This paper has two aims (1) to show if and how HBC–HBE an online course supports family carers of people living with dementia, and (2) to examine the role and importance of peer support in facilitating such support. By focusing on carers’ lived experiences, this research aims to contribute to the development of more effective, user-centered online education programs and inform policy initiatives aimed at supporting family carers in Ireland and beyond.

This study employed an intrinsic case study methodology (Stake, 1995; Yin, 2014). Yin defines a case study as ‘an empirical inquiry that investigates a contemporary phenomenon (the “case”) in depth and within its real-world context, especially when the boundaries between phenomenon and context may not be clearly evident’ (Yin, 2014, p. 16).

The research used multiple methods to investigate the experiences of family carers of people living with dementia on an online course. Part A of this research consisted of an online questionnaire. The online questionnaire contained 32 questions, of which 25 were closed and seven were open-ended. The questionnaire was distributed via email in November 2021 and remained open for 2 weeks. The online questionnaire included questions regarding participants’ perceptions of the course’s supportive nature and examined the role of peer support in fostering feelings of support among family carers of individuals living with dementia.

Part B of this research consisted of one-to-one interviews. Interview questions were developed following analysis of responses to the online questionnaire. The interviews were semi-structured. The interviews investigated participants’ perceptions of the course as a source of support and examined the mechanisms through which peer support was manifested. The issue of emotional readiness was raised in the first interview, and subsequent interviewees were asked to comment on their feelings around this topic.

An interpretivist paradigm guided the research. This emphasized the subjective experiences of family carers as fellow learners engaging with each other in one component of what Ball and Forzani (2007) call the ‘instructional dynamic’ (the others being engagement with course content, tutors and the learning environment).

Ethical approval was obtained from Dublin City University REC (DCUREC/2021/139). Informed consent was secured for both questionnaire and interviews. A participant support plan was implemented to manage potential emotional distress during interviews.

A convenience sampling strategy was used for both Part A and Part B of this research. Invitations to complete Part A the online questionnaire of this research were sent to 697 course participants who completed HBC–HBE between 2019 and 2021. Of these 303 accessed the online questionnaire, 225 completed demographic questions. In Part B of the research 12 people participated in semi-structured interviews.

The online questionnaire was distributed via Qualtrics software. It comprised 32 questions (25 closed, 7 open-ended) addressing course components, peer support, and perceived impact. All responses were anonymous. A note was placed at the end of the online questionnaire inviting those interested in being interviewed to email the lead researcher.

The semi-structured interviews were conducted via Zoom (average duration: 52 min). They were transcribed verbatim by the researcher and pseudonyms are used below in the Results section. Interviews focused on experiences of peer support, emotional readiness, and suggestions for improvement. Research participants were required to read, agree and sign consent forms for Parts A and B of the research. Their anonymity was guaranteed for Part A the online questionnaire. In Part B, each participant was given a pseudonym to protect their anonymity.

Closed questions on the online questionnaire were analyzed quantitatively using simple descriptive statistics via SPSS. Interviews and open ended questions in the online questionnaire were imported into NVivo and then analyzed using a particular form of thematic analysis called Template Analysis (Brooks et al., 2015; King and Brooks, 2018). Template analysis is a type of ‘Codebook’ analysis (Braun and Clarke, 2021) that allows for the development of a thematic template, which was developed and refined throughout the research phases.

The initial template was informed by literature-derived themes (information, education, peer/tutor support, learning environment, psychological support). Thereafter, an iterative refinement produced final thematic structure aligned with research questions. All qualitative data was coded using ‘descriptive’ and ‘values’ coding (Saldaña, 2021).

Respondents to the online questionnaire were mostly female (84.89% or 191 people). The remainder were male (13.33% or 30) or preferred not to say (1.33% or 3). One person described themselves as non-binary/third gender (0.44%). Most respondents were experienced computer users, describing themselves as moderately (43%) or extremely (41%) confident using computers and IT equipment. Nobody described themselves as ‘not at all confident’, though 3% described themselves as ‘slightly confident’ and 13% as ‘somewhat confident’. Overall, 31 people (14% of total) completed the course in 2019, 106 (47%) in 2020 and 87 (39%) in 2021. Primary carers made up 47% of respondents, with secondary carers comprising 53% of respondents. Primary carers provide ‘the most care as opposed to secondary carers (carers who provide only some of the care and are ancillary to the primary carer)’ (Greenwood et al., 2009, p. 339).

Regarding the interview candidates 10 were female and two were male. Two completed the course in 2019, four in 2020 and six in 2021. Six Interviewees were secondary carers, five were primary or joint primary carers, and one was both a primary and secondary carer.

