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Silverman AL, Boggs JM, Eberle JW, Baldwin M, Behan HC, Baglione A, Paolino V, Vela de la Garza Evia ÁF, Boukhechba M, Barnes L, Funk DH, Teachman BA. Minimal Effect of Messaging on Engagement in a Digital Anxiety Intervention. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2023; 54:252-263. [PMID: 37868738 PMCID: PMC10586207 DOI: 10.1037/pro0000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
This study evaluated the effectiveness of different recruitment messages for encouraging enrollment in a digital mental health intervention (DMHI) for anxiety among 1,600 anxious patients in a large healthcare system. Patients were randomly assigned to receive a standard message, or one of five messages designed to encourage enrollment: Three messages offered varying financial incentives, one message offered coaching, and one message provided consumer testimonials. Patients could then click a link in the message to visit the DMHI website, enroll, and start the first session. We examined the effects of message features and message length (short vs. long) on rates of site clicks, enrollment, and starting the first session. We also tested whether demographic and clinical factors derived from patients' electronic health records were associated with rates of enrollment and starting the first session to understand the characteristics of patients most likely to use DMHIs in this setting. Across messages, 19.4% of patients clicked a link to visit the DMHI website, but none of the messages were significantly associated with rates of site clicks, enrollment, or starting the first session. Females (vs. males) had a greater probability of enrollment. No other demographic or clinical variables were significantly associated with enrollment or starting the first session. Findings provide guidance for resource allocation decisions in larger scale DMHI implementations in healthcare settings.
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Affiliation(s)
| | | | | | - Megan Baldwin
- Institute for Health Research, Kaiser Permanente Colorado
| | | | - Anna Baglione
- Department of Engineering Systems and Environment, University of Virginia
| | | | | | - Medhi Boukhechba
- Department of Engineering Systems and Environment, University of Virginia
| | - Laura Barnes
- Department of Engineering Systems and Environment, University of Virginia
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Braun P, Schwientek AK, Angerer P, Guthardt L, Icks A, Loerbroks A, Apolinário-Hagen J. Investigating information needs and preferences regarding digital mental health services among medical and psychology students in Germany: A qualitative study. Digit Health 2023; 9:20552076231173568. [PMID: 37256006 PMCID: PMC10226173 DOI: 10.1177/20552076231173568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Background Since 2020, physicians and psychotherapists in Germany can prescribe digital mental health services (dMHSs). However, even future healthcare professionals (HCPs), such as medical and psychology students, remain reluctant to use dMHSs, although they are a risk group for mental health issues themselves. Reasons include scepticism and lacking awareness of dMHSs, which can be addressed by acceptance-facilitating interventions (AFIs) such as information strategies. To date, though, little is known about their information needs. Methods Semi-structured interviews with n = 21 students were conducted between August and September 2021. Students of legal age studying psychology or medicine at a German university could participate. Interview recordings were transcribed verbatim and content-analyzed according to Mayring, using deductive and inductive coding. Results Most students reported having little experience with dMHSs. Digital health has barely been raised in their study, even though it was perceived as crucial for personal needs as well as in preparation for their work as HCPs. Students favoured receiving information on and recommendations for dMHSs from their university via, e.g. social media or seminars. Among others, information about data safety, scientific evidence base and application scope were preferred. Additionally, information on costs as well as user reviews seemed to be essential components of information strategies because students were concerned that high costs or low usability would hinder uptake. Conclusions The results give first insights on how future HCPs would like to be informed on dMHSs. Future research should focus on systematic variations of AFIs' components mimicking real-world decision scenarios to increase the adoption of dMHSs.
