JMIR Publications

ABSTRACT

Background:

The death of a partner is a very stressful and critical life event in later life, which requires the acceptance of the loss as well as development of a new perspective for the future. Cognitive-behavioural text-based online self-help interventions for coping with prolonged grief have established the efficacy in decreasing symptoms of grief, depression, and loneliness. However, there are few studies addressing partner bereavement, while none have tested the role of self-tailoring in these interventions. Moreover, most studies include only mourners whose loss occurred more than six months ago.

Objective:

The aim of this study is to evaluate the clinical efficacy and acceptance of an online self-help program to support the grief process of older adults who lost their partner. Furthermore, it will compare a standardised and a self-tailored delivery format and investigate moderators and mediators of outcomes. The inclusion of qualitative measures to understand user experience and a cost-effectiveness analysis will complement the study.

Methods:

Participants will consist of older adults from the general population in Switzerland (n = 85), the Netherlands (n = 40) and Portugal (n = 80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The randomised control trial will focus on clinical efficacy for reducing grief, depression symptoms and loneliness and comprise three arms (two active intervention conditions and one waiting list control condition). Furthermore, a standardised versus self-tailored delivery format will be compared, along with the examination of moderators and mediators, such as time since loss, age, adherence to the intervention, and the working alliance. Measurements will take place at baseline, after the intervention and at follow-up, 10 weeks after concluding the use of the program. Data on technology acceptance will be supplemented by qualitative data, obtained from focus groups.

Results:

Results will provide insights into the efficacy and acceptance of an online self-help intervention among older adults who lost a partner.

Conclusions:

While most online grief interventions have focused on coping with prolonged grief or severe grief symptoms, this self-help intervention also includes a more inclusive target group and aims to support the mourning process after a more recent loss. Moreover, the intervention aims to contrast a standardised and self-tailored condition, specifically to examine whether the efficacy of online grief interventions can be increased by providing a self-tailored version, where users can choose the content which best fits their current needs. Finally, the study will also suggest adaptations to improve the acceptance of online self-help interventions for older adults and explore the cost-effectiveness benefits of this intervention. Limitations include a self-selective sample. Clinical Trial: The Portuguese trial was registered at clinicaltrials.gov (NCT05156346) and the Swiss trial will be registered soon in the same platform. For the study in the Netherlands, the Medical Ethical Committee Oost-Nederland ruled that the study was exempt from obtaining medical ethical permission, as the main topic of the intervention and study (mourning) is not a medical condition (file number NL79937.091.21).