The Acceptability of Internet-based Interventions

for Children, Youth and Young Adults: A Review

A. Struthers, S. Winters,

Evaluation Platform

Objectives

• Rationale for the review• Methods• Findings• Discussion and conclusion

Rationale

Barriers to treatment• 10 - 20% of youth have a mental

illness, but only 20% receive services.• Barriers: Stigma, embarrassment,

poor mental health literacy, geography and a preference for self-reliance.

• E-mental health may help to overcome some of these barriers.

(Canadian Mental Health Association 2013; Gulliver,A. 2010; Christensen,H. 2011; Griffiths,K.M. 2007; Christensen,H. 2010).

Research Question• How acceptable are e-mental health

services for children, youth and young adults to providers and clients (including parents)?

• Part of a CIHR- funded study entitled “The availability, effectiveness, cost-effectiveness, acceptability and equity of e-mental health services for children and youth”.

What is acceptability?“The extent to which consumers of a treatment … view the treatment as reasonable, justified, fair, and palatable” We explored five dimensions:

1. satisfaction; 2. client expectations; 3. uptake; 4. adherence; and 5. client/provider experiences

(Kazdin,A.E. 2000)

Methods• Searched published and grey literature• Abstracts screened by the research team • Quality of relevant papers was assessed using:– The Quality Assessment Tool for Quantitative

Studies – The Critical Appraisal Skills Programme Tool for

Qualitative Research.

• Findings were synthesized within the framework of the five dimensions of acceptability

(5468 Thomas,B.H. 2004; 5469 CASP)

Results

Study Selection

Total number of papers: 2,683

Not relevant based on abstract/title/full text:

2,587

Relevant papers: 96

Average age <25 years Excluded: [studies reporting

initial data (2), low quality (38), not relevant to acceptability

(32)]

Studies included for Acceptability: 24

Study SelectionStudies included for Acceptability: 24– eating disorders (8)– depression (7)– anxiety (5)– obsessive compulsive disorder (1). – General (3)

Expectations, satisfaction, uptake, and adherence

• Client expectations: in general, participants had positive expectations of treatment (3 studies)

• Satisfaction: moderate to high (7 studies)• Uptake: participants who agreed to

participate and started the intervention ranged from 62.6 - 100% (7 studies)

• Adherence: participants completing intervention ranged from 29.4% to 87.5% (8 studies)

Client and provider experiences• 6 studies in total

• Therapeutic relationship: participants were able to be open and share emotions and experiences; providers thought therapeutic relationships could be developed online(3 studies)

• Clients appreciated human support elements, anonymity, privacy, accessibility and convenience, but worried about access from public place (3 studies)

• A small number of participants felt services were too impersonal (2 studies)

Perceived benefits of e-mental health

• Improved body image and eating patterns;

• Improved general functioning and wellbeing;

• Development of coping skills; • Development of self-understanding and

self-responsibility; • Increased knowledge; • Increased confidence.

Discussion• Limitations: selection bias in satisfaction

ratings, low quality qualitative studies, many intervention types

• Efficacy: Findings from systematic review• Future study: Factors that affect

adherence, high quality qualitative studies to explore client experience, innovative study designs to account for drop-out, integration into existing systems

Conclusion

E-mental health appears to be an acceptable intervention option in child,

adolescent and young adult mental health

Questions?

AcknowledgementsFunding: Canadian Institutes of Health Research (Grant No. KA1-119794)

Co-authors: C. Charette, S. Bayyavarapu Bapuji, X. Ye, M. Raynard, C. Metge, S. Kreindler, J. Lemaire, M. Synyshyn, K. Sutherland