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Affiliation(s)
- Pia Braun
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Ann-Kathrin Schwientek
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
- Department of Psychiatry and
Psychotherapy, University Hospital rechts der Isar, School of Medicine, Technical
University of Munich, Munchen, Germany
| | - Peter Angerer
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Lisa Guthardt
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research
and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and
Environmental Medicine, Centre for Health and Society, Medical Faculty, Heinrich Heine University
Düsseldorf, Dusseldorf, Germany
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Apolinário-Hagen J, Harrer M, Salewski C, Lehr D, Ebert DD. Akzeptanz und Nutzung von E-Mental-Health-Angeboten unter Studierenden. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2022. [PMCID: PMC9037969 DOI: 10.1007/s11553-022-00945-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Zusammenfassung
Zielsetzung
Trotz der Effektivität verschiedener E‑Mental-Health-Interventionen wurden bislang verhältnismäßig geringe Nutzungsraten, selbst unter Digital Natives wie Studierenden, identifiziert. Ziel dieser Studie ist daher, das Verhältnis der generellen Akzeptanz, dem konkreten Interesse und der tatsächlichen Registrierung für ausgewählte, zielgruppenspezifische E‑Mental-Health-Programme zu untersuchen.
Methodik
Wir führten eine Sekundäranalyse einer in ein Online-Experiment eingebetteten Befragungsstudie mit n = 451 Studierenden (89 % Fernstudierende) zu Informationseffekten auf die Akzeptanz von E‑Mental-Health-Angeboten mit Untersuchung der Nutzungsabsicht sowie des Interesses im Verhältnis zu objektiven Daten, d. h. Registrierungen für ausgewählte E‑Mental-Health-Angebote zur Stressprävention und Gesundheitsförderung, durch.
Ergebnisse
Eine hierarchische Regressionsanalyse ergab das Stresslevel, wahrgenommene Ähnlichkeit mit Informationsquellen und Einstellungen als Determinanten der Nutzungsabsicht (R2 = 0,49). Aktuelles Interesse an der Teilnahme an einem bestimmten E‑Mental-Health-Angebot berichtete weniger als ein Drittel der Stichprobe (31 %). Überdies war die Intentions-Verhaltens-Lücke bei der Follow-up-Messung (n/N in %) beim Programm für Berufstätige geringer (85 % registriert) als für das Programm für Studierende (69 % registriert; insgesamt: 77 %).
Schlussfolgerung
Über drei Viertel der interessierten Studierenden haben sich für ein Programm registriert, was für die Bereitstellung einfacher, direkter Zugangsoptionen spricht. Zukünftige Studien sollten die Determinanten der Nutzung sowie Adhärenz bei E‑Mental-Health-Angeboten in Abhängigkeit von der Akzeptanz für verschiedene Subgruppen von Studierenden zur Entwicklung passgenauer Akzeptanzförderungsmaßnahmen genauer untersuchen.
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Apolinário-Hagen J, Fritsche L, Wopperer J, Wals F, Harrer M, Lehr D, Ebert DD, Salewski C. Investigating the Persuasive Effects of Testimonials on the Acceptance of Digital Stress Management Trainings Among University Students and Underlying Mechanisms: A Randomized Controlled Trial. Front Psychol 2021; 12:738950. [PMID: 34721212 PMCID: PMC8549694 DOI: 10.3389/fpsyg.2021.738950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: This experiment aims to investigate the influence of narrative information varying in the degree of perceived similarity and source credibility in supplemented testimonials on the acceptance of digital mental health services (digi-MHSs). Methods: In fall 2020, n=231 university students were randomly assigned to an active control group (aCG, n=55, “information only”) or one of three intervention groups (IGs) receiving information plus different testimonials being presented either by nonacademic staff (IG1, n=60), university students (IG2, n=58) or experts (IG3, n=58). We assessed mediation effects of similarity and credibility on acceptance in terms of attitudes and usage intentions. Results: Exposure to testimonials was associated with higher usage intentions (d=0.50) and more positive attitudes toward digi-MHSs (d=0.32) compared to mere information (aCG). Regarding source-related effects, one-way ANOVA showed group differences in intentions (ηp2=0.13) that were significantly higher after exposure to testimonials targeted at students than in the other groups after adjusting for baseline intentions (ηp2=0.24). Concerning underlying mechanisms, there were full mediation effects of similarity (IG1 versus IG2) on attitudes [95%CI (0.030, 0.441)] and intentions to use digi-MHSs [95%CI (0.100, 0.528)] and of credibility on attitudes [IG2 versus IG3; 95%CI (−0.217, −0.004)], all favoring students’ testimonials. Conclusion: Overall, this study indicates that the acceptance of digi-MHSs can be substantially increased by providing a simple, context-sensitive information intervention, including testimonials by university students. Since we identified mediating effects of credibility on cognitive attitudes and similarity on affect-driven intentions, a future trial could vary these features using narrative versus statistic information on digi-MHSs.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Centre of Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lara Fritsche
