Positive-Activity App Shows Promise for Easing the Mental Toll of Dementia Caregiving

Caring for a loved one with dementia is one of the most demanding roles in modern health care, and the psychological toll it takes is well documented. Now, a research team at the University of Michigan has tested whether a smartphone app built around small, daily positive activities can help. In a study published in Frontiers in Dementia, Kira S. Birditt and colleagues report that the Roadmap app, a mobile health intervention originally developed for other caregiver populations, proved feasible for dementia caregivers and showed encouraging early links with better mood and lower depression.

The scale of the problem the researchers set out to address is enormous. Roughly 11 million Americans provide unpaid care to people living with Alzheimer’s disease and related dementias, and these caregivers shoulder more hours of hands-on work, more medical and nursing tasks for which they have little training, and greater emotional burden than caregivers of older adults without dementia. As responsibilities accumulate, caregivers face elevated risks of anxiety, sleep problems, reduced physical activity, and chronic illness, risks that can in turn harm the well-being of the person receiving care. Identifying modifiable factors that influence caregiver mental health, the authors argue, is therefore an urgent public health priority.

Decades of research suggest that engaging in pleasant activities is one such factor. Caregivers who engage in fewer pleasant activities report greater depression, more negative affect, less positive coping, and more sleep disturbance, while intensive momentary-assessment studies show that leisure activities can lift mood within the same day. Existing interventions built on these findings, such as pleasant-event scheduling and the LEAF program for frontotemporal dementia caregivers, have produced real benefits, but they tend to be high-burden, requiring multiple sessions over weeks. That is where mobile health technology comes in: apps are low-cost, scalable, and fit into the fragmented schedules of people who are often caregiving around the clock.

Yet the app landscape for dementia caregivers has a striking gap. A recent scoping review identified 44 unique apps for family caregivers, only 12 of them mobile apps, and most focused on education, social support, and self-management rather than building positive emotions. Evaluations of commercially available dementia caregiver apps have found that few have been tested in controlled studies, that the most common feature is care-management information, and that users themselves ask for more self-care content. The Roadmap app, developed by Sung Won Choi and colleagues with funding from the National Institutes of Health, was designed to fill exactly this gap, offering eight positive activity modules grounded in extensive qualitative interviews with caregivers.

To test whether the app could work for dementia caregivers specifically, the team ran the We-Care study, a 14-day intensive protocol involving 20 caregivers drawn from a larger sample of 223 dementia caregiver-care recipient dyads. Caregivers received prompts at 9 a.m. and 6 p.m. to engage in a positive activity of their own choosing, completed a nightly mobile survey about their own and their care recipient’s mental health, and, along with their care recipients, wore Fitbit activity trackers throughout the study. On the final day, they completed a detailed feasibility and acceptability questionnaire. The sample was diverse, with 40 percent Black caregivers and 60 percent White, 75 percent female, and a mix of spousal and adult-child caregivers; care recipients ranged from no impairment to severe dementia on a telephone-adapted Montreal Cognitive Assessment.

The feasibility results were strong. Caregivers engaged in at least one Roadmap positive activity on 87 percent of study days, completing an average of about 1.7 activities per day, and they filled out 95 percent of the nightly surveys, yielding 265 days of data. All 20 caregivers wore their Fitbits, as did 75 percent of care recipients. Among the eight modules, pleasant activity scheduling was the most popular, followed by savoring, gratitude journaling, engaging with beauty, and the so-called positive piggy bank, with signature strengths, random acts of kindness, and love letters trailing behind. The team had set a benchmark of 80 percent completion or agreement for adequate feasibility, and the engagement and survey metrics cleared it comfortably.

Acceptability told a slightly more nuanced story. The Fitbit devices and nightly surveys both exceeded the 80 percent agreement threshold, with caregivers rating them easy to understand, easy to use, and easy to fit into their routines. The Roadmap app itself fell just short, at 78.9 percent overall agreement. Three items drove the shortfall: caregivers were somewhat less likely to agree that the setup instructions were easy to understand, that the app was easy to use, and, most notably, that they were confident they were using it correctly, where agreement dipped to 72 percent. The authors interpret these figures not as a failure of the intervention’s content but as a signal that onboarding materials and training need refinement, a relatively straightforward fix for the next iteration of the study.

The most intriguing findings concern the daily associations between positive activity engagement and mental health. Using two-level multilevel linear models with days nested within participants, the researchers found that on days when caregivers engaged in at least one Roadmap activity, they reported significantly lower depression, lower appraisals of caregiving as stressful, and higher positive mood. Notably, these were within-person effects, meaning the comparison was each caregiver against their own baseline, which strengthens the case that the activities themselves, rather than stable personality differences, were driving the pattern. There were no significant same-day associations with anxiety, negative mood, or appraisals of caregiving as rewarding, and no between-person effects of overall engagement rates on any outcome.

Time in the study itself also mattered. Across the 14 days, caregivers showed gradual improvements in positive mood, anxiety, depression, and appraisals of caregiving as rewarding, and they reported gradual improvements in their proxy ratings of care recipients’ anxiety and depression as well. The authors are careful to caution that these temporal trends could reflect repeated measurement, regression to the mean, or simple passage of time rather than the intervention itself, and that caregiver engagement in positive activities was not significantly linked to proxy reports of care recipient mental health. Post-hoc analyses added one more wrinkle: caregivers who engaged in more positive activities on average across the study reported lower anxiety and higher positive mood, suggesting that cumulative engagement may matter as much as any single day’s effort.

The team is explicit about the study’s limitations. With only 20 participants, no randomization, and no comparison condition, the findings are preliminary and cannot establish that the app causes improvements in mental health. The authors call for a fully powered randomized controlled trial with an attention control condition, a comparison group that matches the intervention on prompts, contact time, and app use but strips out the positive-activity content, to isolate the active ingredients. They also plan to analyze the Fitbit data for effects on sleep, activity, and heart rate, and to test the app over longer periods with follow-up assessments. Still, the message of this first test is clear: dementia caregivers, a population with little spare time and high mental health risk, will engage with a low-burden positive activity app at remarkably high rates, and the days they do so tend to be measurably better days. If larger trials confirm these associations, a simple prompt to savor, schedule, or reflect could become a scalable tool for protecting the mental health of millions of family caregivers.

Subject of Research: Feasibility and acceptability of the Roadmap positive activity mobile health app for dementia caregivers and its preliminary associations with caregiver mental health

Article Title: Use of the Roadmap positive activity app in daily life among dementia caregivers: evidence of feasibility and acceptability

Article References: Use of the Roadmap positive activity app in daily life among dementia caregivers: evidence of feasibility and acceptability. (n.d.). https://doi.org/10.3389/frdem.2026.1861809

Image Credits: AI Generated

DOI: 10.3389/frdem.2026.1861809

Keywords: dementia caregivers, mHealth app, positive activities, Roadmap app, feasibility, acceptability, caregiver mental health, depression, ecological momentary assessment, Fitbit, positive psychology, University of Michigan