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Batterham PJ, Gulliver A, Heffernan C, Calear AL, Werner-Seidler A, Turner A, Farrer LM, Chatterton ML, Mihalopoulos C, Berk M. A Brief Workplace Training Program to Support Help-Seeking for Mental Ill-Health: Protocol for the Helipad Cluster Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55529. [PMID: 38787608 PMCID: PMC11161717 DOI: 10.2196/55529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/25/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Most people with mental health problems do not seek help, with delays of even decades in seeking professional help. Lack of engagement with professional mental health services can lead to poor outcomes and functional impairment. However, few effective interventions have been identified to improve help-seeking in adults, and those that exist are not widely implemented to deliver public health impact. Co-designing interventions with people with lived experience of mental ill-health and other relevant stakeholders is critical to increase the likelihood of uptake and engagement with these programs. OBJECTIVE This study aims to (1) test the effectiveness of a co-designed help-seeking program on increasing professional help-seeking intentions in employees in a workplace setting; (2) determine whether the program reduces mental illness stigma and improves help-seeking intentions and behavior, mental health literacy, mental health symptoms, and work and activity functioning relative to the control condition; (3) explore factors that facilitate broader implementation of the co-designed program; and (4) explore the cost-effectiveness of the co-designed program compared to the control condition over 6 months. METHODS A 2-arm cluster randomized controlled trial will be conducted (target sample: N=900 from 30 to 36 workplaces, with n=25 to 35 participants per workplace). The trial will compare the relative effectiveness of an enhanced interactive program (intervention condition) with a standard psychoeducation-alone program (active control condition) on the primary outcome of professional help-seeking intentions as measured by the General Help-Seeking Questionnaire. Secondary outcomes include the impact on mental illness stigma; mental health literacy; help-seeking attitudes and behavior; work and activity functioning; quality of life; and symptoms of mental ill-health including depression, anxiety, and general psychological distress. RESULTS Facilitators of and risks to the trial are identified and addressed in this protocol. Recruitment of workplaces is scheduled to commence in the first quarter of 2024. CONCLUSIONS If effective, the program has the potential to be ready for rapid dissemination throughout Australia, with the potential to increase appropriate and efficient service use across the spectrum of evidence-based services. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000270617p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385376. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55529.
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Affiliation(s)
- Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton, Australia
| | - Cassandra Heffernan
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton, Australia
| | - Alison L Calear
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton, Australia
| | | | - Alyna Turner
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Acton, Australia
| | - Mary Lou Chatterton
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael Berk
- Deakin University, School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
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Yang Z, Han S, Zhang L, Sun M, Hu Q, Hu Y, Wu B. Dose‒Response Effects of Patient Engagement on Anxiety and Depression in a Cognitive-Behavioral Intervention: Secondary Analysis of a Pilot Randomized Controlled Trial and a Clinical Controlled Trial. AIDS Behav 2024:10.1007/s10461-024-04290-6. [PMID: 38570384 DOI: 10.1007/s10461-024-04290-6] [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] [Accepted: 02/04/2024] [Indexed: 04/05/2024]
Abstract
Understanding the dose‒response relationship between patient engagement in cognitive behavioral therapy (CBT) and health outcomes is critical for developing and implementing effective CBT programs. In studies of CBT interventions, patient engagement is measured only at a single time point, and outcomes are typically assessed before and after the intervention. Examination of the dose‒response relationship between patient engagement in CBT and outcomes is limited. It is unclear whether a dose‒response relationship exists between patient engagement in on-site CBT intervention and anxiety and depression in people living with HIV (PLWH). If present, does this dose‒response relationship occur early or later in the intervention? This study aimed to address this gap by examining the dose‒response relationships between patient engagement and anxiety and depression in CBT interventions among PLWH. Utilizing data from a pilot randomized trial (10 participants) and a clinical controlled trial (70 participants), our secondary analysis spans baseline, 3-month, and 6-month assessments. Both trials implemented the nurse-led CBT intervention. Cluster analysis identified two groups based on on-site attendance and WeChat activity. Patients with good adherence (6-10 times) of on-site attendance exhibited significantly lower anxiety and depression scores at 3 months (β = 1.220, P = 0.047; β = 1.270, P = 0.019), with no significant differences observed at 6 months. WeChat activity did not significantly influence anxiety or depression scores. The findings highlight a significant short-term dose‒response relationship, endorsing nurse-led CBT interventions for mental health in PLWH. Organizational strategies should focus on incentivizing and facilitating patient engagement, particularly through enhancing WeChat features.
