Increasing the acceptance of internet-based mental health interventions in primary care patients with depressive symptoms. A randomized controlled trial

Development of a Questionnaire to Measure the Attitudes of Laypeople, Physicians, and Psychotherapists Toward Telemedicine in Mental Health

BACKGROUND

In the field of psychiatry and psychotherapy, there are now a growing number of Web-based interventions, mobile phone apps, or treatments that are available via remote transmission screen worldwide. Many of these interventions have been shown to be effective in studies but still find little use in everyday therapeutic work. However, it is important that attitude and expectation toward this treatment are generally examined, because these factors have an important effect on the efficacy of the treatment. To measure the general attitude of the users and prescribers toward telemedicine, which may include, for instance, Web-based interventions or interventions through mobile phone apps, there are a small number of extensive tests. The results of studies based on small groups of patients have been published too, but there is no useful short screening tool to give an insight into the general population's attitude. We have developed a screening instrument that examines such attitude through a few graded questions.

OBJECTIVE

This study aimed to explore the Attitude toward Telemedicine in Psychiatry and Psychotherapy (ATiPP) and to evaluate the results of general population and some subgroups.

METHODS

In a three-step process, the questionnaire, which is available in three versions (laypeople, physicians, and psychologists), was developed. Afterwards, it was evaluated by four groups: population-representative laypeople, outpatients in different faculties, physicians, and psychotherapists.

RESULTS

The results were evaluated from a total of 1554 questionnaires. The sample population included 1000 laypeople, 455 outpatients, 62 physicians, and 37 psychotherapists. The reliability of all three versions of the questionnaire seemed good, as indicated by the Cronbach alpha values of .849 (the laypeople group), .80 (the outpatients' group), .827 (the physicians' group), and .855 (the psychotherapists' group).

CONCLUSIONS

The ATiPP was found to be useful and reliable for measuring the attitudes toward the Web-based interventions in psychiatry and psychotherapy and should be used in different studies in this field in the future to evaluate and reflect the attitude of the participants.

Can we improve parent attitudes and intentions to access computer-based therapies for their children and adolescents?

BACKGROUND

As gatekeepers, parents can improve the uptake of mental health services among youth. This article asked whether providing parents with a presentation on computer-based therapies is a feasible strategy to improve their knowledge, attitudes and uptake intentions.

METHOD

Parents completed a survey before, and immediately after, viewing a presentation on computer-based therapies or an active control.

RESULTS

Parents who viewed the computer-based presentation reported significantly greater improvements in knowledge, perceived helpfulness, perceived benefits and intentions to access computer-based therapies; and a significantly greater reduction in perceived problems, compared to active controls.

CONCLUSIONS

Information- and demonstration-based presentations are a feasible method for improving attitudes towards computer-based therapies for youth among parents in the community.

Going global: do consumer preferences, attitudes, and barriers to using e-mental health services differ across countries?

BACKGROUND

e-Mental health services have the capacity to overcome barriers to care and reduce the unmet need for psychological services, particularly in developing countries. However, it is unknown how acceptable e-mental health interventions may be to these populations.

AIMS

The purpose of the current study was to examine consumer attitudes and perceived barriers to e-mental health usage across four countries: Australia, Iran, the Philippines and South Africa.

METHODS

An online survey was completed by 524 adults living in these countries, assessing previous contact with e-mental health services, willingness to use e-mental health services, and perceived barriers and needs for accessing e-mental health services.

RESULTS

Although previous contact with e-mental health services was low, the majority of respondents in each sample reported a willingness to try e-mental health services if offered. Barriers toward e-mental health usage were higher among the developing countries than Australia. The most commonly endorsed barriers concerned needing information and assurances regarding the programmes.

CONCLUSIONS

Across countries, participants indicated a willingness to use e-mental health programmes if offered. With appropriate research and careful implementation, e-mental health has the potential to be a valuable part of mental healthcare in developing countries.

FitMindKit: Randomised controlled trial of an automatically tailored online program for mood, anxiety, substance use and suicidality

PURPOSE

Online mental health programs can be effective in reducing symptoms of depression, anxiety disorders, substance use and suicidal ideation. However, most existing e-mental health programs focus on a single domain of mental health, neglecting comorbidity. Furthermore, few programs are tailored to the symptom patterns of the individual user. FitMindKit was designed to overcome the gaps of existing e-mental health programs, providing tailored, transdiagnostic therapeutic content to address a range of comorbid mental health symptoms. A trial was conducted to test the program's efficacy.

