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Oudbier SJ, Souget-Ruff SP, Chen BSJ, Ziesemer KA, Meij HJ, Smets EMA. Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews. BMJ Open 2024; 14:e075833. [PMID: 38858155 PMCID: PMC11168143 DOI: 10.1136/bmjopen-2023-075833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVES Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs. DESIGN Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. DATA SOURCES Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline. ELIGIBILITY CRITERIA Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal. DATA EXTRACTION AND SYNTHESIS Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators. RESULTS Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients' aptitude with the technology (n=9/33), and technical issues (n=12/33). CONCLUSIONS The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
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Affiliation(s)
- Susan J Oudbier
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Digital Health, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
| | - Sylvie P Souget-Ruff
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Britney S J Chen
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Kirsten A Ziesemer
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hans J Meij
- Outpatient Division, Amsterdam UMC, Amsterdam, The Netherlands
- National University of Singapore Yong Loo Lin School of Medicine, Singapore
| | - Ellen M A Smets
- Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Quality of Care, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Personalized Medicine, Amsterdam, The Netherlands
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2
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O'Sullivan S, McEnery C, Cagliarini D, Hinton JDX, Valentine L, Nicholas J, Chen NA, Castagnini E, Lester J, Kanellopoulos E, D'Alfonso S, Gleeson JF, Alvarez-Jimenez M. A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study. JMIR Ment Health 2024; 11:e49217. [PMID: 38557432 PMCID: PMC11019426 DOI: 10.2196/49217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care. OBJECTIVE This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. METHODS A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. RESULTS eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. CONCLUSIONS eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services.
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Affiliation(s)
- Shaunagh O'Sullivan
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Daniela Cagliarini
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jordan D X Hinton
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
- Health Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Lee Valentine
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nicola A Chen
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | | | | | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - John F Gleeson
- Health Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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3
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Teesson M, Morgan C. Australian perspectives on shared goals for mental health research in the UK. J Ment Health 2023; 32:1022-1023. [PMID: 33966581 DOI: 10.1080/09638237.2021.1898565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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van Straten A, van Trigt S, Lancee J. How to boost implementation for insomnia treatment in primary care? Lancet 2023; 402:940-941. [PMID: 37573860 DOI: 10.1016/s0140-6736(23)01040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/11/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Annemieke van Straten
- Department of Clinical, Neuro, and Developmental psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Shanna van Trigt
- Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, Netherlands
| | - Jaap Lancee
- Department of Psychiatry and Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
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Mathiasen K, Holmberg Sainte-Marie TT, Skaarnes H, Jensen EK, Vis C, Tarp K. Implementing a revised online screening tool in a routine care online clinic treating anxiety and depression. Front Digit Health 2023; 5:1128893. [PMID: 37501814 PMCID: PMC10370275 DOI: 10.3389/fdgth.2023.1128893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
Introduction The ItFits implementation toolkit was developed as part of the ImpleMentAll EU Project, to help guide implementation processes. The ItFits toolkit was tested in the online clinic, Internetpsykiatrien, in the Region of Southern Denmark, where it was employed to optimize screening and intake procedures. We hypothesized that a larger proportion of assessed patients would be referred to treatment. Further, we hypothesized the completion rate and effectiveness would increase, as a result of including a more relevant sample. Method Using the ItFits-toolkit, Internetpsykiatrien developed a revised online screening tool. Data on patient flow and symptom questionnaires was extracted from Internetpsykiatrien six months prior to- and six months after implementation of the revised online screening tool. Results A total of 1,830 applicants self-referred for treatment during the study period. A significantly lower proportion of patients were referred to treatment after implementation of the revised screening tool (pre-implementation, n = 1,009; post-implementation, n = 821; odds ratio 0.67, 95% CI: 0.51; 0.87). The number of patients that completed treatment increased significantly (pre-implementation: 136/275 [49.45%], post-implementation, n = 102/162 [62.96%]; odds ratio 1.79, 95% CI 1.20; 2.70). The treatment effect was unchanged (B = 0.01, p = .996). Worth noting, the number of patients that canceled their appointment for the video assessment interview decreased drastically. Conclusion By using the ItFits toolkit for a focused and structured implementation effort, the clinic was able to improve the completion rate, which is an important effect in iCBT. However, contrary to our hypotheses, we did not find an increase in clinical effect, nor a larger ratio being referred to treatment after assessment. The decreased number of referrals for treatment could be a result of increased awareness of inclusion criteria among the clinicians.
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Affiliation(s)
- Kim Mathiasen
- Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Trine Theresa Holmberg Sainte-Marie
- Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Helene Skaarnes
- Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Esben Kjems Jensen
- Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Christiaan Vis
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Section for Research-Based Innovation, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
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Shin HD, Durocher K, Sequeira L, Zaheer J, Torous J, Strudwick G. Information and communication technology-based interventions for suicide prevention implemented in clinical settings: a scoping review. BMC Health Serv Res 2023; 23:281. [PMID: 36959599 PMCID: PMC10037806 DOI: 10.1186/s12913-023-09254-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/07/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND A large number of information and communication technology (ICT) based interventions exist for suicide prevention. However, not much is known about which of these ICTs are implemented in clinical settings and their implementation characteristics. In response, this scoping review aimed to systematically explore the breadth of evidence on ICT-based interventions for suicide prevention implemented in clinical settings and then to identify and characterize implementation barriers and facilitators, as well as evaluation outcomes, and measures. METHODS We conducted this review following the Joanna Briggs Institute methodology for scoping reviews. A search strategy was applied to the following six databases between August 17-20, 2021: MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and Library, Information Science and Technology Abstracts. We also supplemented our search with Google searches and hand-searching reference lists of relevant reviews. To be included in this review, studies must include ICT-based interventions for any spectrum of suicide-related thoughts and behaviours including non-suicidal self-injury. Additionally, these ICTs must be implemented in clinical settings, such as emergency department and in-patient units. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to prepare this full report. RESULTS This review included a total of 75 citations, describing 70 studies and 66 ICT-based interventions for suicide prevention implemented in clinical settings. The majority of ICTs were computerized interventions and/or applications (n = 55). These ICTs were commonly used as indicated strategies (n = 49) targeting patients who were actively presenting with suicide risk. The three most common suicide prevention intervention categories identified were post-discharge follow-up (n = 27), screening and/or assessment (n = 22), and safety planning (n = 20). A paucity of reported information was identified related to implementation strategies, barriers and facilitators. The most reported implementation strategies included training, education, and collaborative initiatives. Barriers and facilitators of implementation included the need for resource supports, knowledge, skills, motivation as well as engagement with clinicians with research teams. Studies included outcomes at patient, clinician, and health system levels, and implementation outcomes included acceptability, feasibility, fidelity, and penetration. CONCLUSION This review presents several trends of the ICT-based interventions for suicide prevention implemented in clinical settings and identifies a need for future research to strengthen the evidence base for improving implementation. More effort is required to better understand and support the implementation and sustainability of ICTs in clinical settings. The findings can also serve as a future resource for researchers seeking to evaluate the impact and implementation of ICTs.
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Affiliation(s)
- Hwayeon Danielle Shin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
- School of Health, Community Service & Creative Design, Lambton College, Sarnia, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Health Outcomes and Performance Evaluation (HOPE) Research Unit, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Gerald Sheff and Shanitha Kachan Emergency Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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7
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Eysenbach G, Schuurmans J, Aouizerate B, Atipei Craggs M, Batterham P, Bührmann L, Calear A, Cerga Pashoja A, Christensen H, Dozeman E, Duedal Pedersen C, Ebert DD, Etzelmueller A, Fanaj N, Finch TL, Hanssen D, Hegerl U, Hoogendoorn A, Mathiasen K, May C, Meksi A, Mustafa S, O'Dea B, Oehler C, Piera-Jiménez J, Potthoff S, Qirjako G, Rapley T, Rosmalen J, Sacco Y, Samalin L, Skjoth MM, Tarp K, Titzler I, Van der Eycken E, van Genugten CR, Whitton A, Zanalda E, Smit JH, Riper H. Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial. J Med Internet Res 2023; 25:e41532. [PMID: 36735287 PMCID: PMC9938445 DOI: 10.2196/41532] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. OBJECTIVE This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. METHODS A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. RESULTS In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. CONCLUSIONS The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-04686-4.
