An evidence-informed psychosocial intervention program for caregiver burden among family caregivers of children with autism spectrum disorder: a multi-stage development and Delphi study

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BACKGROUND: Family caregivers of children with autism spectrum disorder (ASD) often experience substantial and multidimensional caregiver burden, which may adversely affect their physical and psychological well-being, family functioning, and the child's rehabilitation. Although caregiver-focused psychosocial interventions have shown promise, structured and theory-informed programs specifically designed to address caregiver burden in this population remain limited. METHODS: A multi-stage intervention development design was used, guided by an integrated framework of the ABC-X family stress model and stress and coping theory. First, best-available evidence was synthesized to identify relevant intervention strategies. Second, findings from prior quantitative and qualitative phases of a mixed-methods research program were integrated to define intervention targets and draft content. Third, the draft program was refined through a two-round asynchronous modified Delphi consultation to improve content relevance, clarity, and implementation planning. RESULTS: The finalized program comprised three core modules (stressors, cognitive appraisal, and coping), seven themes, and 22 components. It incorporated psychoeducation, mindfulness-based approaches, gratitude-based expressive writing, acceptance and commitment-informed strategies, self-compassion training, and problem-solving skills. Expert response and authority were high; however, Kendall's W values were modest across the two rounds (0.23 and 0.25). These findings suggest that the Delphi process contributed to systematic refinement and expert appraisal of the program and reflected experts' perceptions of the relevance, clarity, and appropriateness of its content; practical feasibility remains to be tested directly with caregivers. CONCLUSIONS: This study developed a theory-driven and evidence-informed psychosocial intervention framework for caregiver burden among family caregivers of children with autism spectrum disorder. The program provides a structured basis for ongoing caregiver-informed feasibility testing and subsequent effectiveness evaluation; its acceptability, delivery fidelity, and later effectiveness require further empirical validation.

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