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Affiliation(s)
- Zhongfang Yang
- School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Shuyu Han
- School of Nursing, Peking University, Beijing, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Meiyan Sun
- School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, Shanghai, 200032, China
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Qianqian Hu
- School of Nursing, Anhui University of Chinese Medicine, Hefei, China
| | - Yan Hu
- School of Nursing, Fudan University, 305 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China.
| | - Bei Wu
- NYU Rory Meyers College of Nursing, New York University, 433 First Avenue, 5Th Floor, New York, NY, 10010, USA.
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Busby Grant J, Gulliver A, Calear AL, Farrer LM, Batterham PJ. "I don't have time": an exploration of the role of time pressures in acceptance of internet interventions for mental health. J Ment Health 2024; 33:169-176. [PMID: 37212332 DOI: 10.1080/09638237.2023.2210663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/23/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Internet interventions for common mental disorders are widely available, effective, and economical, yet community uptake remains low. One consistently cited reason for not engaging in mental health interventions is lack of time. AIMS This research examined whether lack of time as a rationale for not using online interventions reflects real time scarcity, and whether time availability impacts intention to use interventions. METHODS A nationally representative sample (N = 1094, 51% women) reported their time use in activity categories for a typical week. Participants rated their acceptance and likelihood of use of mental health internet interventions, and completed mental health symptom, help-seeking and stigma measures. RESULTS Amount of leisure time reported by participants was not associated with acceptance or likelihood of use of internet interventions for mental health. However, respondents who worked longer hours ranked time and effort factors as more influential in their intention to use internet-based mental health programs. Younger respondents and those with greater help-seeking attitudes reported higher acceptance of use. CONCLUSION These findings suggest lack of time is not a direct barrier to use of internet interventions, and that perceived time scarcity may be masking real barriers to uptake.
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Affiliation(s)
- Janie Busby Grant
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australia
| | - Amelia Gulliver
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Smoktunowicz E, Maciejewski J, Lesnierowska M, Carlbring P. Bridging the adherence gap in internet interventions: A randomized controlled trial study protocol investigating context-specific self-efficacy. Internet Interv 2024; 35:100697. [PMID: 38149089 PMCID: PMC10750058 DOI: 10.1016/j.invent.2023.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 11/22/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Low adherence in self-guided internet interventions is linked to poorer outcomes. Although some predictors of adherence have been identified, few are modifiable for widespread application. One personal variable with the potential to increase adherence in internet interventions is context-specific self-efficacy. This protocol outlines a randomized controlled trial design, divided into two phases. In Phase 1 (students, N = 216), participants will complete a self-efficacy-enhancing exercise, which will be compared to a waitlist control group to test its effectiveness in increasing internet intervention adherence self-efficacy. Phase 2 will be the main two-arm trial, where all participants (medical students, N = 952) will undergo an internet intervention called Med-Stress Student. In the experimental group, the program will be preceded by the self-efficacy-enhancing exercise developed in Phase 1. We anticipate that participants in the experimental group will show higher adherence (primary outcome) to the intervention and greater improvement in intervention outcomes (secondary outcomes i.e., lower stress and higher work engagement) at posttest, as well as at six-month and one-year follow-ups. If effective, enhancing context-specific self-efficacy could be recommended before any internet intervention as a relatively simple way to boost participants' adherence.