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Affiliation(s)
| | | | - Bruno Aouizerate
- Regional Reference Center for the Management and Treatment of Anxiety and Depressive Disorders, FondaMental Advanced Centre of Expertise in Resistant Depression, Deparment of General and Academic Psychiatry, Charles Perrens Hospital, Bordeaux, France
| | - Mette Atipei Craggs
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Philip Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Leah Bührmann
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Alison Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | | | - Helen Christensen
- Department of Medicine, University of New South Wales, Sydney, Australia
| | | | | | - David Daniel Ebert
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Anne Etzelmueller
- Professorship Psychology & Digital Mental Health, Technical University of Munich, Munich, Germany.,HelloBetter, GET.ON Institut für Online Gesundheitstrainings GmbH, Berlin, Germany
| | - Naim Fanaj
- Mental Health Center Prizren, Prizren, Kosovo
| | - Tracy L Finch
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Denise Hanssen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ulrich Hegerl
- German Depression Foundation, Leipzig, Germany.,Department of Psychiatry, Psychosomatics, and Psychotherapy, Goethe Universität, Frankfurt am Main, Germany
| | - Adriaan Hoogendoorn
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,GGZ InGeest, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Kim Mathiasen
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Carl May
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | | | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain.,Digitalization for the Sustainability of the Healthcare System DS3-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Sebastian Potthoff
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Gentiana Qirjako
- Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle Upon Tyne, United Kingdom
| | - Judith Rosmalen
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ylenia Sacco
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Ludovic Samalin
- Department of psychiatry, Centre Hospitalier Universitaire de Clermont-Ferrand, Expert center for bipolar disorder (Foundation FondaMental), University of Clermont Auvergne, Clermont-Ferrand, France.,Centre national de la recherche scientifique, Clermont-Auvergne INP, Institut Pascal (UMR 6602), Clermont-Ferrand, France
| | - Mette Maria Skjoth
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - Kristine Tarp
- Research Unit for Digital Psychiatry, Deptartment of Clinical Research, University of Southern Denmark, Odense, Denmark.,Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark
| | - Ingrid Titzler
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | | | - Claire Rosalie van Genugten
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands
| | - Alexis Whitton
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Enrico Zanalda
- Department of Mental Health, Local Health Authority Torino 3, ASLTO3, Torino, Italy
| | - Jan H Smit
- Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
| | - Heleen Riper
- Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health research institute, Amsterdam, Netherlands.,Psychiatry, Amsterdam University Medical Center - location VUmc, Amsterdam, Netherlands
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Leung T, Gulliver A, Sunderland M, Farrer L, Kay-Lambkin F, Trias A, Calear A. Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort. J Med Internet Res 2023; 25:e41663. [PMID: 36729613 PMCID: PMC9936370 DOI: 10.2196/41663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community. OBJECTIVE In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake. METHODS Australian adults aged ≥18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings. RESULTS Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99% CI 1.71-5.19; P<.001) use behaviors. CONCLUSIONS Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs.
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Affiliation(s)
| | - Amelia Gulliver
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Louise Farrer
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | | | - Angelica Trias
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
| | - Alison Calear
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton ACT, Australia
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Van Assche E, Bonroy B, Mertens M, Van den Broeck L, Desie K, Bolinski F, Amarti K, Kleiboer A, Riper H, Van Daele T. E-mental health implementation in inpatient care: Exploring its potential and future challenges. Front Digit Health 2022; 4:1027864. [PMID: 36588747 PMCID: PMC9795214 DOI: 10.3389/fdgth.2022.1027864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background There is a great evidence base today for the effectiveness of e-mental health, or the use of technology in mental healthcare. However, large-scale implementation in mental healthcare organisations is lacking, especially in inpatient specialized mental healthcare settings. Aim The current study aimed to gain insights into the factors that promote or hinder the implementation of e-mental health applications on organisational, professional and patient levels in Belgium. Methods Four Belgian psychiatric hospitals and psychiatric departments of general hospitals invited their professionals and patients to use Moodbuster, which is a modular web-based platform with a connected smartphone application for monitoring. The platform was used in addition to treatment as usual for three to four months. The professionals and patients completed pre- and post-implementation questionnaires on their reasons to participate or to decline participation and experiences with the Moodbuster platform. Results Main reasons for the organisations to participate in the implementation study were a general interest in e-mental health and seeing it is a helpful add-on to regular treatment. The actual use of Moodbuster by professionals and patients proved to be challenging with only 10 professionals and 24 patients participating. Implementation was hindered by technical difficulties and inpatient care specific factors such as lack of structural facilities to use e-mental health and patient-specific factors. Professionals saw value in using e-mental health applications for bridging the transition from inpatient to outpatient care. Twenty-two professionals and 31 patients completed the questionnaire on reasons not to participate. For the patients, lack of motivation because of too severe depressive symptoms was the most important reason not to participate. For professionals, it was lack of time and high workload. Conclusions The current implementation study reveals several important barriers to overcome in order to successfully implement e-mental health in inpatient psychiatric care.
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Affiliation(s)
- Eva Van Assche
- Thomas More University of Applied Sciences, Antwerp, Belgium,Correspondence: Eva Van Assche
| | - Bert Bonroy
- Thomas More University of Applied Sciences, Geel, Belgium
| | - Marc Mertens
- Thomas More University of Applied Sciences, Geel, Belgium
| | | | | | - Felix Bolinski
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Khadicha Amarti
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Annet Kleiboer
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands,Department of Psychiatry, Amsterdam University Medical Centre (VUmc), Amsterdam, Netherlands,Faculty of Medicine, University of Turku, Turku, Finland
| | - Tom Van Daele
- Thomas More University of Applied Sciences, Antwerp, Belgium
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Scott S, Knott V, Finlay-Jones AL, Mancini VO. Australian Psychologists Experiences with Digital Mental Health: a Qualitative Investigation. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-11. [PMID: 35991293 PMCID: PMC9381152 DOI: 10.1007/s41347-022-00271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
Digital mental health is changing the landscape of service delivery by addressing challenges associated with traditional therapy. However, practitioners' use of these resources remains underexamined. This study explored psychologists' attitudes and experiences with digital mental health intervention. Taking a qualitative exploratory approach via thematic analysis, the study sought to answer the following research questions: (i) How do psychologists perceive digital mental health? and (ii) What is their experience using digital mental health as part of routine practice? Ten practising psychologists participated in online semi-structured interviews (approximately 50 min), with interviews then transcribed verbatim. Interview data were analysed according to the six-phase approach to thematic analysis proposed by Braun and Clarke. Three themes were identified: (1) attitudes towards digital mental health; (2) use within routine practice; and (3) perspectives on an effective model for implementation. Practitioners play a major role in the design and delivery of digital mental health services. Barriers and facilitators at the practitioner-level (e.g. knowledge and competence with tools, perceptions on the utility of digital interventions) and the service-level (e.g. government support for digital health) should be considered in the future design of digital mental health resources and service delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-022-00271-5.
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Affiliation(s)
- Stephanie Scott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Vikki Knott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Amy L. Finlay-Jones
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
| | - Vincent O. Mancini
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
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Barrera AZ, Morris SY, Ruiz A. Mothers and Babies Online Course: Participant Characteristics and Behaviors in a Web-Based Prevention of Postpartum Depression Intervention. Front Glob Womens Health 2022; 3:846611. [PMID: 35814836 PMCID: PMC9263388 DOI: 10.3389/fgwh.2022.846611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/31/2022] [Indexed: 11/23/2022] Open
Abstract
Despite the availability of evidence-based postpartum depression (PPD) prevention and treatment interventions, perinatal persons continue to suffer. eHealth and mHealth tools to address mental health issues have grown exponentially, especially given the ubiquity of technology and the increased demand for telemental health resources. The Mothers and Babies Online Course (eMB), an 8-lesson prevention of PPD intervention, was digitally adapted to expand the reach of evidence-based interventions to perinatal persons with limited access to maternal mental health resources. This report describes the characteristics, behaviors, and feedback provided by users of the updated eMB website. Two hundred eight predominantly English-speaking U.S. residents enrolled in the eMB. Thirty-seven percent were either pregnant (n = 38) or postpartum (n = 39) women interested in learning skills to manage changes in their mood during and after pregnancy; 63% were health providers (n = 131) interested in learning how to support their patient communities. Seventy-six percent (n = 159) viewed at least one of the eight eMB lessons, with 50.9% exclusively viewing Lesson 1. Few (4.4%) viewed all eight lessons. The lessons were rated favorably on usefulness and understanding. Perinatal women engaged with interactive content at higher rates than health providers. Examining user behaviors and feedback is an essential developmental step before empirically testing the efficacy of digital tools. Future iterations of the eMB will incorporate these preliminary findings to provide perinatal persons with accessible web-based interventions that will hopefully reduce the incidence and negative consequences of postpartum depression.
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12
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Parker E, Banfield M. Consumer Perspectives on Anxiety Management in Australian General Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095706. [PMID: 35565105 PMCID: PMC9103805 DOI: 10.3390/ijerph19095706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
The aim of the current study was to explore consumer views on the management of anxiety in general practice, which is often the first service from which a consumer seeks professional support. We used a mixed methods survey to explore three broad research questions: (1) what are consumer experiences of anxiety management in general practice, (2) what do consumers prioritise when considering treatment for anxiety and what are their preferences for type of treatment, and (3) how do consumers think care for anxiety could be improved? Consumers reported generally positive views of their GP when seeking help for anxiety, though they had mixed experiences of the approach taken to treatment. Consumers noted that they prioritise effective treatment above other factors and are less concerned with how quickly their treatment works. A preference for psychological intervention or combined treatment with medication was apparent. Consumers noted that key areas for improving care for anxiety were improving access and funding for psychological treatments, increasing community knowledge about anxiety, and reducing stigma.
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Affiliation(s)
- Erin Parker
- Research School of Psychology, Australian National University, Canberra 2601, Australia
- Correspondence: (E.P.); (M.B.)
| | - Michelle Banfield
- Centre for Mental Health Research, Australian National University, Canberra 2601, Australia
- Correspondence: (E.P.); (M.B.)