METHODS

Australian adults with elevated symptoms of depression, anxiety, suicidal ideation and/or substance use were recruited through social media, with n = 194 randomised into a fully-automated trial of a 10-day brief intervention. Participants were randomly allocated to receive FitMindKit tailored to their symptoms, an untailored generic version of FitMindKit, or an attention control.

RESULTS

Mixed model repeated measures ANOVA indicated that participants in both FitMindKit and the attention control had significant reductions in symptom composite scores. Effects were not significantly greater in the FitMindKit program relative to control, either at post-test or 3-month follow-up. No effects were detected for specific decreases in depression, generalized anxiety, social anxiety, panic, suicidal ideation or alcohol/substance use. There were no significant differences between the tailored and static versions in effectiveness or adherence. Participants in the tailored and static conditions were more satisfied than in the control condition, with some evidence favouring the tailored condition. High attrition reduced power to find effects.

CONCLUSIONS

FitMindKit provides a model for addressing comorbid mental health symptoms in an online program, using automated tailoring to symptom patterns. Modifications to the program are recommended, along with the need for larger trials to test the effects of tailoring on mental health outcomes.

Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey

BACKGROUND

Despite extensive evidence that Internet interventions are effective in treating mental health problems, uptake of Internet programs is suboptimal. It may be possible to make Internet interventions more accessible and acceptable through better understanding of community preferences for delivery of online programs.

OBJECTIVE

This study aimed to assess community preferences for components, duration, frequency, modality, and setting of Internet interventions for mental health problems.

METHODS

A community-based online sample of 438 Australian adults was recruited using social media advertising and administered an online survey on preferences for delivery of Internet interventions, along with scales assessing potential correlates of these preferences.

RESULTS

Participants reported a preference for briefer sessions, although they recognized a trade-off between duration and frequency of delivery. No clear preference for the modality of delivery emerged, although a clear majority preferred tailored programs. Participants preferred to access programs through a computer rather than a mobile device. Although most participants reported that they would seek help for a mental health problem, more participants had a preference for face-to-face sources only than online programs only. Younger, female, and more educated participants were significantly more likely to prefer Internet delivery.

CONCLUSIONS

Adults in the community have a preference for Internet interventions with short modules that are tailored to individual needs. Individuals who are reluctant to seek face-to-face help may also avoid Internet interventions, suggesting that better implementation of existing Internet programs requires increasing acceptance of Internet interventions and identifying specific subgroups who may be resistant to seeking help.

Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study

BACKGROUND

New technologies are an integral component of today's society and can complement existing suicide prevention programs. Here, we analyzed the use of new technologies in the prevention of suicide in 8 different European countries.

OBJECTIVE

The aim of this paper was to assess the opinions of professionals in incorporating such resources into the design of a suicide prevention program for the region of Zamora in Spain. This investigation, encompassed within the European project entitled European Regions Enforcing Actions against Suicide (EUREGENAS), includes 11 regions from 8 different countries and attempts to advance the field of suicide prevention in Europe.

METHODS

Using a specifically designed questionnaire, we assessed the opinions of 3 different groups of stakeholders regarding the use, frequency of use, facilitators, content, and format of new technologies for the prevention of suicide. The stakeholders were comprised of policy and public management professionals, professionals working in the area of mental health, and professionals related to the social area and non-governmental organizations (NGOs). A total of 416 participants were recruited in 11 regions from 8 different European countries.

RESULTS

The utility of the new technologies was valued positively in all 8 countries, despite these resources being seldom used in those countries. In all the countries, the factors that contributed most to facilitating the use of new technologies were accessibility and free of charge. Regarding the format of new technologies, the most widely preferred formats for use as a tool for the prevention of suicide were websites and email. The availability of information about signs of alarm and risk factors was the most relevant content for the prevention of suicide through the use of new technologies. The presence of a reference mental health professional (MHP) was also considered to be a key aspect. The countries differed in the evaluations given to the different formats suggesting that the cultural characteristics of the country should be taken into account.

CONCLUSIONS

New technologies are much appreciated resources; however they are not often underused in the field of suicide prevention. The results of this exploratory study show that new technologies are indeed useful resources and should be incorporated into suicide prevention programs.

Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review

BACKGROUND

Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems.

OBJECTIVE

This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies.

METHODS

We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs.

RESULTS

The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or "e-awareness" and intentions to use e-mental health services were weak or inconsistent.

CONCLUSIONS

Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care.

A randomized controlled trial of a transdiagnostic Internet intervention for individuals with panic and phobias - One size fits all

BACKGROUND AND OBJECTIVES

Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias ('ConfID'). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness.

METHODS

Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization.

RESULTS

Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants' attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range.

