This protocol is a systematic scoping review of the literature reporting on strategies for alleviating caregiver burden among the informal caregivers of persons with SMDs in transitional countries. A scoping review method was selected to present an outline of the evidence that exists in the area of interest and the gaps for further research [39]. The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute’s (JBI) methodology for scoping reviews [39]. This methodology is based on 5 stages that guide the development of the protocol and the scoping review, which include identifying the research question and the relevant studies, selecting the studies, charting the data, and assembling the results to identify the relevant implications for policy, practice, and research [39].

The main research question is: “What strategies exist for alleviating caregiver burden among informal caregivers of persons with SMDs in transitional countries?”

The research aim is to present existing literature on strategies for alleviating caregiver burden among informal caregivers of persons with SMDs in transitional countries.

This study has the following research objectives:

This study will use the participants, concept, and context (PCC) framework (Textbox 1) to guide the selection of relevant studies and ensure alignment with the research question.

This scoping review will consider both published and unpublished studies detailing strategies for supporting informal caregivers in mental health in transitional countries. The 3-step search strategy process will be used to identify relevant studies. An initial limited search of PubMed, MEDLINE, CINAHL, and PsycINFO will be undertaken to identify relevant articles published over the last 10 years. This will be followed by the analysis of text words contained in the titles and abstracts of relevant articles and of the index terms used to describe the articles. The initial key words will include [informal caregiver/s OR caregiver/s] AND [caregiver burden OR caregiver stress] AND [support strategy/ies OR intervention/s] AND [severe mental disorder/s OR mental illness] AND [developing country/ies OR underdeveloped country/ies]. The second search will include all keywords and index terms identified and revised with the assistance of a librarian at the University of the Witwatersrand. The search strategy will be adapted for each included database and information source (Multimedia Appendix 1). For unpublished or gray literature, a targeted search of dissertations, theses, and conference abstracts will be conducted on “ProQuest Dissertations and Theses Global” and public health and conference databases. Lastly, the reference lists of all included sources of evidence will be screened for additional studies.

The PCC framework (Textbox 1) provides detailed eligibility criteria to ensure that the content of relevant studies aligns with the research question (Textbox 2).

The search strategy will be piloted to check the appropriateness of the identified keywords and databases. All eligible articles will be uploaded on Mendeley Reference Manager. The identified articles will then be uploaded to Covidence, and duplicates will be removed. Covidence is a web-based primary screening and data extraction tool used to streamline the systematic review process. The author will be responsible for searching and uploading the identified studies, and the author and co-reviewer will be responsible for screening the titles, abstracts, and full texts of the identified studies.

The initial search and screening of titles and abstracts will commence in September 2021, and this will be followed by the second search and screening of titles, abstracts, and full texts in January-March 2022. In April-May 2022, the reviewers plan to conduct a full text review for additional studies identified in the references of the included studies. Throughout the process, all attempts will be made to obtain the full texts of the eligible studies by searching the University’s library guides and the internet and by collaborating with a librarian at the University of the Witwatersrand Faculty of Health Sciences. The author and identified co-reviewer will be responsible for conducting a full text review of the identified studies. All excluded studies, along with the reasons for exclusions, will be tracked on Covidence. All identified conflicts will be resolved through constant discussions between the 2 reviewers and a web-based meeting will be held biweekly. The degree of agreement between the reviewers will be calculated on Covidence and reported in the findings. The results of the search and the study inclusion process will follow the recommendations in the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist (Multimedia Appendix 2) [39]. This will be mapped using the PRISMA-P (PRISMA Extension for Protocols) chart (Figure 1).

The data will be charted using an electronic data extraction form [39] on the Covidence software. A total of 2 separate data extraction forms will be used for the research articles (Table S1 in Multimedia Appendix 3) and the policy and guideline documents (Table S2 in Multimedia Appendix 3). This is useful for capturing the relevant information from each included study.