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13
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Batterham PJ, Gulliver A, Kurz E, Farrer LM, Vis C, Schuurmans J, Calear AL. The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study. J Med Internet Res 2022; 24:e34769. [PMID: 35522458 PMCID: PMC9123540 DOI: 10.2196/34769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/27/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community. Objective This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies. Methods Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program—a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants. Results Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity. Conclusions The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Ella Kurz
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
| | - Christiaan Vis
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Alison L Calear
- Centre for Mental Health Research, The Australian National University, Canberra, Australia
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Batterham PJ, Christensen H, Calear AL, Werner-Seidler A, Kazan D. Rates and Predictors of Deterioration in a Trial of Internet-Delivered Cognitive Behavioral Therapy for Reducing Suicidal Thoughts. Arch Suicide Res 2022; 26:937-947. [PMID: 33215554 DOI: 10.1080/13811118.2020.1848671] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE It is necessary for suicide prevention interventions to demonstrate safety. One important aspect of safety is evidence that deterioration rates are low. No studies have examined deterioration of suicidal ideation in the context of an internet-based cognitive behavioral therapy (CBT) intervention to reduce suicidal ideation. A secondary analysis of the outcomes of an online trial was conducted to determine rates of deterioration in a CBT intervention called Living with Deadly Thoughts, relative to an attention control condition, and to identify factors associated with deterioration. METHOD The randomized controlled trial included 418 adults with suicidal ideation at baseline (77% females, mean age 40.6 years). Deterioration was defined in two ways: a reliable increase in Suicidal Ideation Attributes Scale (SIDAS score) of ≥6.0 units; or triggering the safety protocol during the trial as determined by high levels of suicidality. Analyses were repeated with multiply imputed data. Predictors of deterioration were identified using logistic regression analysis. RESULTS 30 (14%) participants in the control group and 15 (7%) in the intervention group met criteria for reliable deterioration (Fisher's exact p = 0.027). In a fully adjusted logistic regression model, greater initial severity of suicidal thinking was associated with lower odds of deterioration, while intervention condition, demographics, psychological factors and mental health factors had no significant association with deterioration. CONCLUSIONS Participation in an online suicide prevention intervention was associated with lower prevalence of reliable deterioration than participation in an attention-control intervention, providing further evidence that internet-based CBT interventions do not cause harm.HighlightsFirst study to assess deterioration in an internet suicide prevention interventionRates of reliable deterioration were higher in control (14%) than intervention (7%)No psychological or demographic factors were robustly associated with deteriorationFindings provide further evidence that internet based CBT programs are not harmful.
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15
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Neher M, Nygårdh A, Broström A, Lundgren J, Johansson P. Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study. J Med Internet Res 2022; 24:e28870. [PMID: 35089139 PMCID: PMC8838545 DOI: 10.2196/28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/01/2021] [Accepted: 10/14/2021] [Indexed: 12/20/2022] Open
Abstract
Background Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers’ conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth.
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Affiliation(s)
- Margit Neher
- Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Annette Nygårdh
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Anders Broström
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Gan DZQ, McGillivray L, Larsen ME, Christensen H, Torok M. Technology-supported strategies for promoting user engagement with digital mental health interventions: A systematic review. Digit Health 2022; 8:20552076221098268. [PMID: 35677785 PMCID: PMC9168921 DOI: 10.1177/20552076221098268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/12/2022] [Indexed: 01/12/2023] Open
Abstract
Background Although digital mental health interventions (DMHIs) offer a potential
solution for increasing access to mental health treatment, their integration
into real-world settings has been slow. A key reason for this is poor user
engagement. A growing number of studies evaluating strategies for promoting
engagement with DMHIs means that a review of the literature is now
warranted. This systematic review is the first to synthesise evidence on
technology-supported strategies for promoting engagement with DMHIs. Methods MEDLINE, EmbASE, PsycINFO and PubMed databases were searched from 1 January
1995 to 1 October 2021. Experimental or quasi-experimental studies examining
the effect of technology-supported engagement strategies deployed alongside
DMHIs were included, as were secondary analyses of such studies. Title and
abstract screening, full-text coding and quality assessment were performed
independently by two authors. Narrative synthesis was used to summarise
findings from the included studies. Results 24 studies (10,266 participants) were included. Engagement strategies ranged
from reminders, coaching, personalised information and peer support. Most
strategies were disseminated once a week, usually via email or telephone.
There was some empirical support for the efficacy of technology-based
strategies towards promoting engagement. However, findings were mixed
regardless of strategy type or study aim. Conclusions Technology-supported strategies appear to increase engagement with DMHIs;
however, their efficacy varies widely by strategy type. Future research
should involve end-users in the development and evaluation of these
strategies to develop a more cohesive set of strategies that are acceptable
and effective for target audiences, and explore the mechanism(s) through
which such strategies promote engagement.
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Affiliation(s)
- Daniel Z Q Gan
- Black Dog Institute, University of New South Wales, Australia
| | | | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Australia
| | | | - Michelle Torok
- Black Dog Institute, University of New South Wales, Australia
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Ellis LA, Meulenbroeks I, Churruca K, Pomare C, Hatem S, Harrison R, Zurynski Y, Braithwaite J. The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis. JMIR Ment Health 2021; 8:e32948. [PMID: 34666306 PMCID: PMC8651237 DOI: 10.2196/32948] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/28/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the "new normal." OBJECTIVE The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. METHODS We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. RESULTS A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. CONCLUSIONS COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sarah Hatem
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Reema Harrison
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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Batterham PJ, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Christensen H, Gulliver A. A Brief Intervention to Increase Uptake and Adherence of an Internet-Based Program for Depression and Anxiety (Enhancing Engagement With Psychosocial Interventions): Randomized Controlled Trial. J Med Internet Res 2021; 23:e23029. [PMID: 34313595 PMCID: PMC8367139 DOI: 10.2196/23029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/24/2020] [Accepted: 06/04/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Psychosocial, self-guided, internet-based programs are effective in treating depression and anxiety. However, the community uptake of these programs is poor. Recent approaches to increasing engagement (defined as both uptake and adherence) in internet-based programs include brief engagement facilitation interventions (EFIs). However, these programs require evaluation to assess their efficacy. OBJECTIVE The aims of this hybrid implementation effectiveness trial are to examine the effects of a brief internet-based EFI presented before an internet-based cognitive behavioral therapy self-help program (myCompass 2) in improving engagement (uptake and adherence) with that program (primary aim), assess the relative efficacy of the myCompass 2 program, and determine whether greater engagement was associated with improved efficacy (greater reduction in depression or anxiety symptoms) relative to the control (secondary aim). METHODS A 3-arm randomized controlled trial (N=849; recruited via social media) assessed the independent efficacy of the EFI and myCompass 2. The myCompass 2 program was delivered with or without the EFI; both conditions were compared with an attention control condition. The EFI comprised brief (5 minutes), tailored audio-visual content on a series of click-through linear webpages. RESULTS Uptake was high in all groups; 82.8% (703/849) of participants clicked through the intervention following the pretest survey. However, the difference in uptake between the EFI + myCompass 2 condition (234/280, 83.6%) and the myCompass 2 alone condition (222/285, 77.9%) was not significant (n=565; χ21=29.2; P=.09). In addition, there was no significant difference in the proportion of participants who started any number of modules (1-14 modules) versus those who started none between the EFI + myCompass 2 (214/565, 37.9%) and the myCompass 2 alone (210/565, 37.2%) conditions (n=565; χ21<0.1; P=.87). Finally, there was no significant difference between the EFI + myCompass 2 and the myCompass 2 alone conditions in the number of modules started (U=39366.50; z=-0.32; P=.75) or completed (U=39494.0; z=-0.29; P=.77). The myCompass 2 program was not found to be efficacious over time for symptoms of depression (F4,349.97=1.16; P=.33) or anxiety (F4,445.99=0.12; P=.98). However, planned contrasts suggested that myCompass 2 may have been effective for participants with elevated generalized anxiety disorder symptoms (F4,332.80=3.50; P=.01). CONCLUSIONS This brief internet-based EFI did not increase the uptake of or adherence to an existing internet-based program for depression and anxiety. Individuals' motivation to initiate and complete internet-based self-guided interventions is complex and remains a significant challenge for self-guided interventions. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001565235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle., Newcastle, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Helen Christensen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Gulliver A, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Batterham PJ. Predictors of acceptability and engagement in a self-guided online program for depression and anxiety. Internet Interv 2021; 25:100400. [PMID: 34026569 PMCID: PMC8122006 DOI: 10.1016/j.invent.2021.100400] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Low engagement with self-guided online programs limits the potential of these programs to provide effective and low-cost treatment of mild to moderate depression and anxiety at scale. Identifying factors that increase uptake and adherence in self-guided online programs may facilitate the development of targeted implementation strategies to increase engagement with these programs in the community. Using data from a randomized controlled trial of a self-guided online program for depression and anxiety, the aim of this study was to identify predictors of the acceptability of internet-based psychological programs, and engagement (uptake and adherence) with the online program tested in the trial. METHODS A total of 556 community members with elevated symptoms of depression or anxiety were recruited via social media into the two active conditions of a three-arm randomized controlled trial. This trial tested the effectiveness of a 7-week self-guided online program for depression and anxiety called myCompass 2, delivered with or without an Engagement-Facilitation Intervention. Predictors of uptake (accessing at least one therapeutic module of the program), adherence (modules completed), and acceptability of internet-based psychological programs (Unified Theory of Acceptance and Use of Technology, UTAUT scale) were examined, including demographics, mental health status, help-seeking attitudes, stigma, acceptability of internet programs, and personality factors. RESULTS Logistic regression demonstrated that higher levels of conscientiousness (OR = 1.06, p = .026, 95% CI =1.01-1.12), and acceptability of internet-based psychological programs (OR = 1.09, p = .005, 95% CI =1.03-1.16) predicted greater uptake, and that failing to complete a module was predicted by lower levels of acceptability (OR = 0.88, p = .027, 95% CI =0.78-0.99). Linear regression showed that higher levels of agreeableness (t = 4.66, p < .001), lower levels of stigma (t = -2.28, p = .023) and more positive help-seeking attitudes (t = 2.05, p = .041) predicted higher acceptability attitudes. DISCUSSION Acceptability of internet-based psychological programs was identified as a factor that increased both uptake and adherence to the myCompass 2 program. Efforts to increase the acceptability of these programs may improve engagement with these programs in the community. It may also be useful to consider personality traits and clinical profiles when considering the appropriate audience for self-guided internet interventions.