Overall, 96% of respondents felt that participating in the course had a positive impact on ‘the way you provide care directly or indirectly to the person with dementia’—39% reported a minor positive impact, while 57% reported a major positive impact. No respondents reported a negative impact, while 4% reported no impact (Q. 28 online questionnaire). The full set of figures are provided in Figure 1.

Respondents were also asked about how the course supported them in their care situation (Q.27 of the online questionnaire). A large number (84%) agreed or strongly agreed that the course provided useful ideas on maintaining an active lifestyle for the person to whom they were providing care. The same figure (84%) also agreed or strongly agreed that the course provided useful ideas about the provision of personal care. A slightly lower, but still significant 70% of respondents agreed or strongly agreed that the course provided new ideas about maintaining an active lifestyle for themselves. However, 91% of respondents agreed or strongly agreed that the course gave them helpful ideas about how to maintain a safe care environment.

Adoption of person-centered care principles was also evident. Jessica explained:

In addition, 65% of respondents to the online questionnaire agreed or strongly agreed that participating in the course reduced their carer stress levels. The vast majority of respondents disagreed that the course made no difference to their care situation. A strong majority of 90% agreed or strongly agreed that the course made them feel more confident. See Figure 2 for more details:

The majority of learners reported high satisfaction levels with their participation in the course, with 89 positive comments recorded. Respondents frequently used descriptors such as “brilliant” (Online Questionnaire Respondent (OQR): 38), “extremely beneficial” (OQR: 63), and “excellent course” (OQR: 182). One participant summarized the transformative impact:

Learners valued long-term access to course materials, recognizing the importance of being able to access materials on an ongoing basis as the dementia progresses:

Twenty-four participants reported significant changes in caregiving practices. One learner reflected: “I found the course extremely beneficial. The space to voice concerns and speak openly without judgement should not be underestimated. It provided a great source of comfort to me, and I could not speak highly enough of it.” (OQR: 270).

Gratitude toward the course provider and course facilitators was widespread:

Notably, 36 respondents indicated they had no suggestions for improvement, with comments such as: “I have nothing to offer to this question… I think the attitude of the course tutors and ethos in the way the course is delivered is just right!” (OQR: 208).

Despite overall positive feedback, some learners expressed dissatisfaction with the course. One secondary carer noted:

Others criticized online delivery during COVID-19 restrictions: “I found doing the course online to be of little benefit to me. I know with the current COVID restrictions that it wasn’t possible any other way.” (OQR: 140).

Learners proposed structural changes, such as adding a mid-course review week: “It would be very beneficial to add an extra week mid-course… oftentimes it’s not until a week or so after that discussion points/questions come to mind.” (OQR: 271) Content-related gaps were highlighted, particularly for early-onset dementia: “The course material seems to cover Dementia in the elderly. The person I care for has early onset… there was very little information to prepare us for that.” (OQR: 167) Other suggestions included consolidating factsheets into a single PDF, providing bullet-point summaries, and incorporating relaxation exercises or expert input from nutritionists and occupational therapists. Calls for ongoing support were also suggested: “I think it would be great if on the anniversary of the course all the participants were invited to a video meeting to see how we are getting on and to reconnect.” (OQR: 22)

Finally, some advocated for specialized courses: “I would really like to see the Alzheimer’s Ass doing courses for rare dementia… I’ve had to go to UK support groups to get proper information.” (OQR: 75)

These findings underscore the HBC–HBE course’s strong impact on family carers of people living with dementia. Positive experiences were linked to practical advice, person-centered care and ongoing resource access. However, dissatisfaction highlights the need for flexible delivery, tailored content, and ongoing engagement. Addressing these areas could enhance inclusivity and long-term effectiveness.

As noted above Ball and Forzani (2007) referred to the ‘instructional dynamic’ as the course participants complex interaction with course content, course tutors, fellow learners and the learning environment. What became clear in this research is that all elements of the instructional dynamic contributed to course participants’ feelings that HBC–HBE was mainly supportive to them in their role as family carers of people living with dementia.

Participants on HBC–HBE were asked in the online questionnaire to rate how supportive various elements of the instructional dynamic were for them. Table 1 shows that ‘interactions with your fellow course participants’ was ranked second behind interactions with course tutors, and ahead of reading the course materials and completing weekly reflective assignments. In response to Q.33 of the online questionnaire (How supportive did you find the following learning activities of the course? To what extent did they help you provide care in your dementia situation), 41% of respondents found these interactions very supportive, while 33% found them extremely supportive, with a total mean score of 3.97.

In addition, participants on HBC–HBE were asked how they gained support (defined as support/advice from other learners on the course) from their peers on the course (Q.42 on the online questionnaire: How important was Peer Support [support/advice from other learners on the course]in assisting or informing the care you deliver?). Their answers are set out in Table 2. It shows that participants on HBC–HBC gained support mostly via live video meetings and discussion forums, and to a lesser extent through private messaging on the Moodle course page.

