Journal of Psychosocial Oncology

ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/wjpo20

A pre-post evaluation of a digital intervention to

improve psychosocial outcomes of caregivers of
people living with cancer in Vietnam

Olinda Santin, Hien Thi Ho, Chi Linh Bui, Huong Thi Nguyen, Hung Quang Ta,
Ngan Thu Tran, Minh Van Hoang, Thinh Huy Quoc Dang, Thanh Minh Pham,
Hiep Nhu Pham, Hoa Thi Chau, Hoai Thi Khanh Nguyen, Kha Van Vo, Thuy
Thanh Pham, Lan Hoang Thanh Dao, Dung Xuan Ho & Penelope Schofield

To cite this article: Olinda Santin, Hien Thi Ho, Chi Linh Bui, Huong Thi Nguyen, Hung
Quang Ta, Ngan Thu Tran, Minh Van Hoang, Thinh Huy Quoc Dang, Thanh Minh Pham,
Hiep Nhu Pham, Hoa Thi Chau, Hoai Thi Khanh Nguyen, Kha Van Vo, Thuy Thanh Pham,
Lan Hoang Thanh Dao, Dung Xuan Ho & Penelope Schofield (2024) A pre-post evaluation
of a digital intervention to improve psychosocial outcomes of caregivers of people
living with cancer in Vietnam, Journal of Psychosocial Oncology, 42:6, 875-887, DOI:
10.1080/07347332.2024.2345115

To link to this article: https://doi.org/10.1080/07347332.2024.2345115

© 2024 The Author(s). Published with Published online: 02 Aug 2024.

license by Taylor & Francis Group, LLC.

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Journal of Psychosocial Oncology
2024, VOL. 42, NO. 6, 875–887
https://doi.org/10.1080/07347332.2024.2345115

Research Article

A pre-post evaluation of a digital intervention to

improve psychosocial outcomes of caregivers of
people living with cancer in Vietnam
Olinda Santin, PhDa , Hien Thi Ho, MD, PhDa,b* , Chi Linh Bui, MDc ,
Huong Thi Nguyen, MDc, Hung Quang Ta, PhDb, Ngan Thu Tran , PhDe,
Minh Van Hoang, MD, PhDf, Thinh Huy Quoc Dang, MD, PhDg, Thanh
Minh Pham, BN, MNg, Hiep Nhu Pham, MD, PhDh, Hoa Thi Chau, BN,
MNh, Hoai Thi Khanh Nguyen, MDi, Kha Van Vo, MD, PhDj, Thuy Thanh
Pham, BAj, Lan Hoang Thanh Dao, BN, MNg, Dung Xuan Ho, MD, PhDk
and Penelope Schofield, PhDl,m
a
School of Nursing and Midwifery, Medical Biology Centre, Queen’s University Belfast, Belfast, UK; bFaculty
of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia; cFaculty of Clinical Medicine,
Hanoi University of Public Health, Hanoi, Vietnam; dTorrens University, Adelaide, Australia; eCentre of Public
Health, Queen’s University Belfast, Belfast, UK; fHanoi University of Public Health, Hanoi, Vietnam; gHo Chi
Minh City Oncology Hospital, Ho Chi Minh City, Vietnam; hHue Central Hospital, Hue, Vietnam; iDa Nang
Oncology Hospital, Da Nang, Vietnam; jCan Tho Oncology Hospital, Can Tho, Vietnam; kHue University of
Medicine and Pharmacy, Hue, Vietnam; lSwinburne University of Technology, Melbourne, Australia; mPeter
MacCallum Cancer Centre, Melbourne, Australia

ABSTRACT KEYWORDS
Objectives: To evaluate a co-designed intervention using digi- cancer; caregivers; carers;
tal resources “Vietnam Cancer Caring Coping” (V-CCC) on the depression; digital; health
health literacy, depression, and quality of life of caregivers sup- literacy; low-middle
porting a cancer patient in oncology hospitals in Vietnam. income; online; quality of
life; support
Methods: A pre-post quantitative evaluation with adult cancer
caregivers across regional Oncology hospitals in Vietnam (Ho Chi
Minh City, Da Nang, Can Tho, and Hue). Participants completed
baseline and follow-up measures of health literacy (HLS-SF12)
depression (PHQ-9) and Health-related Quality of Life (5Q-5D-5L).
Participants accessed and reviewed V-CCC for a 2-week period.
Results: Two hundred and thirty-four caregivers completed pre
and post-tests. Most participants were female (n = 143, 61%),
married (n = 165, 70%), aged 18–44 (n = 155, 66%), lived rurally
(n = 157, 67%). All health literacy scores of participants in
post-intervention were significantly higher than that in pre-in-
tervention across all domain’s healthcare, disease prevention,
and health promotion as well as the total score (p < 0.001). A
significant reduction in the proportion of caregivers reporting
PHQ-9 moderately severe/severe depression post-intervention
was demonstrated (10.2 vs. 6.1%, respectively (p ≤ 0.001). No
significant differences were observed pre and post-intervention
across four 5Q-5D-5L health dimensions: mobility, self-care,
usual activities, and pain/discomfort. Regarding anxiety/depres-
sion as measured by 5Q-5D-5L the proportion of participants

