Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review
TL;DR: This scoping review suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions, and further research is required to understand psychological facilitator and barriers for the implementation of innovative services into health care.
Abstract: Background: Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective: This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results: The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or “e-awareness” and intentions to use e-mental health services were weak or inconsistent. Conclusions: Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care. [JMIR Ment Health 2017;4(2):e10]
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TL;DR: The main tenets of design thinking are introduced and how they can specifically address challenges, including engagement, fidelity, and the lack of personalization, with an entirely new toolbox of mindsets and practices.
Abstract: Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth.
84 citations
TL;DR: The results of this study indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake, and that efforts to explore predictors of acceptance should be focused on.
Abstract: Background: Internet interventions have been proposed to improve the accessibility and use of evidence-based psychological treatments. However, little is known about attitudes toward such treatments, which can be an important barrier to their use. Objective: This study aimed to (1) determine attitudes toward guided internet interventions, (2) assess its acceptability compared with other internet-based formats, and (3) explore predictors of acceptance. Methods: A convenience-sample Web-based survey (N=646) assessed attitudes toward guided internet therapies (ie, perceived usefulness and helpfulness, and advantage relative to face-to-face therapy), preferences for delivery modes (ie, e-preference: guided internet interventions, unguided internet interventions, or videoconferencing psychotherapy), and potential predictors of attitudes and preferences: sociodemographics, help-seeking–related variables, attachment style, and perceived stress. Results: Although most participants perceived internet interventions as useful or helpful (426/646, 65.9%), a few indicated their advantage relative to face-to-face therapy (56/646, 8.7%). Most participants preferred guided internet interventions (252/646, 39.0%) over videoconferencing psychotherapy (147/646, 22.8%), unguided internet interventions (124/646, 19.2%), and not using internet interventions (121/646, 18.8%; missing data: 1/646, 0.2%). Attachment avoidance and stress were related to e-preference (all P<.05). Moreover, preference for therapist-guided internet interventions was higher for individuals who were aware of internet-based treatment (χ26=12.8; P=.046). Conclusions: Participants assessed therapist-guided internet interventions as helpful, but not equivalent to face-to-face therapies. The vast majority (523/646, 81.0%) of the participants were potentially willing to use internet-based approaches. In lieu of providing patients with only one specific low-intensity treatment, implementation concepts should offer several options, including guided internet interventions, but not limited to them. Conversely, our results also indicate that efforts should focus on increasing public knowledge about internet interventions, including information about their effectiveness, to promote acceptance and uptake.
76 citations
Cites background from "Public Acceptability of E-Mental He..."
...Preference for Specific Delivery Formats This study identified a clear preference for guided over unguided internet interventions, which only few studies have investigated before [34]....
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...Taken together, the identification of determinants of attitudes toward and preferences for eMHSs is at an early stage [34]....
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...In accordance with the unified theory of acceptance and use of technology [38], performance expectancy (ie, how useful an individual perceives an intervention to be for reaching a specific goal) might thus play an important role in the adoption and acceptance of internet interventions [39,40] and provide a guideline in overcoming the limitations in the acceptability of eMHSs [34,39,41,42]....
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...Yet there are indicators commonly discussed as influential for help-seeking intentions and acceptance of eMHSs, such as attitudes [33-35] and “e-preferences” [28]....
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TL;DR: The results underline the importance of shared decision-making within primary care and future studies should investigate treatment preferences for different types of internet-based interventions.
Abstract: Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1) investigate treatment preferences for depression including internet-based interventions and (2) examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences. Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences. Results: Patients had a mean age of 43.9 years (SD = 13.8) and more than two thirds (68.6%) were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy. Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions.
47 citations
Cites background from "Public Acceptability of E-Mental He..."
...In this regard, a scoping review (81) investigating public acceptability and service preferences of e-mental health services in four studies (71, 80, 82, 83) showed that most people from the general population preferred guided over unguided programs....
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TL;DR: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming and provided initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy.
