JMIR Publications

ABSTRACT

Background:

Homebound older adults face a high burden of depression and significant barriers to accessing mental health treatments. Few interventions address their specific needs. Empower@Home, an internet-based cognitive behavioral therapy (iCBT) program, was co-designed with stakeholders and tailored to older adults. The program includes nine self-paced online sessions to be completed within 12 weeks, augmented by telephone-based human support. Efficacy studies have demonstrated its acceptability and effectiveness in reducing depression when supported by trained research staff. However, its real-world effects and feasibility for integration into community aging service settings remain unknown.

Objective:

This study aims to assess the real-world effectiveness of Empower@Home integrated into aging services, using non-clinician agency staff as coaches to support older adults. A secondary objective is to evaluate the implementation process through a qualitative process evaluation.

Methods:

The study is a Type 1 Hybrid Effectiveness-Implementation Trial with a two-arm randomized controlled design. A total of 256 homebound older adults will be recruited from three community aging service agencies, and agency staff will be trained as coaches to support iCBT use. Participants in the treatment group will receive Empower@Home immediately, while the control group will receive biweekly friendly calls and enhanced care as usual, including the provision of psychoeducational materials and usual care. Outcomes will be assessed at baseline, post-intervention (12 weeks), and at two follow-up points (24 and 36 weeks). The primary outcome is change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes include changes in social isolation, health-related quality of life, disability burden, pain intensity, and anxiety symptoms.

Results:

Institutional Review Board approval was obtained in August 2024, and recruitment began in October 2024. Recruitment is expected to conclude by April 2028. Upon trial completion, the effectiveness of Empower@Home on primary and secondary outcomes will be analyzed.

Conclusions:

This study will provide critical insights into the real-world effectiveness of Empower@Home. If successful, it offers a scalable, cost-effective model for integrating technology-assisted mental health treatments into community aging services, enhancing access to care for an underserved, hard-to-reach population. Clinical Trial: ClinicalTrials.gov. NCT06584422. Registered on August 30, 2024. https://clinicaltrials.gov/study/NCT06584422