Open ended questions in the online questionnaire sought further insight into how peer support manifested itself. For many (though not all) peer interaction was consistently described as a very valuable element of the course.

It provided a range of important influences on course participants. These included emotional support, practical advice, and a sense of belonging. These connections helped carers feel less isolated, more confident, and better prepared for their caregiving roles. The combination of shared learning, emotional reassurance, and mutual contribution created a powerful support network that extended beyond the course itself. These contributions with supporting quotes are grouped below.

This study had two aims (1) to show if and how HBC–HBE an online course supported family carers of people living with dementia, and (2) to examine the role and importance of peer support in facilitating such support. Findings have demonstrated that many participants on HBC–HBE found that the course supported them in their roles as family carers of people living with dementia. Furthermore, it has described how these same course participants found the course to be supportive. It details—in many cases through direct quotes from research participants—how the course has had a mainly positive impact on their caregiving practice through improved communication techniques, the acquisition of new care skills and increased confidence in their caregiving role.

The findings of this study confirm that peer support is a critical component of online education for dementia family carers. Participants consistently reported emotional benefits, including reduced isolation and increased confidence, alongside practical gains such as improved communication strategies and care skills. These outcomes align with previous research highlighting the value of multi-component interventions that integrate informational content, professional guidance, and peer interaction (Boots et al., 2014; Hopwood et al., 2018).

Peer support facilitated a sense of solidarity among carers, enabling them to share experiences and validate their feelings. This emotional reassurance is particularly significant given the well-documented psychological burden associated with dementia caregiving (Basu and Mukhopadhyay, 2021; Gilsenan et al., 2023). The opportunity to connect with others who “understand” the challenge of caregiving appears to mitigate feelings of loneliness and foster resilience. Moreover, this sense of confidence and openness empowered family carers to seek out services and supports to which they were entitled.

The positive impact of peer interaction observed in this study echoes findings from interventions such as Diapason (Cristancho-Lacroix et al., 2015) and Partner in Balance (Boots et al., 2018), where carers valued opportunities for social exchange and emotional support. Similarly, systematic reviews have emphasized that peer support enhances engagement and improves psychological outcomes (Hopwood et al., 2018; Etxeberria et al., 2021).

However, this study also highlights some limitations that mirror concerns in the literature. Emotional readiness emerged as a barrier for some participants, consistent with observations that carers may struggle to confront sensitive topics or share personal experiences in group settings (Chiu and Eysenbach, 2011). In this study a minority of participants reported difficulty engaging due to emotional unpreparedness. For these carers, the emotional intensity of confronting dementia-related realities within a group setting proved challenging.

This is consistent with findings on a study of another online programme for family carers called Mastery over Dementia, where ‘The discussion forum was not used because caregivers struggled with shame in the early stages, and sharing their story felt like a betrayal to the care recipient’ (Boots et al., 2018, p. 7). Group heterogeneity—particularly differences between spousal and secondary carers—occasionally diluted the relevance of discussions, reinforcing calls for tailored subgrouping within online interventions (Teahan et al., 2021).

Technology-related challenges reported by some participants, including difficulties navigating Moodle and engaging with discussion forums, align with usability issues documented in studies of other platforms (Boyd et al., 2014; Hattink et al., 2016). While synchronous video meetings were generally well-received, asynchronous forums were perceived as less engaging, echoing findings from Diapason where forums were described as “impersonal” (Cristancho-Lacroix et al., 2015).

The findings underscore the need for teaching and learning design strategies that maximize the benefits of peer support (Han et al., 2022; Olesen et al., 2023) while mitigating its limitations. Based on evidence from this study, some recommendations to enhance the effectiveness of peer support include now follow.

Pre-course emotional readiness screening to identify carers who may require additional support before engaging in peer discussions. Psychologists have used the Transtheoretical Model (TTM) to assess the emotional readiness of people to become adoptive parents (Prochaska et al., 2005). Perhaps this tool could be adapted for use as a screening tool for potential HBC–HBE course applicants. It is acknowledged that course organizers would need to be very careful in how they implement this, and pilot testing any such screening process would be advisable.

Further tutor training in facilitation skills to more effectively manage the issue of group dynamics noted above and thus ensure more equitable participation. Tutors have the difficult task of balancing the need to support course participants with empathy and kindness against the need to deliver the education materials in a timely fashion. Feedback suggests that most tutors have found this balance most of the time. But there is undoubtedly a need to constantly review tutor skills and comfort levels as they deliver what can be an emotionally challenging course.