Abstract: Background: Self-harm is common among adolescents and is associated with a number of negative psychosocial outcomes including a higher risk of suicide. Recent reviews highlight the lack of research into specific interventions for children and young people who self-harm. Developing innovative interventions that are coproduced with individuals with lived experience and that reduce self-harm are key challenges for self-harm prevention. Objective: The aim of this study was to explore the acceptability, use, and safety of BlueIce, a mobile phone app for young people who self-harm and who are attending child and adolescent mental health services (CAMHS). Methods: This study is part of a mixed methods phase 1 trial of BlueIce. Young people aged 12-17 years attending specialist CAMHS were recruited. Clinicians were invited to refer young people who were self-harming or who had a history of self-harm. On consent being obtained and baseline measures taken, participants used BlueIce as an adjunct to usual care for an initial familiarization period of 2 weeks. If after this time they wanted to continue, they used BlueIce for a further 10 weeks. Semistructured interviews were conducted at postfamiliarization (2 weeks after using BlueIce) and postuse (12 weeks after using BlueIce) to assess the acceptability, use, and safety of BlueIce. We undertook a qualitative analysis using a deductive approach, and then an inductive approach, to investigate common themes. Results: Postfamiliarization interviews were conducted with 40 participants. Of these, 37 participants elected to use BlueIce, with postuse interviews being conducted with 33 participants. Following 6 key themes emerged from the data: (1) appraisal of BlueIce, (2) usability of BlueIce, (3) safety, (4) benefits of BlueIce, (5) agency and control, and (6) BlueIce less helpful. The participants reported that BlueIce was accessible, easy to use, and convenient. Many highlighted the mood diary and mood lifter sections as particularly helpful in offering a way to track their moods and offering new strategies to manage their thoughts to self-harm. No adverse effects were reported. For those who did not find BlueIce helpful, issues around motivation to stop self-harming impeded their ability to use the app. Conclusions: BlueIce was judged to be a helpful and safe way of supporting adolescents to manage thoughts of self-harming. Adolescents reported numerous benefits of using BlueIce, and all would recommend the app to other young people who were struggling with self-harm. These preliminary findings are encouraging and provide initial support for the acceptability of BlueIce as a self-help intervention used in conjunction with the traditional face-to-face therapy.
42 citations
Cites background from "Public Acceptability of E-Mental He..."
...These results are encouraging as perceived helpfulness of a mental health intervention is considered a key indicator of acceptability [23] and one of the most important criterion for choosing to use a mental health intervention [24]....
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TL;DR: In this article, the authors identified the various uses and efficacy of telehealth technology for people with severe mental illness (SMI) by systematically searching electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database).
Abstract: Background: People with severe mental illness (SMI) must receive early interventions to prevent mental health deterioration or relapse. Telecommunications and other technologies are increasingly being used to assist in health care delivery using “telehealth,” which includes telephones and mobile phones, computers, remote sensors, the internet, and other devices, to provide immediate real-time information to service users to improve the management of chronic health conditions. Some initial findings have suggested that technology could improve the quality of life of people with SMI. Objective: In this systematic review, we aimed to identify the various uses and efficacy of telehealth technology for SMI. Methods: We systematically searched electronic databases from inception to March 2016 (MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, Health Technology Assessment, CINAHL Plus, and NHS Economic Evaluations Database) to identify randomized controlled trials evaluating telehealth for adults with SMI published in English. Additional literature was identified through searching reference lists of key articles. The articles meeting the inclusion criteria were systematically reviewed and assessed for quality and risk of bias. Results: Our search identified 31 articles describing 29 trials as eligible for the review. The included studies evaluated the use of computers to deliver cognitive rehabilitation (15 trials), patient education (3 trials), and Web-based self-management interventions (2 trials) and to support consultations (1 trial). Virtual reality was used to simulate work and social situations (2 trials) and to deliver cognitive training (1 trial). Telephones were used to prompt service users to take medications (3 trials) and to report symptoms to their health care team (1 trial). Remote sensors were used to monitor medication use (1 trial). Telephone support was found effective in improving medication adherence and reducing the severity of symptoms and inpatient days. Computer-assisted cognitive rehabilitation was effective in improving cognitive function. The impact of telehealth on other outcomes was inconsistent. The results of this review should be taken in the context of varied quality in study design, with only 5 studies demonstrating a low risk of bias. Conclusions: A growing variety of telehealth technologies are being used to support the management of SMI. Specific technology types have been found to be effective for some outcomes (eg, telephone and remote medication monitoring for adherence to treatment), while other types of telehealth technologies (eg, delivery of patient education using computers) had no benefit over traditional nurse-based methods and were less acceptable to patients. Further research is warranted to establish the full potential benefits of telehealth for improving the quality of life in people with SMI, acceptability from the service user perspective, and cost-effectiveness. The findings of this review are limited by the poor quality of many of the studies reviewed.
