Introduction: Family caregivers of people with dementia (PwD) face significant psychological burden, particularly in regions with increasing dementia prevalence and critical gaps in support provision, such as Southeastern Europe START is a UK-developed, evidence-based psychosocial intervention for family caregivers of people living with dementia with short- and long-term cost- and clinical-effectiveness. It has been proven feasible and acceptable when adapted for use in minority groups and other countries.


Purpose: This study presents and compares the process of translating, culturally adapting, and piloting the START programme in two Southeastern European countries: Croatia and North Macedonia. It aims to identify key factors that influence feasibility and acceptability, and to offer practical recommendations for structured, scalable implementation that is accessible and sustainable within public health systems.


Method: In North Macedonia, the adapted intervention has been evaluated for feasibility, acceptability, and preliminary outcomes using mixed-methods. In Croatia, the programme has undergone cultural adaptation, with implementation preparations ongoing. Both versions retained fidelity to the original model while integrating context-specific modifications.


Results: In N.Macedonia START bridged an important gap in postdiagnostic support and could be delivered with surface-level adaptations, and in Croatia, validation results point to high potential for successful implementation, with stakeholders expressing strong interest and engagement.


Conclusions: The adaptation of START in Croatia and North Macedonia demonstrates the potential of evidence-based psychological interventions to be scaled across diverse health systems. The study highlights the importance of regional collaboration and provides actionable recommendations for systematic implementation that meet the needs of informal caregivers in low- and middle-income settings.


Keywords: dementia, informal caregivers, adaptation, feasibility, START programme, Southeastern Europe