JMIR Publications

ABSTRACT

Background:

Farming is physically and psychologically hazardous. Farmers face many barriers to help-seeking from traditional physical and mental health services, but higher levels of internet access now provide promising avenues for offering support.

Objective:

To co-design with farmers the content and functionality of a website that aims to help them adopt transferable coping strategies and to test its acceptability in the broader farming population.

Methods:

Research evidence and expert opinions were synthesized to inform key design principles. Eighteen farmers detailed what they would like from new web-based wellbeing-focused websites. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by two independent mental health professionals. Nine farmers provided detailed qualitative feedback on face validity of draft content. Subsequently, nine farmers provided feedback on the website prototype. Following amendments and further internal prototype testing and optimization, prototype usability (i.e. completion rate) was examined with 157 registered website users (66.9% female, 21-73 years, 95.5% residing in inner regional-very remote Australia, 68% sheep/cattle and/or grain farmers) and acceptability was examined with a subset of 114 users who provided a rating /5 for at least Module 1. Brief interviews with 108 farmers who did not complete all five modules helped determine reasons for this, and detailed interviews were conducted with 18 purposively sampled users. The website was then updated, informed by adaptive trial design methodology.

Results:

This systematic co-design process integrating existing research and expert evidence resulted in an online web-based resource based on Acceptance and Commitment Therapy (ACT), designed to overcome existing barriers to engagement with wellbeing strategies. The intervention is an accessible and confidential source of practical and salient farmer-focused, self-help strategies. Strategies are delivered via five interactive modules that include written, drawn, audio and video-based ACT-informed psychoeducation and exercises, as well as farming-related jokes, metaphors, examples and imagery. Module 1 includes distress screening and information on how to speak to general practitioners about mental health-related concerns (including a personalized conversation script). Modules are completed fortnightly. Text messages offer personalized support and remind users to return and continue to practise key strategies. Qualitative interviews and star ratings demonstrated high acceptability with the modules (average 4.06/5 rating), and suggested that additional reminders, higher quality audio recordings and shorter modules would be useful. Thirty-seven percent of users who started Module 1 completed all modules, with ‘too busy/not got to it yet’ being the main reason for not completing all modules, and previous module acceptability not predicting subsequent module completion.

Conclusions:

Sequential integration of research evidence, expert knowledge and farmers’ preferences in the co-design process allowed for development of an ACT-based self-help intervention that focuses on important intervention targets (i.e. relevant, teachable coping strategies) and is acceptable to this difficult-to-engage group.