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Affiliation(s)
- Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, ACT 2601 Australia,Corresponding author at: Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, ACT 2601 Australia.
| | - Alison L. Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, ACT 2601 Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown NSW 2006, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, McAuley Centre, University Drive, Callaghan, NSW 2308, Australia
| | - Louise M. Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, ACT 2601 Australia
| | - Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, ACT 2601 Australia
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20
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Weightman M. Digital psychotherapy as an effective and timely treatment option for depression and anxiety disorders: Implications for rural and remote practice. J Int Med Res 2021; 48:300060520928686. [PMID: 32527170 PMCID: PMC7294488 DOI: 10.1177/0300060520928686] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Patients in regional, rural and remote communities experience perennial difficulties accessing mental health treatments in a timely manner, which contributes to inequitable outcomes when compared with their metropolitan counterparts. This situation frequently stems from a shortage of specialised face-to-face psychotherapy services available in local areas. The recent development of digital psychotherapy as an alternative treatment delivery method provides an opportunity to address this healthcare gap and to avoid the challenges related to workforce maldistribution. This article provides a targeted narrative review of the relevant evidence base, and discusses the potential applications within the rural and remote context. Multiple randomised controlled trials and a large meta-analysis demonstrate that digital psychotherapy, particularly cognitive-behavioural therapy, is as effective as face-to-face psychotherapy. Its use has consequently been endorsed across international clinical practice guidelines as an efficacious and practical way to provide mental healthcare. Despite this, the adoption of digital psychotherapeutic options has been limited to date. Increased awareness of the available options may improve access to psychological treatments in rural and remote populations. Digital psychotherapy should be considered an option for patients with depressive or anxiety disorders of mild-to-moderate severity.
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Affiliation(s)
- Michael Weightman
- Rural and Remote Mental Health Service, SA Health, Glenside, SA, Australia.,Discipline of Psychiatry, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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21
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Batterham PJ, Kazan D, Banfield M, Brown K. Differences in mental health service use between urban and rural areas of Australia. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1111/ap.12449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Dominique Kazan
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia,
| | - Kimberly Brown
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia,
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22
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23
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Gulliver A, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Banfield M, Batterham PJ. Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey. JMIR Form Res 2020; 4:e22528. [PMID: 33118939 PMCID: PMC7661236 DOI: 10.2196/22528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs. Objective This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e–mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs. Methods A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e–mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods. Results Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program’s content or effectiveness and data security, and normalization of using e–mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence. Conclusions EFIs have the potential to improve community uptake of e–mental health programs. They should focus on providing information on the content and effectiveness of e–mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.
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Affiliation(s)
- Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Newcastle, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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24
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Drissi N, Ouhbi S, Janati Idrissi MA, Fernandez-Luque L, Ghogho M. Connected Mental Health: Systematic Mapping Study. J Med Internet Res 2020; 22:e19950. [PMID: 32857055 PMCID: PMC7486675 DOI: 10.2196/19950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. OBJECTIVE The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. METHODS A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. RESULTS The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. CONCLUSIONS CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues.
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Affiliation(s)
- Nidal Drissi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates.,National School For Computer Science, Mohammed V University in Rabat, Rabat, Morocco
| | - Sofia Ouhbi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Mounir Ghogho
- TICLab, International University of Rabat, Rabat, Morocco
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25
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Raphiphatthana B, Maulana H, Howarth T, Gardner K, Nagel T. Digital Mental Health Resources for Asylum Seekers, Refugees, and Immigrants: Protocol for a Scoping Review. JMIR Res Protoc 2020; 9:e19031. [PMID: 32831185 PMCID: PMC7477666 DOI: 10.2196/19031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Asylum seekers, refugees, and immigrants experience a number of risk factors for mental health problems. However, in comparison to the host population, these populations are less likely to use mental health services. Digital mental health approaches have been shown to be effective in improving well-being for the general population. Thus, they may provide an effective and culturally appropriate strategy to bridge the treatment gap for these populations vulnerable to mental health risks. OBJECTIVE This paper aims to provide the background and rationale for conducting a scoping review on digital mental health resources for asylum seekers, refugees, and immigrants. It also provides an outline of the methods and analyses, which will be used to answer the following questions. What are the available digital mental health resources for asylum seekers, refugees, and immigrants? Are they effective, feasible, appropriate, and accepted by the population? What are the knowledge gaps in the field? METHODS The scoping review methodology will follow 5 phases: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. Searches will be conducted in the following databases: EBSCOhost databases (CINAHL Plus with Full Text, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, and APA PsycInfo), PubMed, and Scopus. Additionally, OpenGrey, Mednar, and Eldis will be searched for gray literature. All primary studies and gray literature in English concerning the use of information and communication technology to deliver services addressing mental health issues for asylum seekers, refugees, and immigrants will be included. RESULTS This scoping review will provide an overview of the available digital mental health resources for asylum seekers, refugees, and immigrants and describe the implementation outcomes of feasibility, acceptability, and appropriateness of such approaches for those populations. Potential gaps in the field will also be identified. CONCLUSIONS As of February 2020, there were no scoping reviews, which assessed the effectiveness, feasibility, acceptability, and appropriateness of the available digital mental health resources for asylum seekers, refugees, and immigrants. This review will provide an extensive coverage on a promising and innovative intervention for such populations. It will give insight into the range of approaches, their effectiveness, and progress in their implementation. It will also provide valuable information for health practitioners, policy makers, and researchers working with the population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/19031.
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Affiliation(s)
| | - Herdiyan Maulana
- Faculty of Psychology, State University of Jakarta, Jakarta, Indonesia
| | - Timothy Howarth
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,College of Health and Human Sciences, Charles Darwin University, Darwin, Australia
| | | | - Tricia Nagel
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
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26
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Raphiphatthana B, Sweet M, Puszka S, Dingwall K, Nagel T. Evaluation of a three-phase implementation program in enhancing e-mental health adoption within Indigenous primary healthcare organisations. BMC Health Serv Res 2020; 20:576. [PMID: 32576266 PMCID: PMC7313213 DOI: 10.1186/s12913-020-05431-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 06/15/2020] [Indexed: 01/25/2023] Open
Abstract
Background A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program. Methods A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature. Results The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice. Conclusions By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches.
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Affiliation(s)
- Buaphrao Raphiphatthana
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia.
| | - Michelle Sweet
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Stefanie Puszka
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Kylie Dingwall
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
| | - Tricia Nagel
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, NT, 0811, Australia
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27
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Raphiphatthana B, Sweet M, Puszka S, Whitty M, Dingwall K, Nagel T. Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated "Promoting Action on Research Implementation in Health Services" Framework: Qualitative Study. JMIR Ment Health 2020; 7:e14835. [PMID: 32452812 PMCID: PMC7284395 DOI: 10.2196/14835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 11/25/2019] [Accepted: 02/29/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. OBJECTIVE This study aimed to understand service providers' perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. METHODS Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops. RESULTS Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. CONCLUSIONS The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support.
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Affiliation(s)
| | | | | | - Megan Whitty
- Australian National University, Canberra, Australia
| | | | - Tricia Nagel
- Menzies School of Health Research, Casuarina, Australia
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28
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Ellis LA, Augustsson H, Grødahl AI, Pomare C, Churruca K, Long JC, Ludlow K, Zurynski YA, Braithwaite J. Implementation of e-mental health for depression and anxiety: A critical scoping review. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:904-920. [PMID: 31944324 DOI: 10.1002/jcop.22309] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
The aim of this review was to scope the growth and development of implementation research of e-mental healthcare programs for anxiety and depression, the research and evaluation tools used, and the specific implementation processes and outcomes examined. A search of four electronic databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) was conducted from January 2000 to January 2019. Of 33 studies identified, most (n = 28) were published in the last five years. Only 10 used an implementation framework to guide implementation or evaluation. Most studies reported on acceptability (n = 28), appropriateness (n = 23), and feasibility (n = 17). Less commonly reported implementation outcomes were fidelity (n = 10) and adoption (n = 7); with penetration (n = 4), sustainability (n = 3), and implementation cost (n = 2) being studied rarely. Of the 21 studies that used surveys to study implementation outcomes, less than half used a previously published survey (n = 9). More rigorous implementation studies, underpinned by strong theory and real-world understanding, are urgently needed.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Hanna Augustsson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Department of Learning, Medical Management Centre, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Anne I Grødahl
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Kristiana Ludlow
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Yvonne A Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Partnership Centre in Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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29
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Wilhelm S, Weingarden H, Ladis I, Braddick V, Shin J, Jacobson NC. Cognitive-Behavioral Therapy in the Digital Age: Presidential Address. Behav Ther 2020; 51:1-14. [PMID: 32005328 PMCID: PMC7155747 DOI: 10.1016/j.beth.2019.08.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/01/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Our field has come a long way in establishing cognitive-behavioral therapy as the empirically supported treatment of choice for a wide range of mental and behavioral health problems. Nevertheless, most individuals with mental disorders do not receive any care at all, and those who do often have difficulty accessing care that is consistently high in quality. Addressing these issues is complex and costly and thus progress has been slow. We are entering an exciting stage in which emerging technologies might offer novel solutions to the treatment gap. This paper discusses a number of technology-enabled solutions to our field's challenges, including Internet-based and smartphone-based cognitive-behavioral therapy. Nevertheless, we must remain attentive to potential pitfalls of these emerging technologies. The paper incorporates suggestions for how the field may approach these potential pitfalls and provides a vision for how we might develop powerful, scalable, precisely timed, personalized interventions to enhance global mental health.
