the acceptability of internet-based interventions for children, youth and young adults: a review a....
TRANSCRIPT
The Acceptability of Internet-based Interventions
for Children, Youth and Young Adults: A Review
A. Struthers, S. Winters,
Evaluation Platform
Objectives
• Rationale for the review• Methods• Findings• Discussion and conclusion
Rationale
Barriers to treatment• 10 - 20% of youth have a mental
illness, but only 20% receive services.• Barriers: Stigma, embarrassment,
poor mental health literacy, geography and a preference for self-reliance.
• E-mental health may help to overcome some of these barriers.
(Canadian Mental Health Association 2013; Gulliver,A. 2010; Christensen,H. 2011; Griffiths,K.M. 2007; Christensen,H. 2010).
Research Question• How acceptable are e-mental health
services for children, youth and young adults to providers and clients (including parents)?
• Part of a CIHR- funded study entitled “The availability, effectiveness, cost-effectiveness, acceptability and equity of e-mental health services for children and youth”.
What is acceptability?“The extent to which consumers of a treatment … view the treatment as reasonable, justified, fair, and palatable” We explored five dimensions:
1. satisfaction; 2. client expectations; 3. uptake; 4. adherence; and 5. client/provider experiences
(Kazdin,A.E. 2000)
Methods• Searched published and grey literature• Abstracts screened by the research team • Quality of relevant papers was assessed using:– The Quality Assessment Tool for Quantitative
Studies – The Critical Appraisal Skills Programme Tool for
Qualitative Research.
• Findings were synthesized within the framework of the five dimensions of acceptability
(5468 Thomas,B.H. 2004; 5469 CASP)
Results
Study Selection
Total number of papers: 2,683
Not relevant based on abstract/title/full text:
2,587
Relevant papers: 96
Average age <25 years Excluded: [studies reporting
initial data (2), low quality (38), not relevant to acceptability
(32)]
Studies included for Acceptability: 24
Study SelectionStudies included for Acceptability: 24– eating disorders (8)– depression (7)– anxiety (5)– obsessive compulsive disorder (1). – General (3)
Expectations, satisfaction, uptake, and adherence
• Client expectations: in general, participants had positive expectations of treatment (3 studies)
• Satisfaction: moderate to high (7 studies)• Uptake: participants who agreed to
participate and started the intervention ranged from 62.6 - 100% (7 studies)
• Adherence: participants completing intervention ranged from 29.4% to 87.5% (8 studies)
Client and provider experiences• 6 studies in total
• Therapeutic relationship: participants were able to be open and share emotions and experiences; providers thought therapeutic relationships could be developed online(3 studies)
• Clients appreciated human support elements, anonymity, privacy, accessibility and convenience, but worried about access from public place (3 studies)
• A small number of participants felt services were too impersonal (2 studies)
Perceived benefits of e-mental health
• Improved body image and eating patterns;
• Improved general functioning and wellbeing;
• Development of coping skills; • Development of self-understanding and
self-responsibility; • Increased knowledge; • Increased confidence.
Discussion• Limitations: selection bias in satisfaction
ratings, low quality qualitative studies, many intervention types
• Efficacy: Findings from systematic review• Future study: Factors that affect
adherence, high quality qualitative studies to explore client experience, innovative study designs to account for drop-out, integration into existing systems
Conclusion
E-mental health appears to be an acceptable intervention option in child,
adolescent and young adult mental health
Questions?
AcknowledgementsFunding: Canadian Institutes of Health Research (Grant No. KA1-119794)
Co-authors: C. Charette, S. Bayyavarapu Bapuji, X. Ye, M. Raynard, C. Metge, S. Kreindler, J. Lemaire, M. Synyshyn, K. Sutherland