Online Psychoeducation Program Research Articles

Efficacy and cost-effectiveness of a web-based intervention with mobile phone support to treat depressive symptoms in adults with diabetes mellitus type 1 and type 2: design of a randomised controlled trial

BackgroundA diagnosis of diabetes mellitus types 1 or 2 doubles the odds of a comorbid depressive disorder. The combined diseases have a wide range of adverse outcomes, such as a lower quality of life, poorer diabetes outcomes and increased healthcare utilisation. Diabetes patients with depression can be treated effectively with psychotherapy, but access to psychological care is limited. In this study we will examine the efficacy and cost-effectiveness of a newly developed web-based intervention (GET.ON Mood Enhancer Diabetes) for people with diabetes and comorbid depressive symptoms.Methods/DesignA two-arm randomised controlled trial will be conducted. Adults with diabetes (type 1 or type 2) with increased depression scores (> 22 on the German version of the Center for Epidemiological Studies Depression Scale (CES-D)) will be included. Eligible participants will be recruited through advertisement in diabetes patient journals and via a large-scale German health insurance company. The participants will be randomly assigned to either a 6-week minimally guided web-based self-help program or an online psychoeducation program on depression. The study will include 260 participants, which will enable us to detect a statistically significant difference with a group effect size of d = 0.35 at a power of 80% and a significance level of p = 0.05. The primary outcome measure will be the level of depression as assessed by the CES-D. The secondary outcome measures will be: diabetes-specific emotional distress, glycaemic control, self-management behaviour and the participants’ satisfaction with the intervention. Online self-assessments will be collected at baseline and after a 2 months period, with additional follow-up measurements 6 and 12 months after randomisation. The data will be analysed on an intention-to-treat basis and per protocol. In addition, we will conduct an economic evaluation from a societal perspective.DiscussionIf this intervention is shown to be cost-effective, it has considerable potential for implementing psychological care for large numbers of people with diabetes and comorbid depression in routine practice and improve health outcomes.Trial registrationGerman Clinical Trial Register (DRKS): DRKS00004748.

Mechanisms underpinning effective peer support: a qualitative analysis of interactions between expert peers and patients newly-diagnosed with bipolar disorder

BackgroundThe increasing burden on mental health services has led to the growing use of peer support in psychological interventions. Four theoretical mechanisms have been proposed to underpin effective peer support: advice grounded in experiential knowledge, social support, social comparison and the helper therapy principle. However, there has been a lack of studies examining whether these mechanisms are also evident in clinical populations in which interpersonal dysfunction is common, such as bipolar disorder.MethodThis qualitative study, conducted alongside a randomized controlled trial, examined whether the four mechanisms proposed to underpin effective peer support were expressed in the email exchange between 44 individuals newly-diagnosed with bipolar disorder and their Informed Supporters (n = 4), over the course of a supported online psychoeducation program for bipolar disorder. A total of 104 text segments were extracted and coded. The data were complemented by face-to-face interviews with three of the four Informed Supporters who participated in the study.ResultsQualitative analyses of the email interchange and interview transcripts revealed rich examples of all four mechanisms. The data illustrated how the involvement of Informed Supporters resulted in numerous benefits for the newly-diagnosed individuals, including the provision of practical strategies for illness management as well as emotional support throughout the intervention. The Informed Supporters encouraged the development of positive relationships with mental health services, and acted as role models for treatment adherence. The Informed Supporters themselves reported gaining a number of benefits from helping, including a greater sense of connectedness with the mental health system, as well as a broader knowledge of illness management strategies.ConclusionsExamples of the mechanisms underpinning effective peer support were found in the sample of emails from individuals with newly-diagnosed bipolar disorder and their Informed Supporters. Experiential knowledge, social support, social comparison and helper therapy were apparent, even within a clinical population for whom relationship difficulties are common. Trial registration number ACTRN12608000411347.

Effects of adjunctive peer support on perceptions of illness control and understanding in an online psychoeducation program for bipolar disorder: A randomised controlled trial

To examine the comparative effectiveness of an online psychoeducation program for people diagnosed with bipolar disorder within the previous 12 months, completed alone or with adjunctive peer support, on symptoms and perceived control over the illness. Participants were randomly allocated to an eight-week online psychoeducation program (n=139), a psychoeducation program plus online peer support (n=134) or an attentional control condition (n=134). Increased perceptions of control, decreased perceptions of stigmatisation and significant improvements in levels of anxiety and depression, from pre- to post-intervention were found across all groups. There were no significant differences between groups on outcome measures, although a small clinical difference was found between the supported and unsupported conditions in depression symptoms and in functional impairment at the six-month follow-up. Adherence to the treatment program was significantly higher in the supported intervention than in the unsupported program. Gender and age were also significant predictors of adherence, with females and those over the age of 30 showing greater adherence. Mood state at study entry was measured by self-report rather than by clinical interview. The pattern of outcomes suggests a primary influence of non-specific or common therapeutic factors across all three intervention groups. A personally tailored intervention may be more suitable for individuals recently diagnosed with bipolar disorder, and longer term coaching may increase program adherence and long-term improvement in symptoms and functioning.

