JMIR Publications

ABSTRACT

Background:

Depression in older adults is associated with reduced psychological well-being and negative health outcomes. However, many older adults face barriers in accessing evidence-supported mental health treatments. Digital Mental Health Interventions (DMHIs) have the potential to improve treatment access, but there are few web-based interventions tailored specifically for depression in older adults.

Objective:

This paper describes the design and development process of Empower@Home, a web-delivered intervention for depression in older adults that is based on cognitive behavioral therapy (CBT), and reports on the outcomes of usability studies.

Methods:

Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through focus groups, semi-structured interviews, demographic and health profiles from administrative data, and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs, using the System Usability Scale (SUS) and semi-structured interviews. Field testing was conducted with 4 end-users to detect additional usability issues.

Results:

Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of nine sessions completed over ten weeks, with a printed workbook accompanying the online lessons. The online lessons include psychoeducation and introduce CBT skills and tools through short video clips, interactive content, an animated storyline, and weekly out-of-session home practice. Empower@Home received statistically significantly higher SUS scores than Beating the Blues and MoodGym, and 80% of users preferred Empower@Home over the comparators. In the field test, all participants reported that they liked the program procedures and felt confident in performing program-related tasks.

Conclusions:

Empower@Home is highly responsive to end user needs and implementation setting characteristics. Collaboration with community stakeholders and careful consideration of implementation issues during the design process can result in more usable, engaging, and effective DMHIs.