JMIR Mental Health

Internet interventions, technologies and digital innovations for mental health and behaviour change

Australian Mental Health Worker Attitudes Towards cCBT: What is the role of knowledge? Are there differences? Can we change them?

Background: Australia is a world leader in the development, research and dissemination of computerised cognitive behavioural treatment (cCBT) programs. However, despite the proven efficacy of these programs and their potential to provide a larger proportion of the Australian populace with high quality treatment, their uptake is relatively low. It is important to consider the attitudes of those providing mental health services when examining potential reasons for poor cCBT uptake, as without their commitment toward, and use of cCBT, successful dissemination of these programs is unlikely. Objective: This study had three main objectives: 1. To investigate the impact of mental health worker knowledge of cCBT on a range of attitudes towards these programs. 2. To determine differences in attitudes towards cCBT between a) psychologists and non-psychologists and b) those who reported intending to use cCBT programs compared to those who did not. 3. To determine whether a short presentation that provided information on, and a demonstration of, cCBT was effective in changing mental health worker attitudes towards cCBT. Methods: One hundred and twenty-four Australian mental health workers completed an online survey that measured: knowledge of cCBT; perceived advantages of cCBT; perceived disadvantages of cCBT; circumstances under which cCBT was perceived to be advantageous; belief in the efficacy of cCBT; comfort with using cCBT; and intention to use cCBT. Participants were then randomly allocated into either the cCBT presentation condition or a control presentation condition. After viewing the presentation, participants completed the measures a second time. Results: Higher knowledge of cCBT was found to be associated with fewer perceived disadvantages of cCBT (t=-4.423, p<.001) and a greater number of circumstances under which cCBT was perceived to be advantageous (t=2.210, p=.029). No differences between psychologists and non-psychologists were found. Compared to non-intenders, those who reported intention to use cCBT programs were found to perceive more advantages of cCBT, F(3,120)=9.01, p<.003, fewer disadvantages of cCBT, F(3,120)=16.62, p<.000, more circumstances under which cCBT was considered advantageous, F(3,120)=18.32, p<.000, reported higher belief in the efficacy of cCBT, F(3,120)=25.54, p<.000, and comfort with using cCBT, F(3,120)=6.76, p=.011. Finally, compared to those who viewed the control presentation, those who viewed the cCBT presentation demonstrated a significantly greater increase in knowledge of cCBT, F(1,120)=14.02, p<.000, a greater increase in the perceived advantages of cCBT, F(1,120)=4.98, p=.028, and a greater reduction in the perceived disadvantages for cCBT, F(1,120)=4.93, p<.028. Conclusions: Australian mental health workers attitudes can be changed quickly and easily through provision of information about, and demonstrations of, cCBT programs.

2014-10-17

As in previous years, JMIR will produce a theme issue (e-collections) on Internet Interventions which will also include some of the best papers presented at the ISRII meeting in Valencia. For previous examples see for example:

The e-collection will comprise of papers published in multiple JMIR journals, although most will be published in JMIR Mental Health (http://mental.jmir.org/), which is the best venue for this kind of work and currently offers publication free of charge. Another new journal which publishes articles free of charge is JMIR Human Factors (http://humanfactors.jmir.org/) which may be suitable for usability evaluations.

JMIR Research Protocols (http://researchprotocols.org) publishes proposals, protocols, and formative/pilot evaluations, and JMIR mHealth (http://mhealth.jmir.org/) and JMIR Serious Games (http://games.jmir.org/) (the latter also has no submission or article processing fees) are further options for papers in these respective areas.

The submission site is at http://mental.jmir.org/author (if you presented at the ISRII meeting in Valencia please select "JMIR ISRII Theme Issue 2014" on submission) or the respective submission site from other JMIR journals (when in doubt which journal is best suited, submit to JMIR at http://www.jmir.org/author.

Read Post

Journal Description

JMIR Mental Health (JMH) is a new spin-off journal of JMIR, the leading eHealth journal (Impact Factor 2013: 4.7). 

JMIR Mental Health focusses on digital health and Internet interventions, technologies and electronic innovations (software and hardware) for mental health, addictions, online counselling and behaviour change. This includes formative evaluation and system descriptions, theoretical papers, review papers, viewpoint/vision papers, and rigorous evaluations.

JMIR Mental Health publishes even faster and has a broader scope with including papers which are more technical or more formative/developmental than what would be published in the Journal of Medical Internet Research

JMIR Mental Health features a rapid and thorough peer-review process, professional copyediting, professional production of PDF, XHTML, and XML proofs (ready for deposit in PubMed Central/PubMed), and an ipad App (in prep.).

JMIR Mental Health adheres to the same quality standards as JMIR and all articles published here are also cross-listed in the Table of Contents of JMIR, the worlds' leading medical journal in health sciences / health services research and health informatics.

Submit your paper before Dec 1st, 2014 to be a founding author of this new journal. There are currently NO SUBMISSION OR PUBLICATION FEES, and we aim to publish within 4 weeks.

Editorial Board members are currently being recruited, please contact us if you are interested (jmir.editorial.office at gmail.com).

 

Recent Articles:

  • Image Source: Reid et al. BMC Family Practice 2011, 12:131. Licensed under Creative Commons Attribution.

