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Whitmore C, Mytkolli L, Mangialardi N, Maghera J, Rudick A, Shephard K, Zazzera S, Saiva A, McQuire T, Senior P, Sherifali D, Selby P. Partnered Recruitment: Engaging Individuals With Lived Experience in the Recruitment of Co-Design Participants. Health Expect 2024; 27:e14131. [PMID: 38965808 PMCID: PMC11224126 DOI: 10.1111/hex.14131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) face complex health challenges, including a heightened risk for distress. To counter this distress, there is a need to develop accessible, acceptable comprehensive care solutions that integrate diabetes and mental health care to enhance self-efficacy and counter mental health challenges in this population. OBJECTIVE To describe the engagement of individuals with lived experience of T1D and mental health challenges in the development of a recruitment strategy to support the co-design of an innovative integrated care programme. RESULTS Seven individuals with lived experience formed a Partner Advisory Council (PAC) to recruit young adults (18-29 years old) living with T1D, their friends or family and health researchers and professionals in co-design interviews (n = 19) and co-design events (n = 12). The PAC played a key role in developing a comprehensive recruitment strategy, overcoming traditional barriers and stigmas in the design of an integrated model of care. CONCLUSION Assuming the presence of mental health challenges in young adults living with T1D during recruitment had far-reaching impacts on the development of a whole-person and integrated diabetes and mental health care solution. The efficient recruitment of this sample provided invaluable insights into the nuanced challenges experienced by young adults with T1D, the individual skills developed in response to their mental health challenges and the ways that this understanding can shape future programming to support mental health, quality of life and well-being. The ongoing involvement of the PAC as co-researchers underscores the enduring impact of patient engagement in developing integrated care solutions. PATIENT OR PUBLIC CONTRIBUTION The co-design of the TECC-T1D3 model was enriched by the invaluable contributions of individuals with lived experience. This included the engagement of a diverse PAC in the recruitment of participants in co-design interviews and co-design events. PAC members actively participated in research decision-making with their insights informing a robust recruitment strategy. Beyond recruitment, PAC members continue to serve as co-researchers, shaping ongoing research and actively contributing to the TECC-T1D3 project. Six PAC members are co-authors on this manuscript.
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Affiliation(s)
- Carly Whitmore
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Natalie Mangialardi
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Diabetes Action CanadaTorontoOntarioCanada
| | - Jasmine Maghera
- Diabetes Action CanadaTorontoOntarioCanada
- Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | | | | | | | - Anika Saiva
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Peter Senior
- Faculty of Medicine & DentistryUniversity of Alberta, EdmontonAlbertaCanada
| | - Diana Sherifali
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Peter Selby
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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Racey M, Whitmore C, Alliston P, Cafazzo JA, Crawford A, Castle D, Dragonetti R, Fitzpatrick-Lewis D, Jovkovic M, Melamed OC, Naeem F, Senior P, Strudwick G, Ramdass S, Vien V, Selby P, Sherifali D. Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review. JMIR Diabetes 2023; 8:e44652. [PMID: 37159256 DOI: 10.2196/44652] [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: 11/28/2022] [Revised: 02/23/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. METHODS We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. RESULTS We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. CONCLUSIONS The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Joseph A Cafazzo
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Farooq Naeem
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Senior
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | - Victor Vien
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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3
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Thiblin E, Woodford J, Reuther C, Lundgren J, Lutvica N, von Essen L. Internet-administered, low-intensity cognitive behavioral therapy for parents of children treated for cancer: A feasibility trial (ENGAGE). Cancer Med 2023; 12:6225-6243. [PMID: 36404407 PMCID: PMC10028033 DOI: 10.1002/cam4.5377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/05/2022] [Accepted: 10/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Parents of children treated for cancer may experience mental health difficulties, such as depression and anxiety. There is a lack of evidence-based psychological interventions for parents, with psychological support needs unmet. An internet-administered, guided, low-intensity cognitive behavioral therapy-based (LICBT) self-help intervention may provide a solution. METHODS The feasibility and acceptability of such an intervention was examined using a single-arm feasibility trial (ENGAGE). Primary objectives examined: (1) estimates of recruitment and retention rates; (2) feasibility and acceptability of data collection instruments and procedures; and (3) intervention feasibility and acceptability. Clinical outcomes were collected at baseline, post-treatment (12 weeks), and follow-up (6 months). RESULTS The following progression criteria were met: sample size was exceeded within 5 months, with 11.0% enrolled of total population invited, study dropout rate was 24.0%, intervention dropout was 23.6%, missing data remained at ≤10% per measure, and no substantial negative consequences related to participation were reported. Intervention adherence was slightly lower than progression criteria (47.9%). CONCLUSION Findings suggest an internet-administered, guided, LICBT self-help intervention may represent a feasible and acceptable solution for parents of children treated for cancer. With minor study protocol and intervention modifications, progression to a pilot randomized controlled trial (RCT) and subsequent superiority RCT is warranted.