CONTACT Dr. Olinda Santin [email protected] School of Nursing and Midwifery, Medical Biology Centre,
Queen’s University Belfast, Belfast, UK.
*Joint first authorship
© 2024 The Author(s). Published with license by Taylor & Francis Group, LLC.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.
org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work
is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a
repository by the author(s) or with their consent.
876 O. SANTIN ET AL.

who reported having moderate, severe, and extreme problems

in pre- and post-intervention was statistically significant (32 vs.
24%), respectively (p = 0.0028).
Conclusion: Co-designed digital resources can reduce health
literacy inequities and improve psychological outcomes for can-
cer caregivers.

Introduction
By 2030, ~75% of all cancer deaths will occur in Low- and Middle-Income
Countries (LMICs) with cancer burden far exceeding the capacity of cancer
services.1,2 With tripling incidences of cancer, late presentation of disease, and
a chronic lack of investment, cancer services in Vietnam, like many LMICs
are struggling to manage.3–5 As cancer continues to rapidly rise in LMIC’s, it
is expected that most burden will be shouldered by family caregivers.6–8
Vietnamese family caregivers form a significant component of the cancer
care system bolstering the lack of resources with intensive physical and psy-
chosocial support at home and in hospital.8 Many families manage severe
challenges and complex health care needs, with minimal health literacy and
limited professional support.9 Cancer patients and caregivers may be pushed
into poverty due to the catastrophic costs of healthcare services and cancer
treatments.10,11 Providing care to a patient who has cancer can have devasting
and sustained impacts on Vietnamese caregivers’ physical, psychological, and
social well-being.9 Cultural stigma regarding cancer and a national absence of
formal mental health supports result in caregivers managing demands in iso-
lation.8 Many caregivers feel ill-equipped to manage the complexities of the
patients’ care which in turn impacts upon patients’ health. Patients and families
in Vietnam need urgent assistance to improve health literacy regarding cancer
and develop the skills they require to provide care.8,9,12
Evidence increasingly supports the effectiveness of online interventions
in supportive cancer care,13,14 particularly in low resource contexts.2,15
Digital interventions have the potential to be scaled-up in a cost-neutral
manner that can be easily updated, accessed remotely in urban and rural
locations, and disseminated broadly.15–17 However, the development of
online interventions in low resource settings have typically lacked the
involvement of patients and caregivers or consideration of culture and
context. Involving service users and carers in the design of online resources
is widely regarded as the best design approach for creating resources that
align with end users’ needs.18–21
Using a 6-step co-design framework20 used to develop digital resources
for cancer carer in both the UK20,21 and Australia22 a digital supportive
resource Vietnam Cancer Caring Coping (V-CCC) (https://chamsocbenhn-
hanungthu.vn) was co-developed, with patients, caregivers, and health care
 Journal of Psychosocial Oncology 877

professionals across five regions of Vietnam.20 A series of qualitative studies

identified that depression, health literacy, and quality of life were major
challenges for caregivers.8,9,12 These challenges have also been identified
in cancer patients in Vietnam.22–24 By providing education regarding cancer,
advice, support, and skills training, V-CCC aimed to improve outcomes
for caregivers. Co-design aimed to ensure the content of the resource
would target the main areas in which caregivers required information,
education, and skills training.
The aim of this study was to evaluate the impact of V-CCC on the
health literacy, mental health, and quality of life of caregivers supporting
a cancer patient in a hospital in Vietnam.