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | | | - Frank Wals
- Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Dirk Lehr
- Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - David D Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Christel Salewski
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
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Apolinário-Hagen J, Harrer M, Dederichs M, Fritsche L, Wopperer J, Wals F, Loerbroks A, Lehr D, Salewski C, Angerer P, Ebert DD. Exploring the influence of testimonial source on attitudes towards e-mental health interventions among university students: Four-group randomized controlled trial. PLoS One 2021; 16:e0252012. [PMID: 34038455 PMCID: PMC8153476 DOI: 10.1371/journal.pone.0252012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/09/2021] [Indexed: 11/18/2022] Open
Abstract
Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps<0.01), as well as a partial mediation effect of perceived similarity in favor of testimonials targeted to students (95% CI [0.22, 0.50]). Overall, this study indicated no meaningful impact of information on attitudes and limited evidence for benefits of tailored narrative messages. Since attitudes were already positive at baseline, further research with a representative student sample mimicking real-world decision scenarios is needed to gain an in-depth understanding of acceptance-facilitating message features that may contribute to promote the adoption of evidence-based eMHSs.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- * E-mail:
| | - Mathias Harrer
- Department of Clinical Psychology and Psychotherapy, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Melina Dederichs
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lara Fritsche
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Jeannette Wopperer
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Frank Wals
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Adrian Loerbroks
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Dirk Lehr
- Department of Health Psychology, Leuphana University Lueneburg, Lueneburg, Germany
| | - Christel Salewski
- Faculty of Psychology, Department of Health Psychology, University of Hagen, Hagen, Germany
| | - Peter Angerer
- Faculty of Medicine, Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - David Daniel Ebert
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Shaffer VA, Brodney S, Gavaruzzi T, Zisman-Ilani Y, Munro S, Smith S, Thomas E, Valentine KD, Bekker HL. Do Personal Stories Make Patient Decision Aids More Effective? An Update from the International Patient Decision Aids Standards. Med Decis Making 2021; 41:897-906. [PMID: 34027739 DOI: 10.1177/0272989x211011100] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand. METHOD To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms. RESULTS The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context. CONCLUSION Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.
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Affiliation(s)
- Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Suzanne Brodney
- Division of Internal Medicine, Massachusetts General Hospital, Padova, Veneto, Italy
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, Universita degli Studi di Padova Scuola di Psicologia, Padova, Veneto, Italy
| | - Yaara Zisman-Ilani
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada
| | - Sian Smith
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Elizabeth Thomas
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | | | - Hilary L Bekker
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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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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Apolinário-Hagen J, Hennemann S, Fritsche L, Drüge M, Breil B. Determinant Factors of Public Acceptance of Stress Management Apps: Survey Study. JMIR Ment Health 2019; 6:e15373. [PMID: 31697243 PMCID: PMC6873149 DOI: 10.2196/15373] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/12/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Chronic stress is a major public health concern. Mobile health (mHealth) apps can help promote coping skills in daily life and prevent stress-related issues. However, little is known about the determinant factors of public acceptance of stress management in relation to preferences for psychological services. OBJECTIVE The aim of this survey study was to (1) assess determinant factors of public acceptance (behavioral use intention) of stress management apps based on an adapted and extended version of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and (2) explore preferences