Breakout groups organized by carer type (e.g., spousal vs. secondary) to enhance relevance and empathy. BigBlueButton (the video conferencing software that is integrated into Moodle Workplace) has Break Out Room functionality. Tutors have some knowledge about using Break Out Rooms. More practice should be encouraged to learn how to use it more effectively and flexibly.

Simplification of platform navigation and provision of clear onboarding resources to reduce cognitive load and perceived effort. This would involve the creation of more learner support materials including ‘how to’ support videos, and a learner handbook covering information on course outline, structure, learning resources and activities. In addition, a simplification of onboarding instructions and streamlining of communication methods as participants join the course would be valuable.

Optional asynchronous alternatives for carers with time constraints or limited digital literacy. This could involve the creation of materials that summarize each topic on the course, which would be easy to access from the main HBC–HBE course page.

These measures can enhance the inclusivity of online education programs, ensuring that peer support remains a positive and empowering experience for all participants. The literature suggests that multi-component interventions that include peer support as a vital element are more impactful and helpful to family carers of people living with dementia (Boots et al., 2014; Wallace et al., 2021).

The Irish National Dementia Strategy (Department of Health, 2014) and the Model of Care (Begley et al., 2023) emphasize the centrality of supporting family carers through education and training. Findings from this study reinforce the importance of embedding peer support within such initiatives. Policymakers should prioritize funding for scalable, user-friendly online programs that combine structured content with interactive peer engagement. This approach aligns with broader health policy goals of sustaining community-based care and reducing reliance on institutional services.

Ireland’s digital literacy policy for adults is primarily articulated in the Adult Literacy for Life strategy (Government of Ireland, 2021). This framework addresses adult literacy, numeracy, and digital skills, aiming to reduce the proportion of adults without basic digital skills from 47 to 20%. The strategy emphasizes investment in digital skills provision through both formal and non-formal learning routes. However, the document lacks specific measurable actions, timelines, and accountability mechanisms to achieve these targets.

Complementary reports such as the Digital Inclusion in Ireland Report advocate for closing gaps among older adults—a group disproportionately affected by digital exclusion (National Economic and Social Development Office, 2021). Recommended actions include the development of national digital skills learning programs tailored for older people, integration of digital hubs within existing community infrastructure to provide accessible training and ongoing support for digital technology access and usage.

Age Action (2020) further suggests embedding digital literacy initiatives into community networks, ensuring sustainability and reach. Despite these recommendations, current policy remains fragmented and under-resourced, with insufficient funding streams and limited coordination between health, education, and social care sectors.

For dementia carers, this lack of specificity is critical. As we have seen above in Table 3 almost one fifth of research respondents reported some difficulties in using the online learning platform. This may correspond to the 17% of research respondents in Section 3.1 above reporting lower levels of confidence in using computers and IT equipment. Without targeted digital literacy interventions, many older carers cannot fully engage with online training programs like HBC–HBE. Future policy must therefore be specific, adequately funded, and transparent, incorporating measurable targets and cross-sector collaboration.

Several limitations must be acknowledged. The use of convenience sampling may limit the generalizability of findings, and carers with low digital literacy were underrepresented. The quantitative components of the online questionnaire did not use validated outcome measures such as the Zarit scale for caregiver burden. It should be noted that his research did not include a control group for comparator purposes. In addition, there is the possibility of response bias from course participants who completed the online questionnaire in Part A of this research.

The study did not include tutors’ perspectives, which could provide valuable insights into the facilitation of peer support. Additionally, though the research participants had taken part in HBC–HBE over a 3-year period, it nevertheless focused on short-term outcomes; longitudinal studies are needed to assess the sustained impact of peer networks on carer wellbeing.

Future research can help us further understand the experiences and needs of family carer of people living with dementia, particularly as they relate to online learning initiatives. Some suggestions for future studies include high quality peer-reviewed research on the long-term effects of peer support on psychological resilience and quality of care provision, further qualitative investigation of support to improve our understanding of emotional readiness and its influence on engagement. It would also be useful to further investigate the role of tutor facilitation strategies in optimizing group dynamics, particularly in relation to courses where participants are experiencing stress or burden. Further research could also forensically investigate how digital literacy levels impacted learner activity on online courses for family carers of people living with dementia.

In conclusion, this paper has outlined if and how an online education course has supported family carers of people living with dementia. It has also provided a detailed insight into the role of peer support on HBC–HBE. It is hoped that the areas highlighted above will be of interest to a wide variety of education policy makers and practitioners in the field of education (especially digital and online education). It highlights the importance of trying to create a learning environment that gives people the space and opportunity to express their experiences, emotions and skills to help support their fellow family carers. It has also provided some evidence based ideas on how to further enhance the provision of peer support in online learning.