Programs

Back
Elena Hall - Marinela

Design, development, evaluation and dissemination of digital CBT interventions

Oksana Zelenko, David Kavanagh, John Dalgleish, Gerhard Andersson Speaker

Topic: General Mental Health, Digital Health

Abstract:

Over the last 20 years, there has been a rapid proliferation of digital mental health resources, some of which have gained strong research support on their acceptability and impact. These resources hold the potential to transform the accessibility and provision of clinical services on individual and global scale. However, the quality and evidence base of these resources vary widely. This symposium outlines approaches to the conceptualization, development, testing, quality assurance and dissemination of digital mental health resources that can maximize their quality, use and impact. The first paper presents examples of eHealth CBT interventions incorporating various therapeutic approaches and their quality evaluation. The second paper describes how participatory design can be used as an effective end user engagement framework in conjunction with qualitative research methods to design and develop novel digital interventions. The third paper describes sector-wide outcomes from a national program to disseminate digital mental health resources in primary care. The fourth paper focuses on the implementation of digital innovation in Australia’s largest national youth counselling service. The final paper presents novel data suggesting that clients can benefit from selecting intervention techniques instead of being prescribed techniques by a clinician or computer. End user consultations using participatory design, appropriate quality control and evaluation, and cross-disciplinary collaboration can increase the acceptability, uptake and efficacy of digital mental health resources. Implementation of rigorous scientific approach is required to ensure their widespread dissemination in routine clinical practice.

Presenters:

Mr Stoyan Stoyanov1, 3; Dr Oksana Zelenko1 ; Prof David Kavanagh2;

Mr John Dalgleish4; Prof Gerhard Andersson5,6

Authors Affiliations:

1. School of design, Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia;

2. School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia;

3. School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia;

4. Yourtown/Kids Helpline, Australia;

5. Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden;

6. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

7. University of New South Wales

8. Menzies School

9. University of Sydney

Presentation 1:

eHealth CBT intervention approaches: quality, evaluation and efficacy

Authors: Stoyan Stoyanov1,3; Oksana Zelenko1; David Kavanagh2; Leanne Hides3

1. School of design, Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia;

2. School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia;

3. School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia;

Global spread and adoption of digital health interventions has prompted an unprecedented shift in the provision and utilisation of healthcare. An array of CBT-based interventions are actively applied in digital health. To date, few clear methodological guidelines exist for eHealth design and evaluation. Thus the market offers interventions that lack evidence, and are even potentially harmful. We present examples of evidence-based CBT interventions and approaches to their evaluation. A multi-disciplinary team of researchers, designers, health experts and developers was involved; appropriate intervention strategies were determined; end users were consulted through participatory design workshops; a series of evaluation methodologies was developed to ensure high quality and fidelity of the new eHealth interventions.

Five CBT-based digital health interventions were developed. To assist with determining the efficacy, an evaluation framework, called the Mobile App Rating Scale was devised, in order to assist with the quality evaluation of digital health interventions. A number of considerations and effective strategies need to be implemented in order to increase the usability and utility of CBT-based digital health. A variety of evaluation strategies will be discussed.

 

Presentation 2:

Participatory design: an effective end-user engagement framework to design and develop novel digital interventions 

Authors: Oksana Zelenko1; Stoyan Stoyanov1,3; Gavin Sade1; Leanne Hides3

1. School of design, Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia;

3. School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia;

Digital health interventions provide an unprecedented opportunity to simultaneously increase client accessibility to help and support services, while increasing clinician access to targeted and personalised client treatments. Furthermore, they hold a potential for large-scale economic benefits.

Logically, eHealth has seen exponential growth since the onset, reaching 320,000 health apps today with nearly 100,000 of them published between 2015 and 2016 alone. This growth, however, shows less-than-optimal adoption with 21% of mobile apps being deleted after a single use. Apps are often unengaging and designed without adequate background research and consolation with prospective users. Multi-disciplinary methodologies promoting collaborative partnerships between end-users, researchers and services open potential for increasing acceptance, relevance and uptake of new digital interventions. To increase the usability and acceptability of health apps, through participatory design. A participatory design-led engagement framework using a series of participatory design workshops (PDWs), following qualitative methodological guidelines have been used to inform the development of a set of evidence-based mobile health apps. A series of considerations and best practices relating to transdisciplinary eHealth research have been established in order to efficiently translate user needs into digital health technologies. Resulting apps present with high levels of uptake and user engagement and hold promise for the effective implementation of eHealth into the public domain. Participatory design research is an integral component of the conceptualisation and development process, ensuring higher quality and uptake of novel eHealth interventions.

