Abstract
Blended care, a combination of online and face-to-face therapy, is increasingly being applied in mental health care to obtain optimal benefit from the advantages these two treatment modalities have. Promising results have been reported, but a variety in descriptions and ways of operationalizing blended care exists. Currently, what type of “blend” works for whom, and why, is unclear. Furthermore, a rationale for setting up blended care is often lacking. In this viewpoint paper, we describe postulates for blended care and provide an instrument (Fit for Blended Care) that aims to assist therapists and patients whether and how to set up blended care treatment. A review of the literature, two focus groups (n=5 and n=5), interviews with therapists (n=14), and interviews with clients (n=2) were conducted to develop postulates of eHealth and blended care and an instrument to assist therapists and clients in setting up optimal blended care. Important postulates for blended care are the notion that both treatment modalities should complement each other and that set up of blended treatment should be based on shared decision making between patient and therapist. The “Fit for Blended Care” instrument is presented which addresses the following relevant themes: possible barriers to receiving blended treatment such as the risk of crisis, issues in communication (at a distance), as well as possible facilitators such as social support. More research into the reasons why and for whom blended care works is needed. To benefit from blended care, face-to-face and online care should be combined in such way that the potentials of both treatment modalities are used optimally, depending on patient abilities, needs, and preferences. To facilitate the process of setting up a personalized blended treatment, the Fit for Blended Care instrument can be used. By applying this approach in research and practice, more insight into the working mechanisms and optimal (personal) “blends” of online and face-to-face therapy becomes within reach.
Highlights
The use of eHealth has shown promising results in various mental health treatments [1], especially when guidance from a care provider is included [2,3,4]. eHealth provides opportunities for self-management and continuity of care
Blended mental health care may have some important advantages over face-to-face therapy
Blended care invites patients and therapists to think about personal needs and preferences, for an optimally personalized treatment that can enhance the self-management of patients and translation of treatment into daily life
Summary
The use of eHealth has shown promising results in various mental health treatments [1], especially when guidance from a care provider is included [2,3,4]. eHealth provides opportunities for self-management and continuity of care. Therapists must consider the rationale for providing face-to-face and/or online modalities, following discussions with the patient to assure the fit between technology and the end users [13] With these postulates in mind, a rationale for applying, developing, and researching blended mental health care is provided. To translate these postulates into an instrument that summarizes relevant considerations in setting up blended treatment and guides therapists and clients through the process of jointly discussing and setting up blended treatment, we performed an additional literature search aimed at identifying predictors of blended treatment success. Care providers preferred checklist topics to start a shared decision-making process with their patients on the use and distribution of online care components To validate these facilitators for blended care, we invited health care professionals to discuss the rationale for the development of the instrument.
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