42 citations
References
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TL;DR: The Unified Theory of Acceptance and Use of Technology (UTAUT) as mentioned in this paper is a unified model that integrates elements across the eight models, and empirically validate the unified model.
Abstract: Information technology (IT) acceptance research has yielded many competing models, each with different sets of acceptance determinants. In this paper, we (1) review user acceptance literature and discuss eight prominent models, (2) empirically compare the eight models and their extensions, (3) formulate a unified model that integrates elements across the eight models, and (4) empirically validate the unified model. The eight models reviewed are the theory of reasoned action, the technology acceptance model, the motivational model, the theory of planned behavior, a model combining the technology acceptance model and the theory of planned behavior, the model of PC utilization, the innovation diffusion theory, and the social cognitive theory. Using data from four organizations over a six-month period with three points of measurement, the eight models explained between 17 percent and 53 percent of the variance in user intentions to use information technology. Next, a unified model, called the Unified Theory of Acceptance and Use of Technology (UTAUT), was formulated, with four core determinants of intention and usage, and up to four moderators of key relationships. UTAUT was then tested using the original data and found to outperform the eight individual models (adjusted R2 of 69 percent). UTAUT was then confirmed with data from two new organizations with similar results (adjusted R2 of 70 percent). UTAUT thus provides a useful tool for managers needing to assess the likelihood of success for new technology introductions and helps them understand the drivers of acceptance in order to proactively design interventions (including training, marketing, etc.) targeted at populations of users that may be less inclined to adopt and use new systems. The paper also makes several recommendations for future research including developing a deeper understanding of the dynamic influences studied here, refining measurement of the core constructs used in UTAUT, and understanding the organizational outcomes associated with new technology use.
27,798 citations
TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
25,711 citations
"Public Acceptability of E-Mental He..." refers methods in this paper
...As mentioned by Liberati et al [36], the PRISMA statement is designed for systematic reviews and meta-analyses of randomized controlled trials (RCTs) and is not fully applicable to other types of reviews of health research....
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...The conduction and reporting of this scoping review refers to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines [36], as far as applicable....
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...Research questions were developed using the PICOS approach as suggested by the PRISMA statement [36]: (P) populations, (I) interventions, (C) comparators, (O) outcomes, and (S) study designs (for details, see the Eligibility Criteria subsection)....
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...As mentioned by Liberati et al [36], the PRISMA statement is designed for systematic reviews and meta-analyses of randomized controlled trials (RCTs) and is not fully applicable to other types of reviews of health research....
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TL;DR: Upon returning to the U.S., author Singhal’s Google search revealed the following: in January 2001, the impeachment trial against President Estrada was halted by senators who supported him and the government fell without a shot being fired.
23,419 citations
"Public Acceptability of E-Mental He..." refers background or methods in this paper
...For instance, the diffusion of innovation theory [22] aims to explain how the dissemination and adoption of innovative technologies develops from a sociological perspective....
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...All studies included in this scoping review appeared to have grounded their self-developed measures mainly on research evidence, without referring to applicable theoretical frameworks, such as the diffusion of innovation theory [22] and the UTAUT [23,24]....
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...The UTAUT [22,23] suggested habits or experience as important moderator of intentions to use a technology....
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...CBT: cognitive behavior therapy e-mental health: electronic mental health GP: general practitioner iCBT: Internet-based cognitive behavior therapy IT: information technology MeSH: medical subject headings m-mental health: mobile mental health NOS: Newcastle-Ottawa scale PRISMA: preferred reporting items for systematic reviews and meta-analyses RCT: randomized controlled trial TAM: technology acceptance model UTAUT: unified theory of acceptance and use of technology Edited by G Eysenbach; submitted 09.06.16; peer-reviewed by C Dockweiler, J Tavares, C Eichenberg, S Pezaro; comments to author 17.11.16; revised version received 20.12.16; accepted 29.01.17; published 03.04.17 Please cite as: Apolinário-Hagen J, Kemper J, Stürmer C Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review JMIR Ment Health 2017;4(2):e10 URL: http://mental.jmir.org/2017/2/e10/ doi: 10.2196/mental.6186 PMID: 28373153 ©Jennifer Apolinário-Hagen, Jessica Kemper, Carolina Stürmer....
