Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 12, 2021
Date Accepted: Oct 14, 2021
Online Problem-Solving Training with and without Peer Support in Veterans with Unmet Mental Health Needs: A Pilot Study of Feasibility, User Acceptability and Participant Engagement
ABSTRACT
Background:
Electronic health (eHealth) tools have the potential to meet the mental health needs of individuals who have barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase engagement with eHealth.
Objective:
This pilot study aimed to 1) test the feasibility and acceptability of a novel, completely automated online system to recruit, screen, enroll, assess, randomize and then deliver an intervention to a national sample of military veterans with unmet mental health needs, 2) investigate whether phone-based peer support increased usage of an online problem-solving training compared to self-directed use and 3) generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research.
Methods:
Veterans (n=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to self-directed use of an online problem-solving training called Moving Forward (n=28), peer supported Moving Forward (n=27), or a waitlist control (n=26) (ClinicalTrials.gov NCT03555435). Participants completed pre and post study measures (8 weeks later) of problem-solving skills and confidence as well as mental health symptoms. Satisfaction was assessed at post-treatment and objective use of Moving Forward was measured with number of log-ins.
Results:
Automated recruitment, enrollment and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% retention. Peer support was delivered with high fidelity and was associated with favorable patient satisfaction. Participants randomized to receive peer support had significantly more Moving Forward logins than self-directed Moving Forward participants, and those who received peer support had greater decreases in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support.
Conclusions:
Enrolling and assessing individuals in eHealth studies without human contact is feasible, but different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in online interventions and in reducing symptoms. Future research should investigate when and for whom peer support of eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for online problem-solving training. Clinical Trial: ClinicalTrials.gov NCT03555435
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