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Affiliation(s)
- Ewelina Smoktunowicz
- StresLab Research Centre, Institute of Psychology, SWPS University, Warsaw, Poland
| | - Jan Maciejewski
- StresLab Research Centre, Institute of Psychology, SWPS University, Warsaw, Poland
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Harrer M, Nixon P, Sprenger AA, Heber E, Boß L, Heckendorf H, Buntrock C, Ebert DD, Lehr D. Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials. BMJ MENTAL HEALTH 2024; 27:e300846. [PMID: 38351099 PMCID: PMC10897957 DOI: 10.1136/bmjment-2023-300846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/15/2023] [Indexed: 02/16/2024]
Abstract
QUESTION Depression is highly prevalent and associated with numerous adverse consequences for both individuals and society. Due to low uptake of direct treatment, interventions that target related, but less stigmatising problems, such as perceived stress, have emerged as a new research paradigm.This individual participant data (IPD) meta-analysis examines if a web-based stress management intervention can be used as an 'indirect' treatment of depression. STUDY SELECTION AND ANALYSIS Bayesian one-stage models were used to estimate pooled effects on depressive symptom severity, minimally important improvement and reliable deterioration. The dose-response relationship was examined using multilevel additive models, and IPD network meta-analysis was employed to estimate the effect of guidance. FINDINGS In total, N=1235 patients suffering from clinical-level depression from K=6 randomised trials were included. Moderate-to-large effects were found on depressive symptom severity at 7 weeks post-intervention (d=-0.65; 95% credibility interval (CrI): -0.84 to -0.48) as measured with the Center for Epidemiological Studies' Depression Scale. Effects were sustained at 3-month follow-up (d=-0.74; 95% CrI: -1.01 to -0.48). Post-intervention symptom severity was linearly related to the number of completed sessions. The incremental impact of guidance was estimated at d=-0.25 (95% CrI: -1.30 to 0.82), with a 35% posterior probability that guided and unguided formats produce equivalent effects. CONCLUSIONS Our results indicate that web-based stress management can serve as an indirect treatment, yielding effects comparable with direct interventions for depression. Further research is needed to determine if such formats can indeed increase the utilisation of evidence-based treatment, and to corroborate the favourable effects for human guidance. STUDY REGISTRATION Open material repository: osf.io/dbjc8, osf.io/3qtbe. TRIAL REGISTRATION NUMBER German Clinical Trial Registration (DRKS): DRKS00004749, DRKS00005112, DRKS00005384, DRKS00005687, DRKS00005699, DRKS00005990.
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Affiliation(s)
- Mathias Harrer
- Technical University of Munich, Munich, Germany
- Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Patricia Nixon
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | | | - Elena Heber
- GetOn Institut für Gesundheitstrainings GmbH/HelloBetter, Hamburg, Germany
| | - Leif Boß
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | - Hanna Heckendorf
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
| | | | | | - Dirk Lehr
- Health Psychology and Applied Biological Psychology, Leuphana Universitat Luneburg, Luneburg, Germany
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Lee H, Choi EH, Shin JU, Kim TG, Oh J, Shin B, Sim JY, Shin J, Kim M. The Impact of Intervention Design on User Engagement in Digital Therapeutics Research: Factorial Experiment With a Mixed Methods Study. JMIR Form Res 2024; 8:e51225. [PMID: 38335015 PMCID: PMC10891489 DOI: 10.2196/51225] [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: 07/25/2023] [Revised: 12/08/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND User engagement is crucial for digital therapeutics (DTx) effectiveness; due to variations in the conceptualization of engagement and intervention design, assessment and retention of engagement remain challenging. OBJECTIVE We investigated the influence of the perceived acceptability of experimental intervention components and satisfaction with core intervention components in DTx on user engagement, while also identifying potential barriers and facilitators to user engagement. METHODS We conducted a mixed methods study with a 2 × 2 factorial design, involving 12 outpatients with atopic dermatitis. Participants were randomized into 4 experimental groups based on push notification ("basic" or "advanced") and human coach ("on" or "off") experimental intervention components. All participants engaged in self-monitoring and learning courses as core intervention components within an app-based intervention over 8 weeks. Data were collected through in-app behavioral data, physician- and self-reported questionnaires, and semistructured interviews assessed at baseline, 4 weeks, and 8 weeks. Descriptive statistics and thematic analysis were used to evaluate user engagement, perceived acceptability of experimental intervention components (ie, push notification and human coach), satisfaction with core intervention components (ie, self-monitoring and learning courses), and intervention effectiveness through clinical outcomes. RESULTS The primary outcome indicated that group 4, provided with "advanced-level push notifications" and a "human coach," showed higher completion rates for self-monitoring forms and learning courses compared to the predetermined threshold of clinical significance. Qualitative data analysis revealed three key themes: (1) perceived acceptability of the experimental intervention components, (2) satisfaction with the core intervention components, and (3) suggestions for improvement in the overall intervention program. Regarding clinical outcomes, the Perceived Stress Scale and Dermatology Life Quality Index scores presented the highest improvement in group 4. CONCLUSIONS These findings will help refine the intervention and inform the design of a subsequent randomized trial to test its effectiveness. Furthermore, this design may serve as a model for broadly examining and optimizing overall engagement in DTx and for future investigation into the complex relationship between engagement and clinical outcomes. TRIAL REGISTRATION Clinical Research Information Service KCT0007675; http://tinyurl.com/2m8rjrmv.
