JMIR Publications

ABSTRACT

Background:

A previously reported study examined the treatment of primary care patients with at least moderate severity depressive and/or anxiety symptoms via Beating the Blues, an evidence-based computerized cognitive behavioral therapy program (CCBT), or CCBT and an Online Health Community (OHC) that included a moderated Internet support group (ISG). The two treatment arms proved to be equally successful at 6-month follow-up.

Objective:

Though highly promising, e-mental health treatment programs have encountered high rates of non-initiation, poor adherence, and discontinuation. Identifying ways to counter these tendencies is critical to their success. To further explore these issues, this study identified the primary care patient characteristics that increased the chances patients would: not initiate use of an intervention, that is, not try it even once; initiate use; and, go on to discontinue, or continue to use an intervention.

Methods:

The study had three arms: one received access to CCBT (n=301); another received CCBT plus the OHC (n=302), which included a moderated Internet Support Group; and the third received usual care (n=101). Participants in the two active intervention arms of the study were grouped together for analyses of CCBT utilization (n=603), because both arms had access to CCBT, and there were no differences in outcomes between the two arms. Analyses of the OHC utilization were based on the 302 participants who were randomized to that arm.

Results:

Several baseline patient characteristics were associated with failure to initiate use of CCBT, including, having worse physical health (measured by the SF-12 Physical Components Score, P=.012), more interference from pain (by the PROMIS Pain Interference score, P=.048), less formal education (P=.018), and being African American or other US minority group (P=.006). Characteristics associated with failure to initiate use of the OHC were, better mental health (by the SF-12 Mental Components Score, P=.04), lower use of the internet (P=.005), and less formal education (P=.001). Those who initiated use of the CCBT program but went on to complete less of the program, had less formal education (P=.013) and lower severity of anxiety symptoms (P=.029).

Conclusions:

This study found that there were several patient characteristics that predicted whether a patient was likely to not initiate use, or discontinue use of the CCBT or OHC. These findings have clear implications for actionable areas that can be targeted during initial and on-going engagement activities designed to increase patient buy-in and subsequent utilization and resulting success of e-health programs. Clinical Trial: ClinicalTrials.gov identifier NCT01482806