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The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Lifestyle and rehabilitation in long term illness.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Psychology in Healthcare.
2016 (English)In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 3, no 2, article id e25Article in journal (Refereed) Published
Abstract [en]

Background: The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified.

Objective: The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions.

Methods: Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods.

Results: The preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished communication between therapist and client, fear of negative side effects, requirements of computer literacy, and concerns about confidentiality.

Conclusions: Internet-based interventions were reported as the preferred choice by a minority of participants. The results suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may restrict its use. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study.

Place, publisher, year, edition, pages
2016. Vol. 3, no 2, article id e25
National Category
Psychology
Identifiers
URN: urn:nbn:se:uu:diva-299378DOI: 10.2196/mental.5324ISI: 000414980100013PubMedID: 27302200OAI: oai:DiVA.org:uu-299378DiVA, id: diva2:949263
Available from: 2016-07-18 Created: 2016-07-18 Last updated: 2017-12-17Bibliographically approved
In thesis
1. Health-related Internet use and screening for emotional distress in people with cancer
Open this publication in new window or tab >>Health-related Internet use and screening for emotional distress in people with cancer
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to investigate the preferences and incentives for using Internet-delivered support among people with cancer and to develop and test a generic questionnaire measuring health-related Internet use, the Health Online Support Questionnaire (HOSQ). Another aim was to examine the psychometric properties of the online-administered Hospital Anxiety and Depression Scale (HADS) and Visual Analogue Scale (VAS) regarding anxiety and depression in psychosocial screening among people with cancer, in comparisons with the longer instruments Montgomery Åsberg Depression Rating Scale – Self-report (MADRS-S) and the State Trait Anxiety Inventory – State (STAI-S).

Study I was a correlational and descriptive study on the development and psychometric properties of the HOSQ. Study II was a cross-sectional and descriptive study on health related Internet use in patients with cancer. Study III was a cross-sectional and descriptive study examining preferences for psychological treatments. Study IV was a psychometric comparison study of two short instruments and two longer instruments measuring anxiety and depression.

Findings from study I showed that the HOSQ might be a reliable and valid instrument for measuring the use of online support for people with health problems. Results ought to be replicated though in larger and other groups to confirm the results for different diagnoses.  Findings from study II confirmed results from other studies showing that people with cancer turn to the Internet for informational support that enables them to influence their care and to stay in touch with friends and relatives. Demographical differences regarding the uptake of Internet-based support remains, which indicates a need for research on how to bridge this digital gap. In study III, we found that a large majority preferred psychological treatment face to face whereas Internet-based interventions were reported as the preferred choice by a minority. Findings from the content analysis suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may be perceived as barriers. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study. In study IV we found that the use of the short and ultrashort tools HADS and VAS identified anxiety and depression in patients with cancer with high accuracy in comparisons with the longer instruments.

In conclusion, online screening with the HADS and VAS may be a suitable initial method to identify anxiety and depression in patients with cancer. There is still a large proportion of patients who lack the interest or eHealth literacy to use health-related support on the Internet. By learning more about the barriers, use and perception of eHealth and Internet-based interventions, adequate support may be offered. 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 78
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1413
Keyword
Social support, Internet, Cancer, eHealth, Questionnaire, Oncology, Support, Patient preference, Screening, Depression, Anxiety
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-335968 (URN)978-91-513-0195-2 (ISBN)
Public defence
2018-02-16, Sal IX, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-01-24 Created: 2017-12-17 Last updated: 2018-03-07

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Wallin, EmmaMattsson, SusanneOlsson, Erik

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