The modifying effect of work-care role conflict on the effectiveness of carer support: Results from the Australian Draw Care randomised clinical trial.

BACKGROUND: People who care for a family member with dementia alongside paid work often experience role conflict. This study explores whether work-care role conflict (WCRC) modifies the effectiveness of Draw Care, an online and culturally-adapted carer support intervention. METHODS: Secondary exploratory analysis of a single-blind, parallel-group trial (August 2023-November 2024) that compared Draw Care against waitlist control in adult carers from diverse linguistic backgrounds. To formally test whether WCRC moderated the effect of the Draw-Care intervention, we ran a full-sample linear mixed model that included a three-way interaction between time-point, treatment group and an indicator of WCRC. WCRC was operationalised as self-report of missed work or reduced productivity due to competing care and employment demands. Outcomes included carer burden, mood, quality of life, and productivity/ activity impairment at 6 and 12 weeks. RESULTS: Forty-two of 93 carers reported WCRC. Reductions in caregiver burden due to treatment at 6 weeks (-10.00; 95% CI -19.70 to -0.31, p = 0.043) and 12 weeks (-9.56; 95% CI -18.83 to -0.29, p = 0.043) were significantly larger in participants with WCRC than without. This moderating effect of WCRC was driven by a robust, absolute reduction in caregiver burden in intervention group participants with WCRC over the initial 6 weeks (-7.19, 95%CI: -12.72 to -1.67, p = 0.011), with much of this improvement preserved at 12 weeks (-6.85, 95%CI: -12.17 to -1.53, p = 0.012). CONCLUSIONS: WCRC appears to modify the effectiveness of Draw Care, suggesting that the intervention may be particularly helpful for carers navigating role conflict.