LIMITATIONS

Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results.

CONCLUSIONS

The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants' attitudes towards Internet interventions.

Ready for eHealth? Health Professionals' Acceptance and Adoption of eHealth Interventions in Inpatient Routine Care

eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p < .001), and eHealth literacy was elevated. Social influence, performance expectancy, and treatment-related internet and mobile use significantly predicted overall acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed.

Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany

BACKGROUND

Despite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care.

OBJECTIVE

This pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress.

METHODS

To assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman's rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress.

RESULTS

Descriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled "usefulness or helpfulness," "relative advantage or comparability," and "accessibility or access to health care." Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems.

CONCLUSIONS

This pilot study showed deficient "e-awareness" and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the "black box" of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs.

Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention

Background

Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders.

Objective

To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD).

Methods

A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs).

Results

In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY.

Conclusions

Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale.

Trial registration

German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9)

Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research

Although psychological interventions might have a tremendous potential for the prevention of mental health disorders (MHD), their current impact on the reduction of disease burden is questionable. Possible reasons include that it is not practical to deliver those interventions to the community en masse due to limited health care resources and the limited availability of evidence-based interventions and clinicians in routine practice, especially in rural areas. Therefore, new approaches are needed to maximize the impact of psychological preventive interventions. Limitations of traditional prevention programs could potentially be overcome by providing Internet- and mobile-based interventions (IMIs). This relatively new medium for promoting mental health and preventing MHD introduces a fresh array of possibilities, including the provision of evidence-based psychological interventions that are free from the restraints of travel and time and allow reaching participants for whom traditional opportunities are not an option. This article provides an introduction to the subject and narratively reviews the available evidence for the effectiveness of IMIs with regard to the prevention of MHD onsets. The number of randomized controlled trials that have been conducted to date is very limited and so far it is not possible to draw definite conclusions about the potential of IMIs for the prevention of MHD for specific disorders. Only for the indicated prevention of depression there is consistent evidence across four different randomized trial trials. The only trial on the prevention of general anxiety did not result in positive findings in terms of eating disorders (EDs), effects were only found in post hoc subgroup analyses, indicating that it might be possible to prevent ED onset for subpopulations of people at risk of developing EDs. Future studies need to identify those subpopulations likely to profit from preventive. Disorders not examined so far include substance use disorders, bipolar disorders, stress-related disorders, phobic disorders and panic disorder, obsessive-compulsive disorder, impulse-control disorders, somatic symptom disorder, and insomnia. In summary, there is a need for more rigorously conducted large scale randomized controlled trials using standard clinical diagnostic instruments for the selection of participants without MHD at baseline and the assessment of MHD onset. Subsequently, we discuss future directions for the field in order to fully exploit the potential of IMI for the prevention of MHD.

Drivers and Barriers to Acceptance of Web-Based Aftercare of Patients in Inpatient Routine Care: A Cross-Sectional Survey

Background

Web-based aftercare can help to stabilize treatment effects and support transition after inpatient treatment, yet uptake by patients seems limited in routine care and little is known about the mechanisms of adoption and implementation.

Objective

The aim of this study was to (1) determine acceptance of Web-based aftercare and (2) explore its drivers and barriers in different subgroups of a mixed inpatient sample.

Method

In a cross-sectional design, 38.3% (374/977) of the inpatients from a broad spectrum of diagnostic groups (psychosomatic, cardiologic, orthopedic, pediatric, and substance-related disorders) filled out a self-administered questionnaire prior to discharge. Drivers and barriers to patients’ acceptance of Web-based aftercare were examined based on an extension to the “unified theory of acceptance and use of technology” (UTAUT). In total, 16.7% (59/353) of the participants indicated prior use of eHealth interventions.

Results

Acceptance (min 1, max 5) was low (mean 2.56, SD 1.22) and differed between diagnostic groups (Welch F_4,133.10 =7.77, P<.001), with highest acceptance in adolescent patients (mean 3.46, SD 1.42). Acceptance was significantly predicted by 3 UTAUT predictors: social influence (beta=.39, P<.001), performance expectancy (beta=.31, P<.001), and effort expectancy (beta=.22, P<.001). Furthermore, stress due to permanent availability (beta=−.09, P=.01) was negatively associated with acceptance.

Conclusion

This study demonstrated a limited acceptance of Web-based aftercare in inpatients. Expectations, social environment’s attitude, and negative experience with permanent availability influence eHealth acceptance. Improving implementation, therefore, means increasing eHealth experience and literacy and facilitating positive attitudes in patients and health professionals through education and reduction of misconceptions about effectiveness or usability.

