JMIR Publications

ABSTRACT

Background:

Internet-Delivered Psychological Treatments (IDPT) are built on evidence-based psychological treatment models, such as Cognitive Behavioural Therapy (CBT), and are adjusted for interaction through the Internet. The use of Internet technologies has the potential to increase access to evidence-based mental health services for a larger portion of the population with use of lesser resources. However, despite extensive evidence that Internet Interventions can be effective in treatment of mental health morbidities, user adherence in Internet programs are sub-optimal.

Objective:

The aim of this review was to i) inspect and identify the adaptive elements of IDPT for mental health morbidities, ii) examine how system adaptation influences the efficacy of IDPT in mental health, iii) identify the information architecture, adaptive dimension and strategies for implementing these interventions for mental health illness, and iv) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues.

Methods:

The review followed guidelines from PRISMA. The research databases, Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL and Cochrane, were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analysed.

Results:

A total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were found, most of which described attempts to tailor interventions for mental health illnesses. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies were tunnel-based, while a subsequent study did not report the choice of information architecture. The rule-based technique was the most common adaptive strategy used by these studies. All the studies were broadly grouped into two adaptive dimensions based on a) user preferences, and b) using performance measures such as psychometric tests.

Conclusions:

 Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in such adaptive systems. Hence, focused research on the adaptive IDPT system and clinical trials to assess their effectiveness are needed.