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Affiliation(s)
- Ella Thiblin
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christina Reuther
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Johan Lundgren
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Nina Lutvica
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Buckley D, McHugh SM, Riordan F. What works to recruit general practices to trials? A rapid review. HRB Open Res 2023; 6:13. [PMID: 37753269 PMCID: PMC10518848 DOI: 10.12688/hrbopenres.13650.1] [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] [Accepted: 11/04/2022] [Indexed: 09/28/2023] Open
Abstract
Background: Recruitment challenges are a barrier to the conduct of trials in general practice, yet little is known about which recruitment strategies work best to recruit practices for randomised controlled trials (RCTs). We aimed to describe the types of strategies used to recruit general practices for trials and synthesize any available evidence of effectiveness. Methods: We conducted a rapid evidence review in line with guidance from Tricco et al. Eligible studies reported or evaluated any strategy to improve practice recruitment to participate in clinical or implementation RCTs. PubMed, Embase, and Cochrane Central Library were searched from inception to June 22 nd, 2021. Reference lists of included studies were screened. Data were synthesized narratively. Results: Over 9,162 articles were identified, and 19 studies included. Most (n=13, 66.7%) used a single recruitment strategy. The most common strategies were: in-person practice meetings/visits by the research team (n=12, 63.2%); phone calls (n=10, 52.6%); financial incentives (n=9, 47.4%); personalised emails (n=7, 36.8%) or letters (n=6, 52.6%) (as opposed to email 'blasts' or generic letters); targeting practices that participated in previous studies or with which the team had existing links (n=6, 31.6%) or targeting of practices within an existing practice or research network (n=6, 31.6%). Three studies reporting recruitment rates >80%, used strategies such as invitation letters with a follow-up phone call to non-responders, presentations by the principal investigator and study coordinator, or in-person meetings with practices with an existing affiliation with the University or research team. Conclusions: Few studies directly compared recruitment approaches making it difficult to draw conclusions about their comparative effectiveness. However, the role of more personalised letter/email, in-person, or phone contact, and capitalising on existing relationships appears important. Further work is needed to standardise how recruitment methods are reported and to directly compare different recruitment strategies within one study . PROSPERO registration: CRD42021268140 (15/08/2021).
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Affiliation(s)
- Daire Buckley
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Riordan
- School of Public Health, University College Cork, Cork, Ireland
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5
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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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6
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Shah A, Hussain-Shamsy N, Strudwick G, Sockalingam S, Nolan RP, Seto E. Digital Health Interventions for Depression and Anxiety Among People with Chronic Conditions: Scoping Review (Preprint). J Med Internet Res 2022; 24:e38030. [PMID: 36155409 PMCID: PMC9555324 DOI: 10.2196/38030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored. Objective This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions. Methods A scoping review of the literature was conducted using the Arksey and O’Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research. Results Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI. Conclusions As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research.