Usability assessment of a psycho-educational website for Alzheimer's disease caregivers

Caregivers of persons suffering from Alzheimer's disease (AD) living in rural and remote areas do not have an easy access to support programs specifically addressed to them. However the caregiving impact on their physical and psychological health has been confirmed by several studies. Higher levels of depression, anxiety, stress and mortality rate are described in this population compared to age-matched non-caregivers. In the last decades many intervention programs have used different technological solutions in order to provide support to isolated caregivers. Video conferencing, CD/DVD programs, phone interviews and internet web sites, among others, are currently used for this aim. As a user-lab specialized in elderly with cognitive impairment we have designed a website to deliver a psycho-educational program for AD caregivers. Before assessing its efficacy we are currently conducting a series of user tests in order to evaluate usability factors with a group of potential end-users. The aim of this study is to assure the usability of the web application. Subjects. Sixteen healthy older adults will be recruited for this study, mainly through seniors associations. Inclusion criteria include: being 65 years old or older, having some computer and Internet experience. All participants must sign informed-consent forms prior to inclusion in this study. Procedure: During the individual sessions participants will be invited to explore the site in a pre-defined order. We use the “think aloud” method in order gather users comments while they solve the different tasks they are required to perform. Quantitative and qualitative analysis for this information of data collected will be conducted. The study is currently under way and final results will be available by the end of March. This study will contribute to define website accessibility specifications for an elderly audience. Usability assessment will allow us to modify the graphic interface of the web-based program in order to improve its usability for older caregivers. This study will highlight the influence of Internet use frequency and age on the ability to navigate the online psycho educational program.

The Ins and Outs of an Online Bipolar Education Program: A Study of Program Attrition

BackgroundThe science of eHealth interventions is rapidly evolving. However, despite positive outcomes, evaluations of eHealth applications have thus far failed to explain the high attrition rates that are associated with some eHealth programs. Patient adherence remains an issue, and the science of attrition is still in its infancy. To our knowledge, there has been no in-depth qualitative study aimed at identifying the reasons for nonadherence to—and attrition from— online interventions.ObjectiveThis paper explores the predictors of attrition and participant-reported reasons for nonadherence to an online psycho-education program for people newly diagnosed with a bipolar disorder.MethodsAs part of an ongoing randomized controlled trial (RCT) evaluating an online psycho-education program for people newly diagnosed with a bipolar disorder, we undertook an in-depth qualitative study to identify participants’ reasons for nonadherence to, and attrition from, the online intervention as well as a quantitative study investigating predictors of attrition. Within the RCT, 370 participants were randomly allocated to 1 of 2 active interventions or an attention control condition. Descriptive analyses and chi-square tests were used to explore the completion rates of 358 participants, and standard regression analysis was used to identify predictors of attrition. The data from interviews with a subsample of 39 participants who did not complete the online program were analyzed using “thematic analysis” to identify patterns in reported reasons for attrition.ResultsOverall, 26.5% of the sample did not complete their assigned intervention. Standard multiple regression analysis revealed that young age (P= .004), male gender (P= .001), and clinical recruitment setting (P= .001) were significant predictors of attrition (F7,330= 8.08, P< .001). Thematic analysis of interview data from the noncompleter subsample revealed that difficulties associated with the acute phases of bipolar disorder, not wanting to think about one’s illness, and program factors such as the information being too general and not personally tailored were the major reasons for nonadherence.ConclusionsThe dropout rate was equivalent to other Internet interventions and to face-to-face therapy. Findings from our qualitative study provide participant-reported reasons for discontinuing the online intervention, which, in conjunction with the quantitative investigations about predictors, add to understanding about Internet interventions. However, further research is needed to determine whether there are systematic differences between those who complete and those who do not complete eHealth interventions. Ultimately, this may lead to the identification of population subgroups that most benefit from eHealth interventions and to informing the development of strategies to improve adherence.Trial RegistrationACTRN12608000411347; http://www.anzctr.org.au/ACTRN12608000411347.aspx (Archived by WebCite at http://www.webcitation.org/5uX4uYwVN)