Being Human: A Qualitative Interview Study Exploring Why a Telehealth Intervention for Management of Chronic Conditions Had a Modest Effect

Background

Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service.

Objective

An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention.

Methods

Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention.

Results

Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients’ lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients’ lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients’ motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address their specific risk factors. Implementation was not optimal in the early part of the CVD risk trial owing to technical difficulties and the need to adapt the intervention for use in practice. For both conditions, enthusiastic and motivated staff offering continuity of intervention delivery tailored to individual patients’ needs were identified as important for patient engagement with telehealth; this was not delivered consistently, particularly in the early stages of the trials. Finally, there was a lack of active engagement from primary care.

Conclusions

The conceptual model was supported and could be used to develop further telehealth interventions for chronic conditions. It may be possible to increase the effectiveness of this, and similar interventions, by attending to the human as well as the technical aspects of telehealth: offering it to patients actively wanting the intervention, ensuring continuity of delivery by enthusiastic and motivated staff, and encouraging active engagement from primary care staff.

Dissemination strategies and adherence predictors for web-based interventions-how efficient are patient education sessions and email reminders?

The Internet offers the potential to efficaciously deliver health interventions at a low cost and with a low threshold across any distance. However, since many web-based interventions are confronted with low use and adherence, proactive dissemination strategies are needed. We, therefore, tested the efficacy of a 1-h patient education session as part of a rehabilitation program and an email reminder 4 weeks later on the publicity and use of a web-based intervention aimed at lifestyle changes in patients with either coronary heart disease or chronic back pain (CBP) and examined adherence predictors. The website www.lebensstil-aendern.de is a cost-free, German-language website providing more than 1000 patient narratives about successful lifestyle changes. To test the efficacy of the dissemination strategies and to examine adherence predictors, we conducted a sequential controlled trial with heart and CBP patients recruited from German inpatient rehabilitation centers. The dissemination strategies were found to be efficient. Use rates, however, remained low. The email reminder and internal health locus of control emerged as notable factors in motivating patients to participate in the web-based intervention. Other factors that have been suggested to be related to nonuse, e.g. sociodemographic characteristics and medical condition, did not predict use or adherence.

'One man's medicine is another man's poison': a qualitative study of user perspectives on low intensity interventions for Obsessive-Compulsive Disorder (OCD)

BACKGROUND

Low intensity interventions based on cognitive-behavioral therapy (CBT) such as computerized therapy or guided self-help can offer effective and accessible care for mild to moderate mental health problems. However, critics argue that by reducing therapist input and the level of experience of the professionals delivering therapy, low intensity interventions deprive users of critical 'active ingredients'. Thus, while demand management arguments support the use of low intensity interventions for OCD, their integration into existing mental health services remains incomplete. Studies of user views of low intensity interventions can offer valuable insights to define their role and optimize their implementation in practice.

METHODS

Qualitative interviews (n = 36) in adults with OCD explored user perspectives on the initiation, continuation and acceptability of two low intensity CBT interventions: guided self-help (6 h of professional support) and computerized CBT (1 h of professional support), delivered within the context of a large pragmatic effectiveness trial (ISRCTN73535163).

RESULTS

While uptake was relatively high, continued engagement with the low intensity interventions was complex, with the perceived limitations of self-help materials impacting on users' willingness to continue therapy. The addition of professional support provided an acceptable compromise between the relative benefits of self-help and the need for professional input. However, individual differences were evident in the extent to which this compromise was considered necessary and acceptable. The need for some professional contact to manage expectations and personalize therapy materials was amplified in users with OCD, given the unique features of the disorder. However, individual differences were again evident regarding the perceived value of face-to-face support.

CONCLUSIONS

Overall the findings demonstrate the need for flexibility in the provision of low intensity interventions for OCD, responsive to user preferences, as these preferences impact directly on engagement with therapy and perceptions of effectiveness.

Self-guided internet-based and mobile-based stress management for employees: results of a randomised controlled trial

OBJECTIVE

This randomised controlled trial (RCT) aimed to evaluate the efficacy of a self-guided internet-based stress management intervention (iSMI) for employees compared to a 6-month wait-list control group (WLC) with full access for both groups to treatment as usual.

METHOD

A sample of 264 employees with elevated symptoms of perceived stress (Perceived Stress Scale, PSS-10 ≥22) was randomly assigned to either the iSMI or to the WLC. The iSMI consisted of seven sessions and one booster session including problem-solving and emotion regulation techniques. Self-report data were assessed at baseline, at 7 weeks and at 6 months following randomisation. The primary outcome was perceived stress (PSS-10). The secondary outcomes included other relevant mental-related and work-related health outcomes. Data were analysed based on intention-to-treat principles.

