JMIR Publications

ABSTRACT

Background:

Internet-based interventions (IBIs) are effective for prevention and treatment of various mental disorders and thus, pose a valuable addition to improve routine care. Yet, uptake of and adherence to IBIs is often limited. To increase the actual use of IBIs, it is important to identify factors for engaging and adhering to IBIs.

Objective:

This study qualitatively evaluates perceived barriers and facilitators regarding the use of a portfolio of different IBIs in the occupational group of green professions (i.e. farmers, gardeners, foresters).

Methods:

Interview participants were selected from two randomized controlled trials (RCTs) for either prevention of depression (PROD-A, Trial Registration: DRKS00014000) or reduction of pain interference (PACT-A, Trial Registration: DRKS00014619) in green professions. Intervention group (IG) in PROD-A (N=180) participated in an IBI program receiving access to one of six symptom-tailored guided IBIs. IG in PACT-A (N=44) received access to a pain-specific guided IBI as indicated due to chronic pain symptomology. All participants received guidance by an eCoach. Overall, 41 semi-structured qualitative interviews were conducted and transcribed verbatim. Hindering and facilitating factors were identified based on inductive qualitative content analysis with two independent coders reaching almost perfect intercoder reliability (k=0.92). A quantitative follow-up validation survey (n=30/41) was conducted to validate the results. Subgroup analyses were performed based on participant and intervention characteristics.

Results:

We identified overall 42 barriers and 26 facilitators assigned to four superordinate categories related to the intervention (B=20, F=17), work (B=4, F=1), individual (B=13, F=8) and technical aspects (B=5, F=0). Key barriers (by at least 50% of the interviewees) were time-consuming work (29/40, 73%) and private life (23/40, 58%). Similarly, most often identified facilitating factors included presence of motivation, curiosity, interest, perseverance (30/40, 75%), flexible time-management at work (25/40, 63%) and support from family and friends (20/40, 50%). Whereas agreement with barriers in the validation survey was rather low (mean 24%, SD 11%), agreement with facilitators was substantially higher (mean 80%, SD 13%) and overall largely independent from gender, education level and occupational role. Differences in agreement rates were found particularly between intervention completers and non-completers. Among others, completers agreed significantly more often that the feeling of success, being motivated, curious, interested, and perseverant as well as a persisting level of suffering have been facilitating, whereas non-completers agreed more often with experiencing the eCoach contact as insufficient and technical problems as hindering for intervention completion.

Conclusions:

Based on these results, strategies like the customization of modules for more flexible and adaptive use, video chat options with the eCoach or options to facilitate social support by family, friends or other participants can be derived. These approaches could be evaluated in further quantitative research designs regarding their potential to enhance intervention use in this occupational group.