JMIR Publications

ABSTRACT

Background:

The use of digital technologies for health has been the focus of social studies, which have concentrated on the digital divide between individuals who use technology and those who do not with the latter often being considered as individuals with shortcomings. In Denmark, 91% of the population have a computer and 97 out of 100 families have internet access. This suggests that lack of access to technology is not the primary reason for non-use. While previous studies have primarily focused on patient perspectives of using internet-based treatment for Alcohol Use Disorder (AUD), no studies have investigated individuals’ reasons to prefer face-to-face treatment in comparison to blended face-to-face and internet-based cognitive behavioral therapy (bCBT) for AUD among treatment seeking populations.

Objective:

The aim of this qualitative study is to investigate non-use of bCBT among patients AUD. Specifically, this study aims to explore patient reasons for choosing not to receive treatment via this format.

Methods:

This qualitative study was conducted among Danish patients with AUD, who were enrolled in the study Blending Internet treatment into conventional face-to-face treatment for alcohol use disorder (Blend-A) but had not used bCBT. The participant group consisted of 11 patients, three were women and eight were men, and they were aged between 29-78 years (mean 59). Individual semi-structured interviews were conducted by cellphone to gather participant reasons for not choosing bCBT. The interviews were recorded, transcribed, and analyzed using thematic analysis. Five authors performed the analysis through three steps: 1) Two authors read through transcripts and coded themes from their immediate impression of the material 2) A third author provided feedback which was used to group overlapping themes together or create new themes that better reflected the content 3) Two remaining authors provided feedback on the analysis to improve its structure, readability, and relevance to the research aim.

Results:

We found that the patients had various reasons for choosing face-to-face treatment over bCBT, which were mainly related to personal matters and less to digital health literacy. We identified five themes related to personal matters for choosing face-to-face treatment over bCBT: 1) patients’ need for attending sessions in person, 2) preference for verbal communication, 3) desire for immediate feedback, 4) feeling more empowered and motivated with face-to-face sessions, and 5) lack of digital health literacy.

Conclusions:

This study provides valuable insight into the patient perspective on blended therapy for AUD and highlights the importance of considering personal factors when designing digital health interventions. Our study indicates that most of the patients choose not to use bCBT for AUD because they perceive such treatment format as impersonal. They prefer direct communication with the therapist including the ability to express and comprehend facial expressions and body language. Clinical Trial: Clinicaltrials.gov.: NCT04535258