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Affiliation(s)
| | | | - Ilana Ladis
- Massachusetts General Hospital/Harvard Medical School
| | | | - Jin Shin
- Massachusetts General Hospital/Harvard Medical School
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30
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Fleming TM, Stasiak K, Moselen E, Hermansson-Webb E, Shepherd M, Lucassen M, Bavin LM, Merry SN. Revising Computerized Therapy for Wider Appeal Among Adolescents: Youth Perspectives on a Revised Version of SPARX. Front Psychiatry 2019; 10:802. [PMID: 31824344 PMCID: PMC6883402 DOI: 10.3389/fpsyt.2019.00802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 10/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background: The way in which computerized therapy is presented may be important for its uptake. We aimed to explore adolescents' views on the appeal of a tested computerized cognitive behavioral therapy (CCBT) for depression (SPARX), and a revised version (SPARX-R). The versions were similar but while SPARX is presented explicitly as a treatment for depression, SPARX-R is presented as providing skills that could be useful for young people for when they were depressed, down, angry, or stressed. Methods: We held 9 focus groups with a total of 79 adolescents (13-19 years old; 47 females; 34 New Zealand European; 22 Māori or Pacific; 60 reported having experienced feeling down or low for at least several days in a row). Groups viewed the opening sequences of SPARX and SPARX-R (in random order), then took part in a semi-structured discussion and completed a brief questionnaire. Responses were analyzed using a general inductive approach. Results: Participants considered both SPARX and SPARX-R useful and considered the stated purpose of the program to be important. Four themes contrasted the two approaches. The first, "naming depression is risky", referred to perceptions that an explicit focus on depression could be off-putting, including for adolescents with depression. The second theme of "universality" reflected preferences for a universal approach as young people might not recognize that they were depressed, and all would benefit from the program. In contrast, "validation" reflected the view of a significant minority that naming depression could be validating for some. Finally, the theme of "choice" reflected a near-unanimously expressed preference for both options to be offered, allowing user choice. In questionnaire responses, 40 (68%) of participants preferred SPARX-R, 13 (18%) preferred SPARX, while 10 (14%) "didn't mind". Responses were similar among participants who reported that they had experienced at least a few days of low mood and those who had not. Conclusions: The way a CCBT program is presented may have implications for its appeal. The potential population impact of CCBT programs explicitly targeting depression and those targeting more universal feelings such as being stressed or feeling depressed should be explored for varied user groups.
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Affiliation(s)
- Theresa M. Fleming
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Emma Moselen
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Eve Hermansson-Webb
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Mathijs Lucassen
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- School of Health, Wellbeing and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Lynda M. Bavin
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Sally Nicola Merry
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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31
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Schreiweis B, Pobiruchin M, Strotbaum V, Suleder J, Wiesner M, Bergh B. Barriers and Facilitators to the Implementation of eHealth Services: Systematic Literature Analysis. J Med Internet Res 2019; 21:e14197. [PMID: 31755869 PMCID: PMC6898891 DOI: 10.2196/14197] [Citation(s) in RCA: 135] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/09/2019] [Accepted: 09/01/2019] [Indexed: 12/18/2022] Open
Abstract
Background The field of eHealth has a history of more than 20 years. During that time, many different eHealth services were developed. However, factors influencing the adoption of such services were seldom the main focus of analyses. For this reason, organizations adopting and implementing eHealth services seem not to be fully aware of the barriers and facilitators influencing the integration of eHealth services into routine care. Objective The objective of this work is to provide (1) a comprehensive list of relevant barriers to be considered and (2) a list of facilitators or success factors to help in planning and implementing successful eHealth services. Methods For this study, a twofold approach was applied. First, we gathered experts’ current opinions on facilitators and barriers in implementing eHealth services via expert discussions at two health informatics conferences held in Europe. Second, we conducted a systematic literature analysis concerning the barriers and facilitators for the implementation of eHealth services. Finally, we merged the results of the expert discussions with those of the systematic literature analysis. Results Both expert discussions (23 and 10 experts, respectively) identified 15 barriers and 31 facilitators, whereas 76 barriers and 268 facilitators were found in 38 of the initial 56 articles published from 12 different countries. For the analyzed publications, the count of distinct barriers reported ranged from 0 to 40 (mean 10.24, SD 8.87, median 8). Likewise, between 0 and 48 facilitators were mentioned in the literature (mean 9.18, SD 9.33, median 6). The combination of both sources resulted in 77 barriers and 292 facilitators for the adoption and implementation of eHealth services. Conclusions This work contributes a comprehensive list of barriers and facilitators for the implementation and adoption of eHealth services. Addressing barriers early, and leveraging facilitators during the implementation, can help create eHealth services that better meet the needs of users and provide higher benefits for patients and caregivers.
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Affiliation(s)
- Björn Schreiweis
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany.,Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany
| | - Monika Pobiruchin
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,GECKO Institute for Medicine, Informatics and Economics, Heilbronn University, Heilbronn, Germany
| | - Veronika Strotbaum
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Zentrum für Telematik und Telemedizin GmbH, Bochum, Germany
| | - Julian Suleder
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,ERNW Research GmbH, Heidelberg, Germany
| | - Martin Wiesner
- Consumer Health Informatics Special Interest Group, German Association for Medical Informatics, Biometry and Epidemiology eV, Cologne, Germany.,Department of Medical Informatics, Heilbronn University, Heilbronn, Germany
| | - Björn Bergh
- Institute for Medical Informatics and Statistics, University Hospital Schleswig-Holstein and Kiel University, Kiel, Germany
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Batterham PJ, Calear AL, O'Dea B, Larsen ME, J Kavanagh D, Titov N, March S, Hickie I, Teesson M, Dear BF, Reynolds J, Lowinger J, Thornton L, Gorman P. Stakeholder perspectives on evidence for digital mental health interventions: Implications for accreditation systems. Digit Health 2019; 5:2055207619878069. [PMID: 31565238 PMCID: PMC6755623 DOI: 10.1177/2055207619878069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 08/30/2019] [Indexed: 01/09/2023] Open
Abstract
Background Digital mental health interventions can be effective for treating mental health problems, but uptake by consumers and clinicians is not optimal. The lack of an accreditation pathway for digital mental health interventions is a barrier to their uptake among clinicians and consumers. However, there are a number of factors that may contribute to whether a digital intervention is suitable for recommendation to the public. The aim of this study was to identify the types of evidence that would support the accreditation of digital interventions. Method An expert workshop was convened, including researcher, clinician, consumer (people with lived experience of a mental health condition) and policymaker representatives. Results Existing methods for assessing the evidence for digital mental health interventions were discussed by the stakeholders present at the workshop. Empirical evidence from randomised controlled trials was identified as a key component for evaluating digital interventions. However, information on the safety of users, data security, user ratings, and fidelity to clinical guidelines, along with data from routine care including adherence, engagement and clinical outcomes, were also identified as important considerations when evaluating an intervention. There are considerable challenges in weighing the evidence for a digital mental health intervention. Conclusions Empirical evidence should be the cornerstone of any accreditation system to identify appropriate digital mental health interventions. However, robust accreditation systems should also account for program and user safety, user engagement and experience, and fidelity to clinical treatment guidelines.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Bridianne O'Dea
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Mark E Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Nickolai Titov
- eCentreClinic and MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Ipswich, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre, University of Sydney, Sydney, Australia
| | - Blake F Dear
- eCentreClinic and MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | | | | | - Patrick Gorman
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Hensel JM, Shaw J, Ivers NM, Desveaux L, Vigod SN, Cohen A, Onabajo N, Agarwal P, Mukerji G, Yang R, Nguyen M, Bouck Z, Wong I, Jeffs L, Jamieson T, Bhatia RS. A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial. J Med Internet Res 2019; 21:e10838. [PMID: 31165710 PMCID: PMC6684216 DOI: 10.2196/10838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 04/26/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. OBJECTIVE The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. METHODS A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. RESULTS Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (-1.83 points, 95% CI -2.85 to -0.82) and GAD-7 score (-1.55 points, 95% CI -2.42 to -0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. CONCLUSIONS The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO).