Presentation 3:

e-Mental Health in Practice: A Nation-Wide Initiative to Embed Digital Mental Health in Primary Care 

Authors: David J Kavanagh2, Heidi Sturk2, Jonathon Tennant7, Sarah Connor7, Sarah McNally7, Tricia Nagel, Kylie Dingwell8, James Bennet-Levy, Judy Singer9

2. School of Psychology and Counselling, Faculty of Health, Queensland University of Technology, Brisbane, Australia;

7. University of New South Wales

8. Menzies School

9. University of Sydney

Digital mental health has now obtained substantial evidence supporting its efficacy across a growing range of disorders, but its integration with standard services is limited and lacks consistency.  Since 2013, the Australian government has made substantial investments in e-Mental Health in Practice (eMHPrac), a multi-site project to undertake extensive marketing and training to support practitioners’ use of digital mental health in their work. The initiative has not only focused on GPs and allied health practitioners, but also on workers in Indigenous communities, including ones in remote locations. From its inception, the project has been informed by the different ways in which digital resources fit into these contrasting contexts, and the different challenges for implementation that each pose. Over the first 4 years, the project has documented substantial increases in registered users of web programs and online or phone counselling offered by the leading Australian providers, but numbers of referrals have remained relatively static. While marketing and training efforts are continuing, the project now focuses on implementing a broader model of dissemination science and on fostering sustainability.

Presentation 4:

Implementation of digital innovation in Australia’s largest national youth counselling service

Authors: John Dalgleish4; Stoyan Stoyanov1,3; Oksana Zelenko1; Calvin Smith4

1. School of design, Creative Industries Faculty, Queensland University of Technology, Brisbane, Australia;

4. Yourtown/Kids Helpline, Australia;

Kids Helpline offers Australia’s largest youth counselling service, which received 340,000 direct contacts in 2017 alone. While help seeking amongst young Australians, aged 5-25 years is on the rise helpline resourcing and funding is limited. Thus, 54% of all direct contacts to Kids Helpline remain unanswered. Meanwhile, Kids Helpline has seen a significant shift of support-seekers from traditional phone counselling to online technologies such as chat, or email, which provides a great potential for the service to increase its accessibility via alternative media. To increase access to counselling services by implementing innovative digital health technologies. A review of current help-seeking trends and available resources, provided by organisations worldwide is followed by a series of participatory design workshops, to conceptualise a new resource. Two digital resources are developed, which aim to reshape the way young Australians receive support: The Breakup Shakeup app uses behavioural activation to assist young people after a relationship breakup. The ToolKit app utilises Education, Activity Scheduling, monitoring and a wealth of CBT-based approaches to increase agency and self-efficacy in young people with mental health concerns.

This presentation will outline key learnings concerning how modern technology is being used to support help-seeking by children and young people and to strengthen counselling practice.

Presentation 5:

Tailored internet treatment for depression. A factorial design trial on the role of support and choice of treatment components

Gerhard Andersson5,6; Simon Juhlin5, Carl Wahlström5, Anna Steneskog5, Anna Tholcke5, Edvard de Fine Licht5, Simon Färdeman5, & Kristofer Vernmark5

5. Department of Behavioural Science and Learning, Linköping University, Linköping, Sweden.

6. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

Psykologpartners private practice

While there are several controlled trials on the effects of Internet-delivered CBT (ICBT) for depression most have used a traditional controlled trial design with one or two active treatments and a control condition (most often waitlist control). Another way to investigate components of interventions is to run factorial design trials. In the present study we included 197 persons with depression and or elevated symptoms of depression. They were randomly assigned to eight groups in design with three factors. The treatment was tailored ICBT with a range treatment modules. The first factor was form of support with either scheduled support or support on demand. The second factor was self-tailored versus tailoring done be a clinician informed by a patient interview. The third factor was supervision vs no supervision on client cases. Results showed moderate to large within-group effects (d = 0.73 - 1.23) on measures of depression and anxiety, but no difference between scheduled and support on demand from clinicians or any effect of supervision. However, unexpectedly, there was an effect of self-selection with a between group effect of d = 0.43. The present study has two important implications. First, it illustrates the value of factorial design trials and second if replicated the finding that self-selection of treatment components work could influence how ICBT is set up in future trials and clinical applications.