Methods
Study design and sample size

This study used a pre-post design to evaluate an online intervention:

Vietnam Cancer Caring Coping website, with baseline questionnaire admin-
istered after consent, and follow-up questionnaire two weeks later. Ethical
approval for the study was provided by Hanoi University of Public Health
(304/2022/YTCC-HD3). Caregivers were recruited across regional oncology
hospitals (Ho Chi Minh City, Da Nang, Can Tho and Hue).

Sample size

The sample size was calculated using the formula of hypothesis testing
for two population means in before-after study. Expected degree of change
in mean score measured by the Patient Health Questionnaire and standard
deviation of the change were estimated based on a previous study of
Vietnamese dementia caregivers receiving an intervention to support
dementia caring roles.25 A minimum sample size of 150 was calculated
using a 95% confidence interval (α), 80% power (1-β), expected difference
(Δ) = 1, standard deviation of difference (σ) = 2.973, a design effect of 2
(to account for convenient sampling), and a drop-out rate of 15%. Therefore,
each regional hospital was requested to recruit a minimum of 30 caregivers.

Participants and recruitment

Eligibility criteria for caregivers were ≥18 years, currently supporting some-
one who has been diagnosed with any type of cancer and is still alive and
receiving treatment within the hospital. Caregivers who were under 18 or
bereaved were excluded. A nominated nurse in each of the four main
oncology hospitals recruited cancer caregivers. The nurse was requested
to approach every caregiver they had contact with within the hospital who
878 O. SANTIN ET AL.

met the inclusion criteria and invite them to participate in person. This
recruitment occurred within in-patient departments in each hospital. The
total number of caregivers present in patient departments is not collected
in cancer hospitals in Vietnam. Participants completed printed consent
forms and baseline measures with the support of a nurse. Then, the nurse
provided participants with a unique code to access and review the online
resource for a 2-week period. After 2 weeks, nurses met with caregiver’s
face to face and supported participants to complete follow-up measures.

The intervention

Vietnam Cancer Caring Coping website was co-designed via iterative

rounds of qualitative exploration and co-design workshops.9,12 V-CCC
https://chamsocbenhnhanungthu.vn is an online resource that informs,
upskills, and supports cancer caregivers. V-CCC provides basic information
and support directed to the carer across seven modules: cancer informa-
tion, hospital information, daily care, skills training, traditional medicine,
nutrition, and psychological support. Content is provided in the form of
written and video information delivered by health care professionals, cancer
caregivers, and patients (see Table 1 for V-CCC content).

Measures

All measures have been validated in Vietnamese.26–28

Health literacy
Health literacy was measured by using Vietnamese version of short-form
health literacy questionnaire (HLS-SF12) with 12 items loading into three
domains of health (health care, disease prevention, and health promotion).

Table 1. Vietnam-Cancer Caring Coping content.

Module Content
Cancer information Cancer Education including types of cancer, treatments, and myth busting
Hospital information Managing the process of diagnosis. List of cancer hospitals in Vietnam and
links to hospital websites. Hospital procedures to manage diagnosis and
admissions to hospital
Managing daily care Accommodation for carers
Managing self-care
Managing daily living needs in hospitals (laundry, washing, cooking)
Skills training Managing oral and physical hygiene of patients
Managing skin and nail health of patients
Assisting patients to move
Helping patients eat and drink
Traditional medicine Advice and information on using traditional medicine
Nutrition and exercise Dietary and exercise advice for patients across the illness trajectory. Common
misconceptions
Psychological issues Common emotions experiences and coping mechanisms
 Journal of Psychosocial Oncology 879

Depression
Level of depression severity was measured by using the Patient Health
Questionnaire (PHQ-9). PHQ-9 score ranges from 0 to 27 which
can be used to categorize the level of depression severity into
“minimal” (score = 0–4), “mild,”5–9 “moderate,”10–14 “moderate severe or
severe.”15–27

Quality of life
Health-related Quality of Life (HRQoL) was measured by using standardized
and validated EQ-5D-5L questionnaire. Participants’ health profile was mea-
sured in five dimensions “mobility,” “self-care,” “usual activities,” “pain/dis-
comfort,” and “anxiety/depression.” A utility score (EQ-5D-5L index score)
was derived for each participant by converting their EQ-5D-5L health profile
using the value set of EQ-5D-5L-5L for the general population of Vietnam.

Data analysis

Descriptive statistics [mean and standard deviation (SD) for continuous

variables, percentages for discrete variables] were used to describe the
socio-demographic characteristics of the participants as well as the three
main outcomes. Differences in outcomes pre vs. post-test were tested using
paired-sample t-tests (when outcome variables were continuous) and Stuart-
Maxwell tests (when outcome variables were categorical). The various
statistical procedures were conducted in STATA version 15.0.