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Affiliation(s)
- Jennifer M Hensel
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - James Shaw
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Simone N Vigod
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ashley Cohen
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Nike Onabajo
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Payal Agarwal
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Geetha Mukerji
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rebecca Yang
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Megan Nguyen
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Zachary Bouck
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Ivy Wong
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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Batterham PJ, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Gulliver A. A brief intervention to increase uptake and adherence of an online program for depression and anxiety: Protocol for the Enhancing Engagement with Psychosocial Interventions (EEPI) Randomized Controlled Trial. Contemp Clin Trials 2019; 78:107-115. [PMID: 30711664 DOI: 10.1016/j.cct.2019.01.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/20/2019] [Accepted: 01/30/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is substantial evidence that psychosocial programs delivered online can be effective in treating and preventing mental health problems. However, use of evidence-based programs in the community is currently suboptimal, and there is a lack of evidence around how to increase engagement with existing evidence-based programs. Novel approaches to increasing the acceptability of online programs such as the use of brief engagement-facilitation interventions (EFI) require evaluation. AIMS The aims of this study are to 1) examine the effectiveness of a brief online engagement-facilitation intervention (EFI) presented prior to an online self-help mental health program (myCompass) in improving uptake of and adherence to that program, and 2) assess if greater uptake and/or adherence are associated with improved efficacy (greater reduction in symptoms of depression and anxiety) relative to a control condition). METHODS A three-arm randomized controlled trial will be conducted (target sample: N = 693 participants recruited via social media). An active online cognitive behavioral therapy (iCBT) intervention will be delivered either with (arm 1) or without (arm 2) the EFI. An attention control group (arm 3) will enable testing of the relative efficacy of the iCBT intervention. Primary outcomes are uptake of the intervention (initiation) and adherence (module completion). RESULTS Findings will inform the more efficient dissemination of a range of psychosocial programs into the community, with potential for significant efficiency gains in treating common mental health problems. CONCLUSIONS Greater engagement with online psychosocial programs may lead to significant reductions in the burden of common mental health problems in the community. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001565235.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australia.
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australia
| | - Matthew Sunderland
- National Drug and Alcohol Research Centre, University of New South Wales, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Australia
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35
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Scholten H, Granic I. Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint. J Med Internet Res 2019; 21:e11528. [PMID: 31344671 PMCID: PMC6682276 DOI: 10.2196/11528] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/22/2018] [Indexed: 01/25/2023] Open
Abstract
Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth.
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Affiliation(s)
- Hanneke Scholten
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Isabela Granic
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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36
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Reupert A, Bartholomew C, Cuff R, Foster K, Matar J, Maybery DJ, Pettenuzzo L. An Online Intervention to Promote Mental Health and Wellbeing for Young Adults Whose Parents Have Mental Illness and/or Substance Use Problems: Theoretical Basis and Intervention Description. Front Psychiatry 2019; 10:59. [PMID: 30828308 PMCID: PMC6384231 DOI: 10.3389/fpsyt.2019.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/25/2019] [Indexed: 11/13/2022] Open
Abstract
The transition to adulthood can be a vulnerable period for certain population groups. In particular, young adults aged 18-25 years who have a parent with mental illness and/or substance use problems face increased risks to their mental health compared to same aged peers. Yet these young adults may not have access to age-appropriate, targeted interventions, nor engage with traditional face-to-face health services. To support this vulnerable group, services need to engage with them in environments where they are likely to seek help, such as the Internet. This paper describes the risk mechanisms for this group of young adults, and the theoretical and empirical basis, aims, features and content of a tailored online group intervention; mi.spot (mental illness: supportive, preventative, online, targeted). The participatory approach employed to design the intervention is described. This involved working collaboratively with stakeholders (i.e., young adults, clinicians, researchers and website developers). Implementation considerations and future research priorities for an online approach targeting this group of young adults conclude the paper.
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Affiliation(s)
- Andrea Reupert
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
| | - Catherine Bartholomew
- Wellways Australia Incorporating Australian HealthCall Group Melbourne, VIC, Australia
| | - Rose Cuff
- The Bouverie Centre Melbourne, VIC, Australia
| | - Kim Foster
- School of Nursing, Midwifery & Paramedicine, Australian Catholic University Melbourne, VIC, Australia.,NorthWestern Mental Health Melbourne, VIC, Australia
| | - Jodie Matar
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
| | - Darryl J Maybery
- Department of Rural Health, Monash University Clayton, VIC, Australia
| | - Laura Pettenuzzo
- Faculty of Education, Krongold Clinic, Monash University Melbourne, VIC, Australia
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Carpenter-Song E, Noel VA, Acquilano SC, Drake RE. Real-World Technology Use Among People With Mental Illnesses: Qualitative Study. JMIR Ment Health 2018; 5:e10652. [PMID: 30470681 PMCID: PMC6286425 DOI: 10.2196/10652] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/15/2018] [Accepted: 09/05/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is growing interest in using technology-based tools to support mental health recovery. Yet, despite evidence suggesting widespread access to technology among people with mental illnesses, interest in using technology to support mental health, and effectiveness of technology-based tools developed by researchers, such tools have not been widely adopted within mental health settings. Little is currently known about how mental health consumers are using technology to address mental health needs in real-world settings outside of controlled research studies. OBJECTIVE This qualitative study examined current practices and orientations toward technology among consumers in 3 mental health settings in the United States. METHODS Ethnographic observations and semistructured interviews were conducted. Observations focused on if and how technology was salient within the setting and documented relevant behaviors, interactions, and dialogue in fieldnotes. Ethnographic data informed the development of a semistructured interview that inquired into technology use and interest among consumers (n=15) in a community mental health setting. Fieldnotes and interview transcripts were reviewed and coded by multiple researchers. Key concepts and patterns identified were refined by the research team to develop the main findings. RESULTS Ownership of technology, although common, was not ubiquitous and was varied across the sites. Participants had varying levels of awareness regarding the key capabilities of modern technologies. Participants used technology for many purposes, but there was limited evidence of technology use to support mental health. Technology-based tools specific to mental health were not routinely used, although some participants found widely available mobile apps to be helpful in recovery. CONCLUSIONS Qualitative findings suggest that many, but not all, clients will be interested in using technology to support mental health needs. The variability in type and quality of technology owned by participants suggests the need to design for a range of functionality in the development of mental health tools. Findings also suggest thinking broadly about using existing platforms and widely available tools to support consumers in mental health recovery.
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Affiliation(s)
| | | | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Robert E Drake
- Westat, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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38
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Abu Rahal Z, Vadas L, Manor I, Bloch B, Avital A. Use of information and communication technologies among individuals with and without serious mental illness. Psychiatry Res 2018; 266:160-167. [PMID: 29864616 DOI: 10.1016/j.psychres.2018.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/08/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
Growing interest surrounds the use ofinformation and communication technologies (ICTs) for mental-health-related purposes, yet little is known about rates of ICT use among the psychiatric population and those with severe mental illness. This study examines ICT accessibility among the psychiatric population, focusing on serious and non-serious mental illness (SMI and non-SMI). Patients (N = 427) from all service branches of the Psychiatry Department at Emek Medical Centerwere recruited orally or through advertisement. Responders completed a self-report survey regarding accessibility and use of ICTs (i.e., computer, internet, Facebook, mobile phone, smartphone). Results revealed that 59.3% of respondents used computers, 77.3% used the internet, 92.7% owned a mobile phone, 67.9% owned a smartphone, and 63% used Facebook. Over half of participants who used ICTs reported doing so at least once per day. SMI and non-SMI respondents differed significantly in their use and access to a computer, the internet, Facebook, and smartphones. Results suggest that mental illness is not a barrier to using and accessing technology; however, when differentiating between SMI and non-SMI, illness severity is a barrier to potential ICT utilization. These results may encourage policy makers to design ICTs that suit the needs of individuals with SMI.
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Affiliation(s)
- Ziyad Abu Rahal
- Psychiatry Department, Emek Medical Center, Afula, Israel; Clalit Health Services, Northern District, Israel
| | - Limor Vadas
- Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Iris Manor
- Attention Deficit Hyperactivity Disorder Clinic, Geha Medical Center, Petah Tikva, Israel
| | - Boaz Bloch
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Avi Avital
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel.
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Sadeh-Sharvit S, Kim JP, Darcy AM, Neri E, Vierhile M, Robinson A, Tregarthen J, Lock JD. Subgrouping the users of a specialized app for eating disorders. Eat Disord 2018; 26:361-372. [PMID: 29452025 DOI: 10.1080/10640266.2018.1440043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although mobile technologies for eating disorders (EDs) are burgeoning, there is limited data about the clinical characteristics of individuals using specialized smartphone applications (apps) without accompanying traditional forms of treatment. This study evaluated whether the users of an ED app cluster in clinically meaningful groups. Participants were 1,280 app users (91.3% female; mean age 27) who reported not being in a weekly treatment for their ED. A hierarchical cluster analysis distinguished five groups of participants, all approximating DSM-5 ED categories. One cluster comprised of non-female, ethnically diverse users with Bulimia Nervosa features. Findings suggest that app users resemble known patient classifications.
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Affiliation(s)
- Shiri Sadeh-Sharvit
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Jane Paik Kim
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Alison M Darcy
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Eric Neri
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Molly Vierhile
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | - Athena Robinson
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
| | | | - James D Lock
- a Department of Psychiatry and Behavioral Sciences , Stanford University , Stanford , California , USA
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Newton NC, Stapinski L, Slade T, Champion KE, Barrett EL, Chapman C, Smout A, Lawler S, Mather M, Castellanos-Ryan N, Conrod PJ, Teesson M. Pathways to prevention: protocol for the CAP (Climate and Preventure) study to evaluate the long-term effectiveness of school-based universal, selective and combined alcohol misuse prevention into early adulthood. BMC Public Health 2018; 18:643. [PMID: 29783974 PMCID: PMC5963131 DOI: 10.1186/s12889-018-5554-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/08/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Alcohol use and associated harms are among the leading causes of burden of disease among young people, highlighting the need for effective prevention. The Climate and Preventure (CAP) study was the first trial of a combined universal and selective school-based approach to preventing alcohol misuse among adolescents. Initial results indicate that universal, selective and combined prevention were all effective in delaying the uptake of alcohol use and binge drinking for up to 3 years following the interventions. However, little is known about the sustainability of prevention effects across the transition to early adulthood, a period of increased exposure to alcohol and other drug use. This paper describes the protocol for the CAP long-term follow-up study which will determine the effectiveness of universal, selective and combined alcohol misuse prevention up to 7 years post intervention, and across the transition from adolescence into early adulthood. METHODS A cluster randomized controlled trial was conducted between 2012 and 2015 with 2190 students (mean age: 13.3 yrs) from 26 Australian high schools. Participants were randomized to receive one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). The positive effect of the interventions on alcohol use at 12-, 24- and 36-month post baseline have previously been reported. This study will follow up the CAP study cohort approximately 5- and 7-years post baseline. The primary outcome will be alcohol use and related harms. Secondary outcomes will be cannabis use, alcohol and other drug harms including violent behavior, and mental health symptomatology. Analyses will be conducted using multi-level, mixed effects models within an intention-to-treat framework. DISCUSSION This study will provide the first ever evaluation of the long-term effectiveness of combining universal and selective approaches to alcohol prevention and will examine the durability of intervention effects into the longer-term, over a 7-year period from adolescence to early adulthood. TRIAL REGISTRATION This trial was registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12612000026820 ) on January 6th 2012.
