JMIR Publications

ABSTRACT

Background:

Depression is common among homebound older adults. Internet-based cognitive-behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities.

Objective:

This study aimed to understand the experiences of homebound older adults who took part in a pilot feasibility trial of an iCBT for depression.

Methods:

Informants included 21 homebound older adults who participated in a generic iCBT program not specifically designed for older adults and eight home care workers (HCWs) who assisted in iCBT. Informants completed semi-structured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questioning of initial codes. Data analysis was conducted using Dedoose, a web application for mixed methods research.

Results:

Three themes and various subthemes emerged related to participants’ experience of the iCBT intervention: (a) intervention impact, involving subthemes related to participants’ perceived impact of the intervention; (b) challenges and difficulties, involving subthemes on the challenges and difficulties that participants experienced in the intervention; and (c) facilitators, involving subthemes on the factors that facilitated intervention usage and engagement.

Conclusions:

iCBT has promise as an intervention for homebound older adults experiencing depression. HCWs reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Clinical Trial: The study has been registered on ClinicalTrials.gov as NCT04267289.