Results
Sample description: In total 241 caregivers were approached with only
seven declining participations (response rate = 97%). 234/241 caregivers
completed pre and post-tests and were included in the final analysis. Most
participants were female (n = 143, 61%), married (n = 165, 70%), aged 18–44
(n = 155, 66%), lived rurally (n = 157, 67%), and described their financial
situation as rather difficult (n = 113, 48%). Most of the caregivers (n = 157,
80%) had provided care for <5 years with most patients in a late to pro-
gressed state of disease (Table 2).
Table 3 shows the HLS-SF12 score reflecting health literacy in three
domains: healthcare, disease prevention, and health promotion as well as
the total score. All scores of participants in post-intervention were sig-
nificantly higher than that in pre-intervention (p < 0.001). Specifically, mean
(SD) health literacy score increased from 12.3 (2.84) to 13.7 (2.78) for
healthcare (p = <0.001); increased from 10.5 (2.19) to 11.3 (2.23) for disease
prevention (p = <0.001); and increased from 8.41 (2.05) to 9.05 (1.85) for
health promotion (p = <0.001).
880 O. SANTIN ET AL.

Table 2. Characteristics of the participants.

Characteristics n (%)
Sex Male 91 (38.9)
Female 143 (61.1)
Mean age (years old) 38.4 ± 12.5
Ethnicity Kinh 224 (95.7)
Others (Ede, Hoa) 10 (4.3)
Marital status Single 56 (23.8)
Married 165 (70.4)
Widowed/Divorced/Separate 13 (5.8)
Age groups (years old)* 18–44 155 (66.2)
45–59 58 (24.8)
≥60 16 (6.8)
Education levels Primary school 24 (10.3)
Secondary school 66 (28.2)
High school 56 (23.9)
College 36 (15.4)
University 51 (21.8)
Others (no schooling) 1 (0.4)
Location Rural area 157 (67.1)
Urban area 77 (32.9)
Monthly income (VND) ≤3,000,000 52 (22.2)
3,000,001–6,000,000 75 (32.1)
6,000,001–9,000,000 34 (14.5)
9,000,001–12,000,000 30 (12.8)
>12,000,000 43 (18.4)
Median income (IQR) 6,000,000 (6,000,000)
Affordability to pay for necessary Very easy 10 (4.3)
health services Rather easy 61 (26.1)
Rather difficult 113 (48.3)
Very difficult 50 (21.4)
Occupation* Farmer 40 (17.1)
Craftsman 25 (10.7)
Civil servants and public employees 42 (17.9)
Self-employed 40 (17.1)
Housewife 29 (12.4)
Retired person 9 (3.8)
Social status Low 63 (26.9)
Average 166 (71)
High 5 (2.1)
Duration of caring for patients <6 months 146
(years)* More than 6 months 79
Cancer stages Stage I 46 (19.6)
Stage II 52 (22.2)
Stage III 75 (32.1)
Stage IV 61 (26.1)
Total 234 (100%)
*Missing demographic data.

Table 3. Short-form health literacy questionnaire (HLS-SF12) score, by pre- and

post-intervention.
Domains Pre mean (SD) Post mean (SD) p-Value*
Healthcare 12.3 (2.84) 13.7 (2.78) <0.001
Disease prevention 10.5 (2.19) 11.3 (2.23) <0.001
Health promotion 8.41 (2.05) 9.05 (1.85) <0.001
HLS-SF12 total score 31.3 (5.95) 34.1 (5.89) <0.001
*Result of paired t-tests compared the score between participants pre- and post-intervention.
 Journal of Psychosocial Oncology 881

The mean (SD) PHQ-9 score pre and post-intervention were 6.5 (0.39)
and 5.9 (0.34), respectively. While being categorized into levels of depres-
sion severity (Table 4), the proportion of participants who had moderately
severe/severe depression pre-intervention was 1.7 times more that in
post-intervention (10.2 vs. 6.1%, respectively). The difference was statis-
tically significant (p = 0.0014, Stuart-Maxwell test).
Table 5 shows the health profile and 5Q-5D-5L index score of partic-
ipants pre- and post-intervention. Regarding quality of life related to
anxiety/depression, the proportion of participants who reported having
moderate, severe, or extreme problems was significantly lower post-test
compared to pretest (24 and 32%, respectively; p = 0.0286). The differences
were not observed in the other four health quality of life dimensions (i.e.
mobility, self-care, usual activities, and pain/discomfort).

