Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 8, 2021
Date Accepted: Apr 4, 2022
The effect of dissemination pathways on uptake and relative costs for a transdiagnostic self-guided internet intervention for reducing depression, anxiety, and suicidal ideation: Comparative implementation study
ABSTRACT
Background:
Self-guided online programs are effective, but inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of online programs in the community.
Objective:
The aim of the study was to compare the uptake, reach, relative costs and adherence associated with three community-based pathways for delivering a low intensity online transdiagnostic mental health program. The three dissemination pathways were: 1) social media advertising, 2) advertising in general practice, and 3) advertising in pharmacies.
Methods:
Participants were recruited online, in general practices, or in community pharmacies, completed a screener for psychological distress, and offered the 4-week FitMindKit program, a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the online program, reach was defined as the rate of uptake per exposure, and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants.
Results:
Uptake consisted of 1014 participants who were recruited through the three dissemination pathways: online (n=991), general practice (n=16), and pharmacy (n=7). Reach was highest for online: One in every 50 people exposed to the online advertising took up the intervention, compared to one in every 441 in GP clinics and one in every 1,708 in pharmacies. The dissemination cost online was AU$6.95 per user, AU$795 per user for GP clinics and AU$1,817 per user for pharmacy dissemination. No significant differences in adherence were observed between conditions, while all pathways showed an under-representation of males and linguistic diversity.
Conclusions:
The online dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds with online interventions. Clinical Trial: The randomised controlled trial portion of the study was registered with the Australian New Zealand Clinical Trials Registry (number ACTRN12618001688279).
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