Family caregivers play a vital and often invisible role in the care of people living with dementia. This responsibility is especially heightened in low- and middle-income countries (LMICs), where formal care services are limited and health systems are frequently unprepared to address the growing number of individuals affected by this condition. The World Health Organization’s Global Action Plan on Dementia (2017–2025) and the WHO iSupport program recommend structured psychoeducation and ongoing emotional support for family caregivers as essential elements of national dementia strategies [1,2].

Evans et al. (2024), in their systematic review “A Systematic Review of Educational Interventions for Informal Caregivers of People Living with Dementia in Low- and Middle-Income Countries,” report that psychoeducational interventions targeting family caregivers in LMICs consistently demonstrate positive outcomes, particularly in alleviating caregiver burden and strengthening adaptive coping mechanisms in the context of dementia care [3]. These findings align with a broader international movement advocating for the integration of caregiver support into dementia care pathways [4]. Beyond summarizing the findings of Evans et al., this commentary contributes an implementation-oriented perspective by translating the evidence into practical strategies for integration within primary care systems in low- and middle-income countries. Specifically, we propose feasible delivery models, emphasize culturally responsive adaptation, and discuss workforce-optimization approaches, such as task-shifting and hybrid formats, thereby extending the original review from evidence synthesis to actionable health-system planning.

While the systematic review by Evans et al. establishes the effectiveness of psychoeducational interventions, the present commentary advances the discussion by focusing on how such interventions can be operationalized within real-world primary care structures, particularly in resource-constrained settings. The systematic review highlights that psychoeducational interventions, particularly those delivered in group settings, can improve caregiver well-being by fostering peer support, increasing knowledge about dementia, and enhancing confidence in managing complex caregiving situations. The review also shows that interventions do not need to be lengthy; many successful programs involve approximately 12 hours of education delivered over several weeks. This is especially relevant in LMICs where time, resources, and personnel are limited.

Dementia caregiving unfolds within cultural frameworks that shape how aging, cognitive decline, and obligations of family caregiving are interpreted and experienced. Interventions are more effective when adapted to local norms, incorporating culturally meaningful coping practices and communication styles [5–7]. Rather than hindering standardization, thoughtful adaptation enhances the relevance and acceptability of interventions across diverse contexts.

Despite their promise, psychoeducational interventions face implementation barriers. Variability in program structure and outcomes makes comparison difficult. Few studies include long-term follow-up, making it challenging to assess the sustainability of benefits. Cost-effectiveness analyses are also scarce, limiting policymakers’ ability to make informed decisions [8–10]. These limitations highlight a need for standardized frameworks and implementation research focused on scalability and sustainability [8–11].

Task-shifting approaches, defined as the delegation of specific care activities from specialized professionals to trained community health workers or other non-specialist providers, may represent a feasible strategy to mitigate workforce limitations. First, nurse-led caregiver education programs integrated into primary care may provide structured group sessions, periodic counseling, and routine follow-up as part of chronic and long-term care management workflows, including dementia care. Second, community health worker–based models could enable trained lay providers to deliver brief psychoeducational modules and ongoing monitoring through home visits or community outreach, thereby extending reach to underserved populations. Both approaches may align with existing primary care infrastructures in many LMICs, where decentralized and community-based services already constitute established components of the health system. To maximize their impact, psychoeducational interventions should be integrated into primary care systems. Primary care settings are more accessible to caregivers and can serve as centralized hubs for screening, referral, and ongoing support. Task-shifting approaches, in which trained health professionals and community health workers deliver structured caregiver support, may help address workforce limitations. Hybrid delivery models, combining in-person and virtual components, can increase accessibility while maintaining program effectiveness [5,6,9,12]. Taken together, the evidence synthesized by Evans et al. positions psychoeducational support not as an optional add-on, but as a core therapeutic component within dementia care models. Interventions that strengthen caregiver knowledge, emotional regulation, and coping skills may influence the trajectory of care, mitigate the emergence and escalation of behavioral and psychological symptoms of dementia, and may help reduce preventable health crises affecting both the caregiver and the care recipient. In LMICs, where caregiving responsibilities are often gendered, intergenerational, and embedded in cultural expectations of filial duty, the absence of structured support increases the risk of cumulative psychological strain, caregiver burnout, and ultimately the breakdown of home-based care. Therefore, psychoeducational interventions carry not only clinical and economic value, but also ethical significance, acknowledging the caregiver as an essential partner within the care dyad and recognizing their well-being as a fundamental determinant of dementia care quality.

Evans et al. demonstrate that psychoeducational interventions are effective, feasible, and culturally adaptable tools for supporting dementia caregivers in LMICs. The next challenge is ensuring broader implementation. By embedding caregiver support programs within primary care systems, health systems can provide sustainable, equitable support for caregivers. Ultimately, the delivery of high-quality dementia care is contingent upon recognizing, supporting, and continuously monitoring the health and quality of life of family caregivers. The expansion of national dementia strategies commonly prioritizes diagnostic access and pharmacological management, yet caregiver support often remains underdeveloped or unfunded. Strengthening caregiver support requires recognizing the caregiver not merely as a resource, but also as an individual vulnerable to psychological and physical strain. Policies that incorporate structured caregiver training, counseling, and routine psychosocial follow-up within primary care have been shown to reduce hospitalizations, improve continuity of care, and delay institutionalization. Additionally, caregiving is a dynamic process involving cycles of adjustment, emotional labor, and ongoing renegotiation of personal identity. Psychoeducational interventions that incorporate reflective dialogue, coping, and strengthening emotional resilience may facilitate meaning-making and resilience. This is especially crucial in LMIC settings, where caregiving roles are often shaped by cultural expectations of filial duty and gendered labor distributions. Finally, primary care systems must be equipped to identify caregiver burden early and intervene with appropriate supportive approaches. Standardized caregiver assessment tools, embedded referral workflows, and interdisciplinary care coordination can support timely access to psychoeducational services. A comprehensive assessment of these interventions, encompassing both caregiver-centered outcomes, such as reductions in caregiver burden and improvements in quality of life, and system-level indicators, including decreased emergency department utilization, lower hospitalization rates, enhanced outpatient follow-up, reduced institutionalization, and preservation of caregiving capacity, will be critical for informing and guiding the implementation of effective public health policies.

The authors declare that the research was carried out in the absence of any commercial or financial relationships that could be interpreted as a potential conflict of interest.

The authors received no financial support for the research, authorship, or publication of this manuscript.