Discussion
Findings demonstrated a significant improvement in caregivers’ health
literacy, severity of depression, and quality of life following two weeks of
access to the digital resource V-CCC.
Significant improvements in health literacy were demonstrated across
all three domains, health care, disease prevention, health promotion as
well as total health literacy score. This supports the finding that online
interventions can be used to rapidly improve health literacy and in a short
time frame. Health literacy inequities have been cited as a major contrib-
utor to delays and barriers to cancer care in LMICs.29,30 This study supports
the evidence based those co-designed online interventions can meet the
information needs of cancer caregivers,20,21 increase knowledge, and improve
health literacy.
Results demonstrated a significant reduction in the proportion of care-
givers reporting moderate/severe depression post-intervention. It is difficult
to deduce what components of the resource may have impacted on depres-
sion, however, the inclusion of common emotions and how to manage may
have been helpful to caregivers. Preliminary findings of an online support
intervention for partners of cancer patients in Germany have also demon-
strated positive impacts on depression and anxiety scores.31 These findings
Table 4. Level of depression severity based on distribution of PHQ-9 scores, by pre- and
post-intervention and compare PHQ-9 scores.
Level of depression severity,
PHQ-9 score Pre n (%) Post n (%) p-Value*
Minimal (normal), 0–4 108 (46.1) 115 (49.2) 0.0014
Mild, 5–9 73 (31.3) 81 (34.6)
Moderate, 10–14 29 (12.4) 24 (10.3)
Moderately severe/severe, 24 (10.2) 14 (6.0)
15–27
*Results of Stuart-Maxwell test compared between participants pre- and post-intervention.
882 O. SANTIN ET AL.

Table 5. Compare EQ-5D-5L health profile and index score, by pre- and post-intervention.
Dimension Pre n (%) Post n (%) p-Value
Mobility
 No problems 117 (50.0) 117 (50.0) 0.1685*
 Slight problems 78 (33.3) 78 (33.3)
Moderate problems 21 (9.0) 21 (9.0)
 Severe problems 17 (7.3) 17 (7.3)
 Unable/extreme problems 1 (0.4) 1 (0.4)
Self-care
 No problems 173 (73.9) 177 (75.6) 0.6857*
 Slight problems 44 (18.8) 37 (15.8)
Moderate problems 8 (3.4) 11 (4.7)
 Severe problems 6 (2.6) 6 (2.6)
 Unable/extreme problems 3 (1.3) 3 (1.3)
Usual activities
 No problems 140 (59.8) 139 (59.4) 0.1691*
 Slight problems 50 (21.4) 63 (26.9)
Moderate problems 24 (10.3) 15 (6.4)
 Severe problems 16 (6.8) 14 (6.0)
 Unable/extreme problems 4 (1.7) 3 (1.3)
Pain/discomfort
 No problems 125 (53.4) 127 (54.3) 0.7228*
 Slight problems 83 (35.5) 82 (35.0)
Moderate problems 15 (6.4) 16 (6.8)
 Severe problems 8 (3.4) 4 (1.7)
 Unable/extreme problems 3 (1.3) 5 (2.1)
Anxiety/depression
 No problems 64 (27.3) 70 (29.9) 0.0286*
 Slight problems 95 (40.6) 108 (46.2)
Moderate problems 34 (14.5) 32 (13.7)
 Severe problems 23 (9.8) 14 (6.0)
 Unable/extreme problems 18 (7.7) 10 (4.3)
EQ-5D-5L index score, 0.77 (0.22) 0.79 (0.22) 0.0086**
mean (SD)
SD: standard deviation.
*Results of Stuart-Maxwell test compared EQ-5D-5L health profile between participants pre- and
post-intervention.
**Result of paired t-test compared EQ-5D-5L index score between participants pre- and post-intervention.

