowledge, attitudes and beliefs about mental illness. Discussion: The formative research enabled the intervention to remain culturally appropriate to the socio-cultural practices of the targeted rural audience. Conclusion: Targeted audiences need to be understood carefully for their beliefs and notions about mental health and sickness. Their socio-cultural practices need incorporation in street plays to make them relevant and meaningful. [ABSTRACT FROM AUTHOR]

Objectives The National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS. Design Multisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage. Setting Conducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology. Participants A total of 34 802 adults (>18 years) were interviewed. Main outcome measure Prevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0. Results The weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40-59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly twothirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD. Conclusion Around 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes. [ABSTRACT FROM AUTHOR]

Background: Despite the rapid proliferation of smartphones in low and middle‐income countries (LMICs), few studies have explored how to harness this technology to improve dementia care. Using a case‐study from India, where 830 million people are smartphone users, we describe the co‐design of a fully digitalised dementia care intervention for family carers in a resource‐poor setting. Method: Qualitative in‐depth video interviews were conducted in English, Hindi, and/or Kannada with 19 family carers and 25 health providers in Bangalore, India. Data were thematically analysed, then presented to 10 of the interview participants in a co‐design workshop, where they were asked to storyboard the data to form the basis of nine short films on dementia care. Result: Workshop participants developed storyboards for nine films: signs of dementia and the diagnostic process; first steps and treatment; managing difficult behaviours; working with doctors and going to hospital; managing pain; eating, nutrition, and dental care; managing hygiene and incontinence; later stages and palliative care; and self‐care for carers. A proposed film on care pathways was deemed too broad and discarded. Instead, carers wanted greater specificity on routine, sleep, and pleasant activities as well as legal and ethical issues in dementia care. Overall, 11 films were proposed. Carers used the parent‐child analogy to describe their relationship with the person with dementia, utilised various surveillance technologies to keep their relative safe, and expressed differing views about institutionalised care. These cultural nuances and systemic issues associated with care will be reflected in the films. Once produced, the films will be member checked with all interview participants and community members for cultural salience and relevance before progressing to a full digital trial to evaluate its impact on reducing carer burden and improving carer's mood and quality of life. Conclusion: The films will be available on a mobile‐optimised website, freely accessible, and bypass barriers of distance, being time‐poor, and semi‐literate. By co‐producing resources in country, this model is scalable, based on knowledge of local resources and burden of disease, and relevant to LMICs where substantive increases in dementia prevalence are anticipated to occur. [ABSTRACT FROM AUTHOR]

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014–15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015–16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015–16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries. [ABSTRACT FROM AUTHOR]

Objective: Multiple health problems among the elderly necessitate a comprehensive enquiry to detect problems early and also initiate treatment. We utilized available validated instruments to comprehensively identify older persons with neuro-psychiatric problems including dementia and comorbid medical ailments in the screening desk of the geriatric clinic. Materials and Methods: Individuals aged 60 years and above seeking outpatient care at NIMHANS during a 2-year period (October 2008-September 2010) participated. We used General Health Questionnaire (12-item), AD8, questions to identify psychoses and neurological problems and a checklist of common medical ailments. A probable clinical diagnosis was made at the end by medical personnel based on ICD-10. Results: A total of 5,260 individuals were screened and more than one-third (36.7%) were women. About 50% had psychological distress (⩾2 on GHQ-12), 20.1% had probable cognitive impairment (⩾2 on AD8) and about 17% had symptoms suggestive of psychoses (⩾1 on Psychoses screener). More than 65% had either a neurological or neurosurgical problems (⩾1 on Neurological screener) and headache was the commonest complaint. At probable diagnosis, more than 50% had a neurological problem and over 30% had psychiatric disorders. Of these the most common psychiatric illnesses were psychotic disorders (22.0%), mood disorders (21.4%) and dementia (14.4%). The most common medical comorbidity included hypertension (36.4%), visual impairment (31.8%) and joint pains (30.5%). Nearly 80% had one or more medical comorbidity in addition to psychiatric illness. The overall set of instruments took about 15-20 minutes. It systematically and comprehensively guided in evaluating the elderly for neuropsychiatric problems and hence was collated to constitute the Instruments for Comprehensive Evaluation of the Elderly (ICE-E). Conclusions: ICE-E was brief, easy to administer and improved decision making even by personnel from a non-medical background. The instrument aided in systematically detecting neuro-psychiatric problems among the elderly (including psychological distress and cognitive changes) and other medical comorbidities. [ABSTRACT FROM AUTHOR]

This study explores gender issues from a sociocultural perspective related to stigma among people suffering from schizophrenia in India. Stigma experiences were assessed by conducting semistructured interviews with 200 patients attending urban or rural psychiatry clinics. The resulting narratives were examined by thematic content analysis. Men with schizophrenia reported being unmarried, hid their illness in job applications and from others, and experienced ridicule and shame. They reported that their experience of stigma was most acute at their places of employment. Women reported experiences of stigma in relation to marriage, pregnancy, and childbirth. Both men and women revealed specific cultural myths about their illnesses and described how these had negatively affected their lives. Information gathered from this study can be useful to understand the needs of individuals who suffer from schizophrenia to improve the quality of their treatment, and plan culturally appropriate interventions to counter stigma and discrimination. [ABSTRACT FROM PUBLISHER]