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Affiliation(s)
- Amika Shah
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Gillian Strudwick
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Robert P Nolan
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Cardiac eHealth, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Emily Seto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada
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7
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Heim E, Ramia JA, Hana RA, Burchert S, Carswell K, Cornelisz I, Cuijpers P, El Chammay R, Noun P, van Klaveren C, van Ommeren M, Zoghbi E, van't Hof E. Step-by-step: Feasibility randomised controlled trial of a mobile-based intervention for depression among populations affected by adversity in Lebanon. Internet Interv 2021; 24:100380. [PMID: 33747798 PMCID: PMC7967003 DOI: 10.1016/j.invent.2021.100380] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/16/2021] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND E-mental health interventions may help to bridge the mental health treatment gap. Evidence on their effectiveness is compelling in high-income countries. Not enough evidence has been generated on their use with communities affected by adversity in low- and middle-income countries. The World Health Organization (WHO), the National Mental Health Programme (NMMP) at Ministry of Public Health (MoPH) in Lebanon and other partners have adapted a WHO intervention called Step-by-Step for use with Lebanese and displaced people living in Lebanon. Step-by-Step is a minimally guided, internet-based intervention for adults with depression. In this study, a feasibility randomised controlled trial (RCT) and a qualitative process evaluation were conducted to explore the feasibility and the acceptability of the research methods, and the intervention, in preparation for two fully powered trials to assess the effectiveness and cost-effectiveness of Step-by-Step in Lebanon. METHOD Participants were recruited through social media. Inclusion criteria were: being able to understand and speak Arabic or English; access to an internet connected device; aged over 18; living in Lebanon; scores above cut-off on the Patient Health Questionnaire and the WHO Disability Assessment Schedule 2.0. Participants were randomly assigned to the intervention or enhanced care as usual. They completed post-assessments eight weeks after baseline, and follow-up assessments another three months later. Primary outcomes were depression and level of functioning, secondary outcomes were anxiety, post-traumatic stress, and well-being. Qualitative interviews were conducted to evaluate the feasibility and acceptability of the research procedures and the intervention. RESULTS A total of N = 138 participants, including 33 Syrians, were recruited and randomised into two equal groups. The dropout rate was higher in the control group (73% post- and 82% follow-up assessment) than in the intervention group (63% post- and 72% follow-up assessment). The intervention was perceived as relevant, acceptable and beneficial to those who completed it. Suggestions were made to further adapt the content and to make the intervention more engaging. Statistical analyses were conducted despite the small sample size. Complete cases analysis showed a statistically significant symptom reduction in depression, anxiety, disability, and post-traumatic stress, and statistically significant improvement in well-being and functioning. Intention-to-treat analysis revealed non-significant effects. CONCLUSION The research design, methods and procedures are feasible and acceptable in the context of Lebanon and can be applied in the RCTs. Preliminary findings suggest that Step-by-Step may be effective in reducing symptoms of depression and anxiety and improving functioning and well-being.
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Affiliation(s)
- Eva Heim
- Department of Psychology, University of Zurich, Switzerland,Corresponding author at: University of Zurich, Department of Psychology, Binzmuehlestrasse 14/17, 8050 Zurich, Switzerland.
| | - Jinane Abi Ramia
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Racha Abi Hana
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Sebastian Burchert
- Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Ilja Cornelisz
- Amsterdam Center for Learning Analytics, Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Rabih El Chammay
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon,Psychiatry Department, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Philip Noun
- National Mental Health Programme, Ministry of Public Health, Beirut, Lebanon
| | - Chris van Klaveren
- Amsterdam Center for Learning Analytics, Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mark van Ommeren
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Edwina Zoghbi
- Country Office for Lebanon, World Health Organization, Beirut, Lebanon
| | - Edith van't Hof
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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8
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Baldwin PA, Sanatkar S, Clarke J, Fletcher S, Gunn J, Wilhelm K, Campbell L, Zwar N, Harris M, Lapsley H, Hadzi-Pavlovic D, Christensen H, Proudfoot J. A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial. J Med Internet Res 2020; 22:e16729. [PMID: 33258790 PMCID: PMC7738252 DOI: 10.2196/16729] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/26/2020] [Accepted: 06/22/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further hampered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. OBJECTIVE This study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community sample of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. METHODS Adults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles; n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. RESULTS A total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. CONCLUSIONS The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&isReview=true.
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Affiliation(s)
| | | | | | | | - Jane Gunn
- University of Melbourne, Melbourne, Australia
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9
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Affiliation(s)
- Neal Kaufman
- Fielding School of Public Health, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
- Canary Health, Inc., Los Angeles, CA
| | - Eran Mel
- The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Centre for Childhood Diabetes, Schneider's Children's Medical Center of Israel, Petah Tikva, Israel
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