RESULTS

The iSMI participants showed a significantly higher reduction in perceived stress from baseline to post-treatment at 7 weeks (d=0.96, 95% CI 0.70 to 1.21) and to the 6-month follow-up (d=0.65, 95% CI 0.40 to 0.89) compared to the WLC. Significant differences with small to moderate effect sizes were also found for depression, anxiety, emotional exhaustion, sleeping problems, worrying, mental health-related quality of life, psychological detachment, emotion regulation skills and presenteeism, in favour of the experimental group. At the 6 -month follow-up, all outcomes remained significantly better for the experimental group with the exception of work engagement, physical health-related quality of life and absenteeism, which were not found to significantly differ between the iSMI and WLC groups.

CONCLUSIONS

The iSMI investigated in this study was found to be effective in reducing typical mental-related and work-related health symptoms of stressed employees. Internet-based self-guided interventions could be an acceptable, effective and potentially cost-effective approach to reduce the negative consequences associated with work-related stress.

Acceptability of internet interventions for youth mental health in Vietnam

BACKGROUND

Despite high levels of mental illness, Vietnamese youth have limited access to mental health care. Internet interventions, evidence-based psychotherapy treatments delivered through the internet, have the potential to increase access to mental health for youth in Vietnam. This study explored the perceptions of youths and parents toward internet interventions for youth mental health.

METHODS

Four focus groups were conducted with youths (n = 20) and parents (n = 20) in Danang, Vietnam. The Technology Acceptance Model was used a framework for focus group questions. The data were analyzed using direct content analysis.

RESULTS

Most youths and parents agreed that the internet serves well as a care delivery model. Participants expressed that the web would be useful for psychoeducation and sharing and receiving information with others. Both groups reported lack of awareness of web-based interventions and logistical concerns regarding access as main barriers. In addition, many parents were concerned about internet addiction. Specific adaptations in Vietnam such as standalone internet service centers and partnering with local organizations may benefit uptake of internet interventions.

CONCLUSION

This study suggests that internet-based programs for youth mental health, particularly interventions incorporating psychoeducation and social networking components, will be well received in Vietnam. Barriers need to be addressed to successfully implement internet-based treatment. Future initiatives should incorporate acceptance models to improve development of internet interventions for youth.

Development of a questionnaire measuring Attitudes towards Psychological Online Interventions-the APOI

BACKGROUND

Only a minority of people suffering from depression receive adequate treatment. Psychological Online Interventions (POIs) could help bridge existing treatment gaps and augment the effectiveness of current treatments. Apart from effectiveness, user acceptance of POIs must be achieved if such interventions are to be broadly implemented in existing health-care. Valid measurement tools examining attitudes towards POIs are lacking. Therefore, we examined the dimensionality of attitudes towards POIs, developed a novel questionnaire, the Attitudes towards Psychological Online Interventions Questionnaire (APOI), and gathered data to examine its reliability.

METHODS

We recruited a sample of 1004 adults with mild to moderate depressive symptoms from a range of sources. We constructed a set of 35 items based on literature review as well as expert and patient queries. The initial items were subjected to an exploratory factor analysis (EFA) in a randomly selected subsample. A final set of 16 items was subjected to a confirmatory factor analysis (CFA) to cross-validate the factor structure in a separate subsample.

RESULTS

The EFA revealed four dimensions: "Scepticism and Perception of Risks", "Confidence in Effectiveness", "Technologization Threat" and "Anonymity Benefits". The model fit in the CFA was excellent relating to all applied indices (χ(2)=105.816, p=.651; SRMR=.042; RMSEA=.013; CFI=.994) and the APOI total scale showed acceptable to good internal consistency.

CONCLUSIONS

Further research with the APOI might facilitate the development and dissemination of POIs and, ultimately, help improve the quality of care for people experiencing depressive symptoms.

Internet- und Mobilebasierte Interventionen in der Psychotherapie

Strukturelle Versorgungslücken und niedrige Inanspruchnahmeraten therapiebedürftiger Menschen beschränken eine bedarfsgerechte psychotherapeutische Versorgung. Internet- und Mobilebasierte Interventionen (IMIs) können als ort- und zeitunabhängige Angebote dazu beitragen, die psychotherapeutische Versorgung zu verbessern. Der vorliegende Beitrag gibt einen Überblick zum Gegenstandsbereich, der Evidenzbasierung sowie den Implementierungsmöglichkeiten von IMIs.