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Affiliation(s)
- Nicola C Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
| | - Lexine Stapinski
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Katrina E Champion
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Emma L Barrett
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Catherine Chapman
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Anna Smout
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Siobhan Lawler
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Marius Mather
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | | | | | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS) National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Drozd F, Haga SM, Lisøy C, Slinning K. Evaluation of the implementation of an internet intervention in well-baby clinics: A pilot study. Internet Interv 2018; 13:1-7. [PMID: 30206512 PMCID: PMC6112086 DOI: 10.1016/j.invent.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/19/2018] [Accepted: 04/27/2018] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Despite promising results, internet interventions are not widely accessible or well-integrated in health services. The objective of this study was, therefore, to examine the implementation of an internet intervention ('Mamma Mia') for the prevention of perinatal depression in Norwegian well-baby clinics (i.e., primary care). METHODS Mamma Mia begins in mid-pregnancy and lasts up to 6 months after childbirth. It consists of 44 online sessions, supported by midwives and public health nurses at up to 5 contact points during this period, following principles of empathic communication. Well-baby clinics offer free, universal services to all pregnant women and children aged 0 to 5 years in Norway and were recruited via an intermediary organization for this study. Data were collected at pre- and post-training, but before the delivery of Mamma Mia in clinics, and at 3 and 6 months follow-up. Quantitative and qualitative data were used to evaluate the training in Mamma Mia, examine program implementation (i.e., number of pregnant women registered for the program), and identify barriers and enablers of implementation. RESULTS Twenty-four self-selected healthcare professionals from 14 well-baby clinics were recruited, for this study. Training increased participants' knowledge about Mamma Mia and exceeded their expectations. The program review and implementation plan were necessary training components. Implementation climate was related to the number of colleagues working with Mamma Mia and overall satisfaction with implementation, while characteristics of the intervention predicted the number of registered women at 6 months. Organizational re-structuring, leadership, and competing activities were identified as barriers to implementation that need to be considered further. CONCLUSIONS The dissemination and implementation of a health-service supported internet intervention appears to be promising but requires further research.
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Affiliation(s)
- Filip Drozd
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Corresponding author at: Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O. Box 4623, Nydalen, N-0405 Oslo, Norway.
| | - Silje Marie Haga
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Carina Lisøy
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Kari Slinning
- Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
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Folker AP, Mathiasen K, Lauridsen SM, Stenderup E, Dozeman E, Folker MP. Implementing internet-delivered cognitive behavior therapy for common mental health disorders: A comparative case study of implementation challenges perceived by therapists and managers in five European internet services. Internet Interv 2018; 11:60-70. [PMID: 30135761 PMCID: PMC6084870 DOI: 10.1016/j.invent.2018.02.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Internet-delivered cognitive behavior therapy programs have been developed and evaluated in randomized controlled trials during the past two decades to alleviate the rising demand for effective treatment of common mental health disorders such as anxiety and depression. While most of the research on internet-based cognitive behavior therapy (iCBT) has focused on efficacy and effectiveness only little attention has been devoted to the implementation of iCBT. The aim of this study was to identify the main implementation challenges perceived by therapists and managers involved in the practical operation of iCBT services in routine care settings in five European countries. METHOD The study was designed as a multiple comparative case study to explore differences and similarities between five different iCBT services in Sweden, Norway, Denmark, The Netherlands and Scotland. Field visits were carried out to each of the five services including interviews with the management of the service (n = 9), focus group interviews with key staff (n = 15) and demonstration of online programs. The data material was processed through thematic, comparative analysis. RESULTS The analysis generated four transversal themes: 1) integration in the mental health care system; 2) recruitment of patients; 3) working practice of therapists; and 4) long-term sustainability of service. The main results concerned the need to address the informal integration in the health care systems related to the perceived skepticism towards iCBT from GPs and face-to-face therapists, the role of referral models and communication strategies for the stable recruitment of patients, the need for knowledge, standards and material for the training of therapists in the provision of online feedback, the need to improve the possibilities to tailor programs to individual patients, and the need for considerate long-term sustainability planning of the transitions from local projects to permanent regional or national services. CONCLUSION The present study gives an overview of the main implementation challenges regarding the practical operation of iCBT services perceived by the therapists and managers of the iCBT services. Future studies into specific details of each challenge will be important to strengthen the evidence base of iCBT and to improve uptake and implementation of iCBT in routine care.
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Affiliation(s)
- Anna Paldam Folker
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Kim Mathiasen
- University of Southern Denmark, Department of Psychology, Campusvej 55, 5230 Odense M, Denmark
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Sigurd Mørk Lauridsen
- University of Southern Denmark, National Institute of Public Health, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Ellen Stenderup
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
| | - Els Dozeman
- GGZ inGeest, onderzoek en innovatie, Locatie Oldenaller, Oldenaller 1, Postbus 74077, 1070 BB Amsterdam, Netherlands
| | - Marie Paldam Folker
- Mental Health Services of Southern Denmark, Centre for Telepsychiatry, Heden 11, 5000 Odense C, Denmark
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Domek GJ, Contreras-Roldan IL, Asturias EJ, Bronsert M, Bolaños Ventura GA, O’Leary ST, Kempe A, Bull S. Characteristics of mobile phone access and usage in rural and urban Guatemala: assessing feasibility of text message reminders to increase childhood immunizations. Mhealth 2018; 4:9. [PMID: 29780812 PMCID: PMC5945665 DOI: 10.21037/mhealth.2018.03.05] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/21/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite efforts to promote vaccination in low- and middle-income countries (LMICs), over 20 million infants remain under-immunized and at risk for unnecessary morbidity and mortality. Mobile health technologies, such as Short Message Service (SMS) texts, have tremendous and untapped potential for disease management. Patient reminder systems are an important mechanism for improving childhood vaccination coverage and can be easily adapted to SMS platforms. However, current research lacks an understanding of the barriers and facilitators to mHealth program design, implementation, and scale in LMICs. METHODS We analyzed survey data collected March-November 2016 at the enrollment visit from a randomized controlled trial conducted at public health clinics in urban and rural Guatemala. Participants included eligible infants 6 weeks to 6 months of age receiving the first dose of the primary immunization series. At least one parent needed to own a mobile phone and be capable of deciphering SMS. Chi-square or Fisher's exact and Student's t-test were used to assess significance levels in demographic differences to describe factors that contribute to the feasibility of using an SMS-based vaccination reminder system. RESULTS Of 1,088 families approached for enrollment, 871 were eligible and 720 (82.7%) participated with equal numbers of urban and rural children enrolled; 54 parents did not own a mobile phone with SMS capability and three parents could not use SMS. There was no significant difference between urban and rural maternal mobile phone ownership (94.4% vs. 93.3%, P=0.53), but more urban fathers owned mobile phones (72.8% vs. 47.1%, P<0.0001) and, overall, more mothers compared to fathers owned mobile phones (93.9% vs. 61.1%, P<0.0001). Most families (90.4%) chose to have reminders sent to the mother. Urban participants reported more mobile phones present in the home (P<0.0001), but rural participants reported more telephone landlines (34.7% vs. 15.6%, P<0.0001). Most participants reported a daily average of ≤5 telephone calls made (87.4%), ≤10 texts sent (91.0%), and ≤10 texts received (89.9%), with urban families reporting greater telephone usage (P=0.006, P<0.001, and P<0.001 respectively). Parents preferred to make calls over sending texts (74.7% vs. 25.3%, P<0.0001), with more urban families preferring text messaging (31.9% vs. 18.6%, P<0.0001). CONCLUSIONS Our study results provide important insight into mobile phone access, usage, and preferences for voice and text communication across rural and urban populations of an LMIC that can be used to inform future mHealth interventions. Our findings suggest that offering a combination of more traditional communication methods with newer, modern technologies may be more effective at reminding families about vaccination visits, particularly for our rural population, and that targeting mothers for mobile phone interventions may provide the greatest benefits. Overall, our study suggests that using SMS reminders in LMICs can be a feasible tool for public health interventions.