suggest that providing psychological support on how to manage common

issues, information regarding cancer and its treatments, and skills training
online may improve the psychological health of caregivers. The development
of digital resources to meet caregivers support needs has been prioritized
by expert stakeholders,32,33 this study supports the view that online inter-
ventions can enhance caregivers wellbeing34 and can do so in a short time
frame. However, the importance of co-design must be emphasized as con-
siderable investment was given to the co-design of V-CCC.
Regarding quality of life related to anxiety/depression, the proportion
of participants who reported having moderate, severe, or extreme problems
was significantly lower post-test compared to pretest. This finding again
supports the viewpoint that the content of V-CCC has a significant impact
on depression. No significant differences in overall health related quality
of life or in domains mobility, self-care, usual activities, and pain and
discomfort were identified. However, it should be noted most caregivers
did not report pain/discomfort, mobility, self-care, or problems with usual
activities pre-V-CCC. The average age of caregivers who participated in
 Journal of Psychosocial Oncology 883

this study was young (mean age 38 years old) and therefore expected to
have a reasonably high level of physical health thus not experiencing
physical issues. Hence, there may be a “floor” effect in these findings.35
For those caregivers who experience physical quality of life issues it is
possible that the information and support provided was not helpful or
perhaps did not make an impact in the short term.
As burden of cancer continues to grow, this study supports the use of
leveraging online/digital solutions to provide support and care.36 Caregiver
burden will exponentially grow with the predicted rise of cancer in LMIC’s.6
The global cancer community must rapidly move to ensure supports are
in place to alleviate this burden and reduce the potential for mental and
physical health catastrophes. If caregivers get sick, cancer services will not
manage thus there is an urgent need to provide support to caregivers.
Digital resources may be a cost-effective way to service large-scale pop-
ulations of caregivers. There is increased recognition that online interven-
tions are a convenient, cost-effective, and efficacious approach to delivering
supportive care.36 By supporting caregivers, we have an opportunity to
improve patients’ outcomes due to the reciprocal relationship between
patient and caregiver health.

Study limitations

Despite providing evidence in a large population of caregivers in Vietnam,

an LMIC, this study has several limitations that should be considered.
Firstly, caregivers who participated in the study were providing in-patient
care for patients, thus those who are providing care and support in the
community are not represented in this study. The hospitals included in
this study are central and specialist hospitals therefore not represented of
all inpatient cancer care. Due to the opportunistic method of sampling,
it is likely that those who were comfortable and likely to benefit from a
digital intervention participated thus not capturing the views of those who
maybe unsure or unwilling to engage in technology. There is also a like-
lihood of recruitment bias as nurses may have been more likely to recruit
and approach those who were likely to benefit. The young age (38 years)
of caregivers should also be noted as this finding may not be replicated
in an older age group. Using a pre-post design and nurse assisted com-
pletion of pre-post survey instruments also includes the likelihood of bias.
It is likely that the caregiver may have rated post-outcome measures higher
due to the potential of socially desirable responding.37
There was no control group within this study therefore we cannot eliminate
the possibility of improvements being part of a natural trajectory or due to
social desirability as nurse was present during outcome completion. Furthermore,
as the follow-up period of data collection was two weeks, the long-term
884 O. SANTIN ET AL.

impact of V-CCC on caregivers outcomes is unknown. In addition, the pre-

post nature of the study design means we are unable to determine if V-CCC
is more beneficial for specific subgroups of carers. Future studies may also
consider including longer term follow-up and measures of cost-effectiveness
particularly when investigating intervention use in a low-income context.

Clinical implications

Vietnam-Cancer Caring Coping (V-CCC) may help Vietnam cancer services

to address the health care needs of caregivers, which in turn improves out-
comes for patients. Ensuring that cancer caregivers needs are met will reduce
pressure on the health care system and society, improve health care delivery,
and promote health equity. However, like all interventions, particularly in
low-income contexts, implementation is a challenge.2 Health care providers,
community organizations, researchers, and funders must work to explore the
most effective and low-cost implementation strategies to ensure beneficial
interventions, such as V-CCC get to those that require support. Incorporating
evidence-based resources within routine cancer care should be made a priority.

Conclusion
Cancer caregivers across the globe, particularly those in LMICs face
extreme burden and cancer inequities. Cancer services are under pressure
and failing to meet the needs of caregivers and as a result caregivers health
can be affected. Co-designed digital resources can reduce health literacy
inequities and improve outcomes for cancer caregivers, particularly psy-
chological outcomes.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Funding
This project was funded by UKRI GCRF/Newton Fund.

ORCID
Olinda Santin http://orcid.org/0000-0001-7600-0259
Hien Thi Ho http://orcid.org/0000-0002-1181-7580
Chi Linh Bui http://orcid.org/0000-0003-4919-9826
Penelope Schofield http://orcid.org/0000-0001-9495-9543

Data availability statement

Data is available on request.
 Journal of Psychosocial Oncology 885

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