Objective: It is important to understand stigma in India, given its varied culture and mixture of rural and urban populations. Information from western literature cannot be applied without considering the sociocultural differences. Aims: The research aimed to study the subjective experiences of stigma and discrimination undergone by people suffering from schizophrenia in rural and urban environments in India. Settings and Design: Patients were selected from the outpatient services of six adult psychiatric units of the National Institute of Mental Health and Neurosciences (NIMHANS), India, and from the six outreach centers located in rural areas. Materials and Method: Two hundred patients diagnosed with schizophrenia were selected from rural and urban areas. The experiences of stigma and discrimination were assessed using a semi-structured instrument. Statistical Techniques: Both quantitative and qualitative analyses were done. Results: Significant differences were seen between rural and urban respondents. Urban respondents felt the need to hide their illness and avoided illness histories in job applications, whereas rural respondents experienced more ridicule, shame, and discrimination. The narratives provide direct views of patients, supporting the key findings. Conclusion: Mental health programs and policies need to be sensitive to the consumers' needs and to organize services and to effectively decrease stigma and discrimination. [ABSTRACT FROM AUTHOR]

The article looks at the promotion of the health of children and adolescents based on the National Institute of Mental Health and Neuro Sciences model of life-skills education in India. It discusses the importance of training teachers as well as highlights the aspects relevant to the transition of teenagers and adolescents to being a youth. The implications of including a mental health literacy component on increasing awareness and promoting positive attitudes on mental illness is explored.

A letter to the editor is presented in response to the article "Postgraduate patients as simulated patients in psychiatric training: Role players and interviewers perceptions," by S. K. Chaturvedi and P. S. Chandra in the 2010 issue.

OBJECTIVES METHODS RESULTS CONCLUSIONS CLINICAL IMPLICATIONS Resources to support dementia carers from ethnically diverse families are limited. We explored carers’ and service providers’ views on adapting the World Health Organization’s iSupport Lite messages to meet their needs.Six online workshops were conducted with ethnically diverse family carers and service providers (n = 21) from nine linguistic groups across Australia. Recruitment was via convenience and snowball sampling from existing networks. Data were analyzed using thematic analysis.Participants reported that iSupport Lite over-emphasized support from family and friends and made help-seeking sound “too easy”. They wanted messages to dispel notions of carers as “superheroes”, demonstrate that caring and help-seeking is stressful and time-consuming, and that poor decision-making and relationship breakdown does occur. Feedback was incorporated to co-produce a revised suite of resources.Beyond language translation, cultural adaptation using co-design provided participants the opportunity to develop more culturally relevant care resources that meet their needs. These resources will be evaluated for clinical and cost-effectiveness in future research.By design, multilingual resources for carers must incorporate cultural needs to communicate support messages. If this intervention is effective, it could help to reduce dementia care disparities in ethnically diverse populations in Australia and globally. [ABSTRACT FROM AUTHOR]

Social contact refers to the facilitation of connection and interactions between people with and without mental health conditions. It can be achieved, for example, through people sharing their lived experience of mental health conditions, which is an effective strategy for stigma reduction. Meaningful involvement of people with lived experience (PWLE) in leading and co-leading anti-stigma interventions can/may promote autonomy and resilience. Our paper aimed to explore how PWLE have been involved in research and anti-stigma interventions to improve effective means of involving PWLE in stigma reduction activities in LMICs. A qualitative collective case study design was adopted. Case studies from four LMICs (China, Ethiopia, India and Nepal) are summarized, briefly reflecting on the background of the work, alongside anticipated and experienced challenges, strategies to overcome these, and recommendations for future work. We found that the involvement of PWLEs in stigma reduction is commonly a new concept in LMIC. Experienced and anticipated challenges were similar, such as identifying suitable persons to engage in the work and sustaining their involvement. Such an approach can be difficult because PWLE might be apprehensive about the negative consequences of disclosure. In many case studies, we found that long-standing professional connectedness, continued encouragement, information sharing, debriefing and support helped the participants' involvement. We recommend that confidentiality of the individual, cultural norms and family concerns be prioritized and respected during the implementation. Taking into account socio-cultural contextual factors, it is possible to directly involve PWLEs in social contact-based anti-stigma interventions., Competing Interests: The authors have no conflicts of interest to declare., (© The Author(s) 2024.)

Objectives: Resources to support dementia carers from ethnically diverse families are limited. We explored carers' and service providers' views on adapting the World Health Organization's iSupport Lite messages to meet their needs., Methods: Six online workshops were conducted with ethnically diverse family carers and service providers ( n  = 21) from nine linguistic groups across Australia. Recruitment was via convenience and snowball sampling from existing networks. Data were analyzed using thematic analysis., Results: Participants reported that iSupport Lite over-emphasized support from family and friends and made help-seeking sound "too easy". They wanted messages to dispel notions of carers as "superheroes", demonstrate that caring and help-seeking is stressful and time-consuming, and that poor decision-making and relationship breakdown does occur. Feedback was incorporated to co-produce a revised suite of resources., Conclusions: Beyond language translation, cultural adaptation using co-design provided participants the opportunity to develop more culturally relevant care resources that meet their needs. These resources will be evaluated for clinical and cost-effectiveness in future research., Clinical Implications: By design, multilingual resources for carers must incorporate cultural needs to communicate support messages. If this intervention is effective, it could help to reduce dementia care disparities in ethnically diverse populations in Australia and globally.