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Affiliation(s)
- Gretchen J. Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
| | | | - Edwin J. Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
| | - Michael Bronsert
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | | | - Sean T. O’Leary
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Allison Kempe
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sheana Bull
- Center for Global Health, Colorado School of Public Health; Mail Stop A090, 13199 E Montview Blvd., Suite 310, Aurora, CO 80045, USA
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO 80045, USA
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Lin J, Sander L, Paganini S, Schlicker S, Ebert D, Berking M, Bengel J, Nobis S, Lehr D, Mittag O, Riper H, Baumeister H. Effectiveness and cost-effectiveness of a guided internet- and mobile-based depression intervention for individuals with chronic back pain: protocol of a multi-centre randomised controlled trial. BMJ Open 2017; 7:e015226. [PMID: 29288172 PMCID: PMC5770830 DOI: 10.1136/bmjopen-2016-015226] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Depression often co-occurs with chronic back pain (CBP). Internet and mobile-based interventions (IMIs) might be a promising approach for effectively treating depression in this patient group. In the present study, we will evaluate the effectiveness and cost-effectiveness of a guided depression IMI for individuals with CBP (eSano BackCare-D) integrated into orthopaedic healthcare. METHODS AND ANALYSIS In this multicentre randomised controlled trial of parallel design, the groups eSano BackCare-D versus treatment as usual will be compared. 210 participants with CBP and diagnosed depression will be recruited subsequent to orthopaedic rehabilitation care. Assessments will be conducted prior to randomisation and 9 weeks (post-treatment) and 6 months after randomisation. The primary outcome is depression severity (Hamilton Rating Scale for Depression-17). Secondary outcomes are depression remission and response, health-related quality of life, pain intensity, pain-related disability, self-efficacy and work capacity. Demographic and medical variables as well as internet affinity, intervention adherence, intervention satisfaction and negative effects will also be assessed. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Moreover, a cost-effectiveness and cost-utility analysis will be conducted from a societal perspective after 6 months. ETHICS AND DISSEMINATION All procedures are approved by the ethics committee of the Albert-Ludwigs-University of Freiburg and the data security committee of the German Pension Insurance (Deutsche Rentenversicherung). The results will be published in peer-reviewed journals and presented on international conferences. TRIAL REGISTRATION NUMBER DRKS00009272; Pre-results.
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Affiliation(s)
- Jiaxi Lin
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
- Psychology Department, Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), London, United Kingdom
| | - Lasse Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sarah Paganini
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Sandra Schlicker
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - David Ebert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Jürgen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Stephanie Nobis
- Department of Gerontology, University of Vechta, Vechta, Germany
| | - Dirk Lehr
- Department of Psychology, Leuphana University Lüneburg, Lüneburg, Germany
| | - Oskar Mittag
- Section of Health Care Research and Rehabilitation, Center for Medical Biometry and Medical Informatics, Medical Center, University of Freiburg, Freiburg, Germany
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, The Netherlands
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Ulm, Ulm, Germany
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Batterham PJ, Calear AL, Farrer L, McCallum SM, Cheng VWS. FitMindKit: Randomised controlled trial of an automatically tailored online program for mood, anxiety, substance use and suicidality. Internet Interv 2017; 12:91-99. [PMID: 30135773 PMCID: PMC6096326 DOI: 10.1016/j.invent.2017.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/07/2017] [Accepted: 08/15/2017] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia,Corresponding author at: Centre for Mental Health Research, Research School of Population Health, 63 Eggleston Road, The Australian National University, Acton ACT 2601, Australia.
| | - Alison L. Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Louise Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Sonia M. McCallum
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Fogarty AS, Proudfoot J, Whittle EL, Clarke J, Player MJ, Christensen H, Wilhelm K. Preliminary Evaluation of a Brief Web and Mobile Phone Intervention for Men With Depression: Men's Positive Coping Strategies and Associated Depression, Resilience, and Work and Social Functioning. JMIR Ment Health 2017; 4:e33. [PMID: 28798009 PMCID: PMC5571234 DOI: 10.2196/mental.7769] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/13/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous research has identified that men experiencing depression do not always access appropriate health services. Web-based interventions represent an alternative treatment option for men, are effective in reducing anxiety and depression, and have potential for wide dissemination. However, men do not access Web-based programs at the same rate as women. Programs with content explicitly tailored to men's mental health needs are required. OBJECTIVE This study evaluated the applicability of Man Central, a new Web and mobile phone intervention for men with depression. The impact of the use of Man Central on depression, resilience, and work and social functioning was assessed. METHODS A recruitment flier was distributed via social media, email networks, newsletters, research registers, and partner organizations. A single-group, repeated measures design was used. The primary outcome was symptoms of depression. Secondary outcomes included externalizing symptoms, resilience, and work and social functioning. Man Central comprises regular mood, symptom, and behavior monitoring, combined with three 15-min interactive sessions. Clinical features are grounded in cognitive behavior therapy and problem-solving therapy. A distinguishing feature is the incorporation of positive strategies identified by men as useful in preventing and managing depression. Participants were directed to use Man Central for a period of 4 weeks. Linear mixed modeling with intention-to-treat analysis assessed associations between the intervention and the primary and secondary outcomes. RESULTS A total of 144 men aged between 18 and 68 years and with at least mild depression enrolled in the study. The symptoms most often monitored by men included motivation (471 instances), depression (399), sleep (323), anxiety (316), and stress (262). Reminders were scheduled by 60.4% (87/144). Significant improvements were observed in depression symptoms (P<.001, d=0.68), depression risk, and externalizing symptoms (P<.001, d=0.88) and work and social functioning (P<.001, d=0.78). No change was observed in measures of resilience. Participants reported satisfaction with the program, with a majority saying that it was easy (42/51, 82%) and convenient (41/51, 80%) to use. Study attrition was high; 27.1% (39/144) and 8.3% (12/144) of the participants provided complete follow-up data and partial follow-up data, respectively, whereas the majority (93/144, 64.6%) did not complete follow-up measures. CONCLUSIONS This preliminary evaluation demonstrated the potential of using electronic health (eHealth) tools to deliver self-management strategies to men with depressive symptoms. Man Central may meet the treatment needs of a subgroup of depressed men who are willing to engage with an e-mental health program. With further research, it may provide an acceptable option to those unwilling or unable to access traditional mental health services. Given the limitations of the study design, prospective studies are required, using controlled designs to further elucidate the effect of the program over time.
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Affiliation(s)
| | | | | | | | | | | | - Kay Wilhelm
- St Vincent's Hospital, Faces in the Street, Darlinghurst, Australia
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Norr AM, Gibby BA, Fuller KL, Portero AK, Schmidt NB. Online Dissemination of the Cognitive Anxiety Sensitivity Treatment (CAST) Using Craigslist: A Pilot Study. COGNITIVE THERAPY AND RESEARCH 2017. [DOI: 10.1007/s10608-017-9834-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Batterham PJ, Calear AL. Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey. JMIR Ment Health 2017; 4:e26. [PMID: 28666976 PMCID: PMC5511366 DOI: 10.2196/mental.7722] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/17/2017] [Accepted: 06/03/2017] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Acton ACT, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Acton ACT, Australia
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Wozney L, Newton AS, Gehring ND, Bennett K, Huguet A, Hartling L, Dyson MP, McGrath P. Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates. BMC Med Inform Decis Mak 2017; 17:78. [PMID: 28577543 PMCID: PMC5455087 DOI: 10.1186/s12911-017-0474-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/24/2017] [Indexed: 12/25/2022] Open
Abstract
Background The use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care. Methods From September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data. Results Key informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment. Conclusion This study provides previously unavailable information about key informant perspectives on eMental Health care implementation. The themes that emerged, namely the need to intensify intersectoral research, measure/monitor readiness to implement, define cost-utility benchmarks, raise awareness about available technologies, and test assumptions that ‘proven’ technologies will be easily integrated can inform the design and evaluation of eMental Health care implementation models. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0474-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lori Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada. .,Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, Canada, T6G 1C9.
| | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Bennett
- Department of Clinical Epidemiology and Biostatistics, and Offord Centre for Child Studies, McMaster University, Hamilton, ON, Canada
| | - Anna Huguet
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Patrick McGrath
- IWK Health Centre, 5850-5980 University Avenue, Halifax, NS, Canada
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Deady M, Mills KL, Teesson M, Kay-Lambkin F. An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial. J Med Internet Res 2016; 18:e71. [PMID: 27009465 PMCID: PMC4823588 DOI: 10.2196/jmir.5178] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/02/2015] [Accepted: 01/04/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this is associated with increased harm and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective; however, there remains a significant gap between those in need of treatment and those receiving it. The increased availability of eHealth programs presents a unique opportunity to treat these conditions. OBJECTIVE This study aimed to evaluate the feasibility and preliminary efficacy of an automated Web-based self-help intervention (DEAL Project) in treating co-occurring depressive symptoms and problematic alcohol use in young people. METHODS Young people (aged 18 to 25 years) with moderate depression symptoms and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n=60) or a Web-based attention-control condition (HealthWatch; n=44). The trial consisted of a 4-week intervention phase with follow-up assessment at posttreatment and at 3 and 6 months postbaseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9 as well as quantity and frequency of alcohol use (TOT-AL). RESULTS The DEAL Project was associated with statistically significant improvement in depression symptom severity (d=0.71) and reductions in alcohol use quantity (d=0.99) and frequency (d=0.76) in the short term compared to the control group. At 6-month follow-up, the improvements in the intervention group were maintained; however, the differences between the intervention and control groups were no longer statistically significant, such that between-group effects were in the small to moderate range at 6 months (depression symptoms: d=0.39; alcohol quantity: d=-0.09; alcohol frequency: d=0.24). CONCLUSIONS Overall, the DEAL Project was associated with more rapid improvement in both depression symptoms and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6fpsLEGOy).
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Affiliation(s)
- Mark Deady
- National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, Kensington, Australia.
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