A Preliminary Study of an Online Psychoeducational Program for Hypersexuality

This is a preliminary outcome study of an online recovery program for hypersexuality, with an emphasis on problematic pornography use and masturbation. The sample included 138 (M age = 37.97, SD = 12.40; 97% male; 86% European American) individuals enrolled in the Candeo online recovery program. The survey included questions regarding the helpfulness of other treatment options compared to Candeo, self-reports of various psychological and behavioral aspects of hypersexuality and recovery, and overall self-perceptions of the extent to which they had recovered prior to Candeo and currently. On average other treatments were rated as somewhat less helpful than Candeo. Participants showed significant improvements in all measured aspects of recovery when comparing retrospective and current ratings. All psychological aspects of recovery were correlated in the expected direction with current pornography use and masturbation. Further, changes in some psychological aspects of recovery were associated with changes in pornography use and masturbation. In short, evidence was found for the potential utility of online psychoeducational programs such as Candeo for aiding recovery from problematic pornography viewing and masturbation.

A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia.

Family psychoeducation has been found to reduce relapse in schizophrenia but penetration rates are low. In this study, we evaluate the feasibility of an online multifamily group program for relatives of persons with schizophrenia that can be accessed from participants' homes. We explored participation rates and evaluations of a 12-month multimodal website intervention. Using a quasi-experimental design, we compared illness outcomes (factors on the Brief Psychiatric Rating Scale, hospitalizations) of persons with diagnosed schizophrenia, and relative distress outcomes (somatic concerns and anxiety/depression subscales on the Brief Symptom Inventory) from relatives participating in the intervention (n = 26) to archival data we had from comparable dyads who received customary care (n = 16). The majority of participants in the program attended more than half the core online support sessions, expressed high levels of satisfaction, and found the technology easy to access. There appeared to be little impact of online participation on clinical status of persons with schizophrenia or relatives' distress, although there was a trend for fewer hospitalizations in the online group. Small sample size is a factor in interpreting results. Online interventions for relatives of persons with schizophrenia, while feasible, present unique challenges. These include 1) assuring access to the intervention in populations who do not own a computer; 2) addressing privacy concerns; 3) overcoming the special challenges of conducting groups in real time; 4) managing emergent situations adequately; and 5) questions about efficacy.

O-130: A randomized-controlled study of an online infertility psychoeducational program

This study sought to develop an evidence-based, online psycho-educational program grounded in cognitive behavioral and social learning theories to provide a comprehensive educational experience for infertility patients. The study goal was to determine if an online psycho-educational program could positively influence problematic fertility beliefs and attitudes, decisional conflict, and self-efficacy in the management of fertility treatment. A randomized-control study with 297 fertility patients (188 females and 109 males) from 3 major US treatment centers. Female patients were the primary study participants; >50% of their partners were recruited for an exploratory study. Patients seeking fertility treatment were recruited via flyers posted at fertility clinics to participate in an online study about how patients cope with fertility treatment. Using a rigorous research design that controls for assessment affects, patients were randomized into one for four groups, two of which received the online psycho-educational program and two groups which did not. The assessment battery, which was delivered online at a secure web portal, included measures of perceived distress, attitudes and beliefs about fertility problems, decisional conflict, ways of coping, and infertility self-efficacy. Participants exposed to the online psycho-educational program were asked to spend two 45-minute sessions using the program, which included 4 media-rich modules on basic fertility facts, coping skills, partner and provider communication. An online follow-up assessment battery was administered at one-month after baseline. The Solomon 4 analysis revealed several important findings. Overall, participants in the intervention group decreased their “sexual concern” score on the Fertility Problem Inventory (p=.03), and improved their self-efficacy on the “body integrity” subscale of the Infertility Self-Efficacy Scale (p=.04). In spite of pre-assessment reactivity to “planful problem solving”, participants further increased their use of this coping style after viewing the intervention (p<.01). An effect was also observed for decisional conflict whereby decisions for which participants felt “uninformed” (p=.02) and “unclear” (p=.06) improved at post-test. By gender, the intervention resulted in less distress for women in the areas of sexual concerns (p=.04) and rejection of childfree lifestyle (p=.06), and improvements in infertility self-efficacy around body integrity and decisional conflicts initially perceived “uninformed” (p=.02). For the men in the intervention group, improvements were observed in the area of relationship concern (p<.05) and decisional conflict where “clarity” was perceived as needed (p=.07). An online psycho-educational support program may offer a viable adjunct service for fertility clinics to offer patients seeking a fertility evaluation or treatment, and may be particularly effective in teaching skills for problem solving and decision making. The confidential nature of an online program may also serve as an important approach in helping patients grapple with intimate matters related to one’s relationship and sexual concerns, especially for patients who do not have access to counseling services or do not feel comfortable raising these issues with medical staff.