A total of 2 independent reviewers based at separate tertiary institutions will carry out the data extraction. Communications regarding consensus will be facilitated through regular web-based meetings and face-to-face meetings when necessary. Before using the data extraction forms, piloting will be done to ensure the standardization and relevance of the extracted information. This process will be conducted at the end of the initial limited search phase of the scoping review. This process is essential to ensure efficient, meaningful extraction of data from all included papers. This process will be conducted at the end of the initial limited search phase of the scoping review. A sample of 10 included papers meeting the eligibility criteria will be selected to test the quality and validity of the data extraction tools [40]. First, the included studies will be purposely sampled, and second, data will be extracted from the included studies. The sample synthesis will then be conducted after the data analysis process, which is outlined in the data analysis and presentation. The results from the synthesis will be used to inform the modification of the data extraction form. This process is essential to ensure efficient and meaningful extraction of data from all included papers. To ensure the quality and validity of the modified data extraction form, the piloting process will be repeated at the end of the second search.

A descriptive qualitative content analysis will be conducted inductively using NVIVO software to code the characteristics of the extracted data into overall categories [39]. This method of analysis is selected as it allows for rich meanings and insights to be derived from text by interpreting the manifest and latent content of the text, which is done through rigorous analysis and an understanding of a phenomenon’s critical processes [41]. The outcome of this scoping review will inform the development of interview guides for the subsequent studies, and therefore, a rigorous data analysis is required. A PRISMA-ScR flowchart (Figure 1) will be used to show the number of identified included and excluded studies. The various strategies for alleviating informal caregiver burden and their outcomes will be tabled under the different identified categories, including, but not limited to, the type of support strategies and interventions, the outcomes of the strategies and interventions used, and the challenges related to the implementation of these strategies and interventions [39]. Graphs and tables will be provided to enhance clarity. Existing gaps identified in the support strategies and interventions for informal caregivers in mental health, as well as the outcomes and challenges encountered will be identified to draw conclusions on the scoping review.

This scoping review forms part of a PhD project aimed at developing guidelines to alleviate caregiver burden among informal caregivers of persons with SMDs in South Africa, a transitional country. Ethical clearance (M200957) was obtained from the University of the Witwatersrand Human Research Ethics Committee.

This protocol will guide a scoping review to identify and describe the extent and type of evidence on the existing strategies for alleviating caregiver burden among informal caregivers of persons with SMDs in transitional countries. There is acknowledgment of the unique role informal caregivers play in the care and management of people with SMDs within transitional countries and the subsequent burden arising from occupying this role [13,42,43]. A supported informal caregiver is likely to provide quality care, which is critical for the recovery of a person with a SMD [44]. The synthesis and analysis of existing literature on the various services and intervention strategies for alleviating caregiver burden forms a basis through which the development and implementation of these strategies can be facilitated within transitional countries where such evidence is lacking. Three researchers who have knowledge and experience in the JBI scoping review methodology developed the protocol. A librarian helped develop a comprehensive search strategy to allow for broad access to existing literature sources. To the best of our knowledge, there is no synthesis of literature in this area; this review therefore adds to the body of knowledge on the support for informal caregivers in mental health.

The scoping review is limited to studies conducted in transitional countries; thus, the scope excludes studies conducted in developed countries, limiting the extent of the evidence on the strategies for supporting informal caregivers in mental health. Additionally, the review only includes studies conducted in English, creating a bias in the scope of the collated evidence. While the scoping review intends to include both peer reviewed and gray literature, it may not cover the entire existing evidence; as a result, studies in indexed databases may not be identified. The current review focuses on strategies for alleviating caregiver burden in SMDs, which locates it within the traditional Western medical health system paradigm. It is critical to acknowledge culture-bound syndromes, particularly within transitional countries; however, in other transitional countries, these syndromes are still classified under SMDs, which is within the Western medical terminology.

Informal caregivers are the backbone of recovery for persons with SMDs, and thus, strategies for alleviating their caregiver burden are critical, especially in resource-constrained transitional countries. With the growing research on the need for strategies aimed at supporting informal caregivers in their role, it is necessary to understand the extent of the burden and characteristics of these strategies in transitional countries. This scoping review will generate evidence to raise awareness on the various services and intervention strategies that can be developed and implemented to alleviate burden among informal caregivers in mental health within transitional countries.