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...To examine determinants of technology use and behavioral intentions to use, the UTAUT provides different key determinants of IT acceptance and moderators such as age, gender, and experience....
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01 Jan 2014
TL;DR: The Newcastle-Ottawa Scale (NOS) as discussed by the authors was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results.
Abstract: Nonrandomised studies, including case-control and cohort studies, can be challenging to implement and conduct. Assessment of the quality of such studies is essential for a proper understanding of nonrandomised studies. The Newcastle-Ottawa Scale (NOS) is an ongoing collaboration between the Universities of Newcastle, Australia and Ottawa, Canada. It was developed to assess the quality of nonrandomised studies with its design, content and ease of use directed to the task of incorporating the quality assessments in the interpretation of meta-analytic results. A 'star system' has been developed in which a study is judged on three broad perspectives: the selection of the study groups; the comparability of the groups; and the ascertainment of either the exposure or outcome of interest for case-control or cohort studies respectively. The goal of this project is to develop an instrument providing an easy and convenient tool for quality assessment of nonrandomised studies to be used in a systematic review.
17,590 citations
"Public Acceptability of E-Mental He..." refers methods in this paper
...The NOS consists of three categories with different rating dimensions for quality assessment....
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...CBT: cognitive behavior therapy e-mental health: electronic mental health GP: general practitioner iCBT: Internet-based cognitive behavior therapy IT: information technology MeSH: medical subject headings m-mental health: mobile mental health NOS: Newcastle-Ottawa scale PRISMA: preferred reporting items for systematic reviews and meta-analyses RCT: randomized controlled trial TAM: technology acceptance model UTAUT: unified theory of acceptance and use of technology Edited by G Eysenbach; submitted 09.06.16; peer-reviewed by C Dockweiler, J Tavares, C Eichenberg, S Pezaro; comments to author 17.11.16; revised version received 20.12.16; accepted 29.01.17; published 03.04.17 Please cite as: Apolinário-Hagen J, Kemper J, Stürmer C Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review JMIR Ment Health 2017;4(2):e10 URL: http://mental.jmir.org/2017/2/e10/ doi: 10.2196/mental.6186 PMID: 28373153 ©Jennifer Apolinário-Hagen, Jessica Kemper, Carolina Stürmer....
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...However, this could be not emphasized through higher NOS scores....
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...Furthermore, we used the NOS for the quality assessment despite potential reliability issues [48]....
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...As information on the scoring (cut-off thresholds; poor-fair-good) of the NOS is under development for observational nonrandomized studies [37], we did not refer to NOS scoring algorithms suggested for quality assessments of RCTs because they were hardly convertible....
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TL;DR: In this paper, the authors developed and tested a theoretical extension of the TAM model that explains perceived usefulness and usage intentions in terms of social influence and cognitive instrumental processes, which was tested using longitudinal data collected regarding four different systems at four organizations (N = 156), two involving voluntary usage and two involving mandatory usage.
Abstract: The present research develops and tests a theoretical extension of the Technology Acceptance Model (TAM) that explains perceived usefulness and usage intentions in terms of social influence and cognitive instrumental processes. The extended model, referred to as TAM2, was tested using longitudinal data collected regarding four different systems at four organizations ( N = 156), two involving voluntary usage and two involving mandatory usage. Model constructs were measured at three points in time at each organization: preimplementation, one month postimplementation, and three months postimplementation. The extended model was strongly supported for all four organizations at all three points of measurement, accounting for 40%--60% of the variance in usefulness perceptions and 34%--52% of the variance in usage intentions. Both social influence processes (subjective norm, voluntariness, and image) and cognitive instrumental processes (job relevance, output quality, result demonstrability, and perceived ease of use) significantly influenced user acceptance. These findings advance theory and contribute to the foundation for future research aimed at improving our understanding of user adoption behavior.
16,513 citations