for mHealth apps compared with other mental health services. METHODS Using convenience sampling, participants completed a multiscale 54-item Web-based survey. Based on significant correlations with acceptance, hierarchical stepwise regression analysis was performed within three blocks: (1) background and stress-related control variables, (2) beliefs and attitudes toward using mHealth, and (3) the core UTAUT determinants. The preference for mHealth apps in comparison with nine other mental health services (operationalized as readiness to use) was analyzed using paired t tests. RESULTS Of 141 participants, nearly half (69/141, 48.9%) indicated prior mHealth use. Acceptance of stress coping apps was moderate (mean 3.10, SD 1.03, range 1-5). Hierarchical stepwise regression including four of 11 variables (R2=.62; P=.01, f2=1.63) identified positive attitudes toward using mHealth for stress coping (beta=0.69, P<.001, 46% R2 increase above block 1, f2=0.85), skepticism/perceived risks (beta=-0.14, P=.01, f2=0.16), and stress symptoms (beta=0.12, P=.03, f2=0.14) as significant predictors of acceptance. UTAUT determinants added no predictive contribution beyond attitudes (all P>.05, R2 increase of 1%), whereas post hoc analysis showed significant R2 increases of attitudes and skepticism/perceived risks beyond UTAUT determinants (all P<.001, R2 increase of 13%). The readiness to use apps was equivalent to or significantly higher than most service types, but lower than information websites. CONCLUSIONS Attitudes may be at least as predictive for the acceptance of stress management apps as for more elaborated outcome beliefs. Efforts aimed at improving the public adoption of mHealth could put more emphasis on the pleasant aspects of app use, address misconceptions, offer stress screening tools on health websites, and increase options to try high-quality apps.
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Affiliation(s)
- Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Institute of Psychology, University of Mainz, Mainz, Germany
| | - Lara Fritsche
- Department of Health Psychology, Faculty of Psychology, University of Hagen, Hagen, Germany
| | - Marie Drüge
- Psychotherapy Research, Department of Clinical Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland
| | - Bernhard Breil
- Faculty of Health Care, Niederrhein University of Applied Sciences, Krefeld, Germany
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Apolinário-Hagen J, Fritsche L, Bierhals C, Salewski C. Improving attitudes toward e-mental health services in the general population via psychoeducational information material: A randomized controlled trial. Internet Interv 2018; 12:141-149. [PMID: 30135778 PMCID: PMC6096329 DOI: 10.1016/j.invent.2017.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In recent years, effective Internet-delivered electronic (e-) mental health services have been developed to overcome the limited resources in face-to-face health care. For the successful dissemination of e-mental health services, individual predictors for their uptake and utilization need to be explored. For instance, little is known about the role of different information sources in attitudes toward Internet therapies. On the basis of technology acceptance framework, this pilot study aimed to identify differences in both attitudes and intentions to use e-mental health treatment services after providing psychoeducational information. METHODS 439 participants (mean age 33 years, SD = 10.6 years; 72% female) were randomly assigned to one of three text-based information groups (neutral text: n = 111; expert evaluation: n = 108; user evaluation: n = 112) or a control condition (no information: n = 108). We assessed attitudes toward e-mental health treatments using a 15-item German e-therapy attitudes measure. RESULTS Descriptive analyses revealed overall neutral attitudes toward Internet therapies. Ambivalent perceptions were found in terms of Perceived Usefulness (positive attitude) and Relative Advantage (negative attitude). The awareness of Internet therapies was rather low. Most participants evaluated self-help books, health websites and face-to-face counselling as more useful than web-based counselling and therapies and reported higher intentions to use conventional services in case of emotional problems. As hypothesized, variance analyses demonstrated that text-based information, especially expert evaluations, were associated with significantly more positive attitudes toward e-mental health treatment services compared to the control condition. CONCLUSIONS Taken together, this pilot study suggested a positive connection between the provision of general facts about e-mental health treatment services and attitudes as well as behavioral intentions to future use such services. However, a limitation was the omission of baseline attitudes assessment. Thus, further research is needed to gain deeper insights into the impact of information on attitudes.
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