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Affiliation(s)
- Hyerim Lee
- Department of Psychology, College of Liberal Arts, Yonsei University, Seoul, Republic of Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Tae-Gyun Kim
- Department of Dermatology, Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Oh
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute of Behavioral Sciences in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bokyoung Shin
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Republic of Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Meelim Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, United States
- The Design Lab, University of California San Diego, San Diego, CA, United States
- Center for Wireless & Population Health Systems, Calit2's Qualcomm Institute, University of California San Diego, San Diego, CA, United States
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Forbes A, Keleher MR, Venditto M, DiBiasi F. Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review. J Med Internet Res 2023; 25:e43727. [PMID: 37566447 PMCID: PMC10457707 DOI: 10.2196/43727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. OBJECTIVE This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. METHODS We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. RESULTS This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. CONCLUSIONS Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations.
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Affiliation(s)
- Ainslie Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | | | - Faith DiBiasi
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
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Balci S, Küchler AM, Ebert DD, Baumeister H. An Online Mindfulness Intervention for International Students: A Randomized Controlled Feasibility Trial. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e9341. [PMID: 37732147 PMCID: PMC10508251 DOI: 10.32872/cpe.9341] [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: 04/19/2022] [Accepted: 05/03/2023] [Indexed: 09/22/2023] Open
Abstract
Background Student mobility across borders poses challenges to health systems at the university and country levels. International students suffer from stress more than their local peers, however, do not seek help or underutilize existing help offers. Some barriers to help-seeking among international students are insufficient information regarding the health offers, stigma, and language, which might be overcome via culturally adapted internet and mobile-based interventions (IMI). Method A randomized controlled feasibility trial with a parallel design assessed the feasibility and potential efficacy of an online mindfulness intervention adapted for international university students. Participants were randomized into either an adapted online mindfulness intervention (StudiCareM-E) (IG, n = 20) or a waitlist control group (WL, n = 20). Participants were assessed at baseline (t0) and eight-week post-randomization (t1). The feasibility of StudiCareM-E was evaluated regarding intervention adherence, client satisfaction, and potential negative effects. The potential efficacy of StudiCareM-E was measured by means of the level of mindfulness, perceived stress, depression, anxiety, presenteeism, and wellbeing. Efficacy outcomes were evaluated with regression models on the intention-to-treat (ITT) sample (n = 40), adjusting for the baseline values. Results Participants' formative feedback suggested improvements in the content of the IMI. There were no crucial negative effects compared to WL. Assessment dropout was 35% (IG: 50%: WL: 20%), and intervention dropout was 60%. StudiCareM-E yielded significant improvements in mindfulness (β = .34), well-being (β = .37), and anxiety (β = -.42) compared to WL. Conclusion StudiCareM-E might be used among culturally diverse international student populations to improve their well-being. Future studies might carefully inspect the extent of the adaptation needs of their target group and design their interventions accordingly.
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Affiliation(s)
- Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Ann-Marie Küchler
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - David Daniel Ebert
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Gulliver A, Morse AR, Banfield M. Cancer Survivors' Experiences of Navigating the Australian Health Care System for Physical and Mental Health Care Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3988. [PMID: 36900994 PMCID: PMC10002190 DOI: 10.3390/ijerph20053988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
People living with cancer experience many impacts on their health and mental health, and are thus likely to require ongoing health care. The aim of the current study was to investigate the health and mental health care experiences and needs of Australian cancer survivors. A total of 131 people (119 female, 12 male) with lived experience of a cancer diagnosis (at least 12 months ago) participated in an online survey collecting qualitative and quantitative data, advertised via social media groups and paid advertising. Analysis of the written responses was conducted using inductive qualitative content analysis. The findings showed that a major issue facing cancer survivors was difficulties around access to and management of services for both their mental and physical health. There was also a strong preference for increasing access to allied health care, such as physiotherapy, psychology, and remedial massage. There appear to be some inequities in the experiences of cancer survivors, particularly in accessing care. Improving the experiences of health care for physical and mental health cancer survivors should focus on increasing access to and improving the management of services, specifically allied health, through a variety of avenues, including reducing costs, increasing transport, and providing closer and more co-located services.
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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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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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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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