    Assessing the Evidence for e-Resources for Mental Health Self-Management: A Systematic Literature Review

    Abstract:

    Background: In a climate which recognizes mental health as a key health improvement target, but where mental health services are increasingly over-stretched, self-management e-resources can play a potentially important role in helping to ensure people get the care and support they need. They have the potential to enable individuals to learn more about, and to exercise active involvement in, their care, and thus we see a growing interest in this area for both research and practice. However, for e-resources to become important adjuncts to clinical care, it is necessary to understand if and how they impact on patients and care outcomes. Objective: The objective of this study was to review systematically the research evidence for theory-driven and evidence-based mental health self-management e-resources; and make recommendations about strengthening the future evidence base. Methods: A comprehensive literature search in MEDLINE, EMBASE, AMED, PsycINFO, Scopus, and Cochrane Library was conducted. No limits to study design were applied. We did not restrict the types of Web-based technologies included, such as websites and mobile applications, so long as they met the study inclusion criteria. A narrative synthesis of data was performed to elaborate both the development and effectiveness of online resources. Results: In total, 2969 abstracts were identified. Of those, 8 papers met the inclusion criteria. Only one randomized controlled trial was identified. The e-resources were aimed at self-management of bipolar disorder, depression, or general mental health problems. Some of the e-resources were intended to be used as prevention aids, whereas others were recovery orientated. Conclusions: Mental health self-management e-resources have the potential to be widely effective, but our review shows it is early days in terms of development of the evidence base for them. To build robust evidence, clear guidelines are needed on the development and reporting of e-resources, so that both developers and researchers maximize the potential of a new, but rapidly evolving area.

  • The COGWEB network.

    Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training – COGWEB Network

    Abstract:

    Background: Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector. Objective: The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB). Methods: The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled. Results: The network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education. Conclusions: Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden.

  • TOC image. Image created by Mr. Michael Carney, The Australian National University.

    A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial

    Abstract:

    Background: Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users. Objective: The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group. Methods: We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and “readiness to change”. The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment. Results: We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43%) intervention and 45/79 (57%) control participants provided follow-up data. In the intervention group, 51/81 (63%) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16). Conclusions: This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP).

Citing this Article

Right click to copy or hit: ctrl+c (cmd+c on mac)

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Australian Mental Health Worker Attitudes Towards cCBT: What is the role of knowledge? Are there differences? Can we change them?

    Date Submitted: Dec 14, 2014

    Open Peer Review Period: Dec 16, 2014 - Feb 10, 2015

    Background: Australia is a world leader in the development, research and dissemination of computerised cognitive behavioural treatment (cCBT) programs. However, despite the proven efficacy of these pr...

    Background: Australia is a world leader in the development, research and dissemination of computerised cognitive behavioural treatment (cCBT) programs. However, despite the proven efficacy of these programs and their potential to provide a larger proportion of the Australian populace with high quality treatment, their uptake is relatively low. It is important to consider the attitudes of those providing mental health services when examining potential reasons for poor cCBT uptake, as without their commitment toward, and use of cCBT, successful dissemination of these programs is unlikely. Objective: This study had three main objectives: 1. To investigate the impact of mental health worker knowledge of cCBT on a range of attitudes towards these programs. 2. To determine differences in attitudes towards cCBT between a) psychologists and non-psychologists and b) those who reported intending to use cCBT programs compared to those who did not. 3. To determine whether a short presentation that provided information on, and a demonstration of, cCBT was effective in changing mental health worker attitudes towards cCBT. Methods: One hundred and twenty-four Australian mental health workers completed an online survey that measured: knowledge of cCBT; perceived advantages of cCBT; perceived disadvantages of cCBT; circumstances under which cCBT was perceived to be advantageous; belief in the efficacy of cCBT; comfort with using cCBT; and intention to use cCBT. Participants were then randomly allocated into either the cCBT presentation condition or a control presentation condition. After viewing the presentation, participants completed the measures a second time. Results: Higher knowledge of cCBT was found to be associated with fewer perceived disadvantages of cCBT (t=-4.423, p<.001) and a greater number of circumstances under which cCBT was perceived to be advantageous (t=2.210, p=.029). No differences between psychologists and non-psychologists were found. Compared to non-intenders, those who reported intention to use cCBT programs were found to perceive more advantages of cCBT, F(3,120)=9.01, p<.003, fewer disadvantages of cCBT, F(3,120)=16.62, p<.000, more circumstances under which cCBT was considered advantageous, F(3,120)=18.32, p<.000, reported higher belief in the efficacy of cCBT, F(3,120)=25.54, p<.000, and comfort with using cCBT, F(3,120)=6.76, p=.011. Finally, compared to those who viewed the control presentation, those who viewed the cCBT presentation demonstrated a significantly greater increase in knowledge of cCBT, F(1,120)=14.02, p<.000, a greater increase in the perceived advantages of cCBT, F(1,120)=4.98, p=.028, and a greater reduction in the perceived disadvantages for cCBT, F(1,120)=4.93, p<.028. Conclusions: Australian mental health workers attitudes can be changed quickly and easily through provision of information about, and demonstrations of, cCBT programs.

  • How patients contribute to an online psychoeducation forum for bipolar disorder: a virtual participant observation study

    Date Submitted: Dec 9, 2014

    Open Peer Review Period: Dec 10, 2014 - Feb 4, 2015

    Background: In a recent exploratory randomised controlled trial, an online psychoeducation intervention for bipolar disorder has been found to be feasible and acceptable to patients and may positively...

    Background: In a recent exploratory randomised controlled trial, an online psychoeducation intervention for bipolar disorder has been found to be feasible and acceptable to patients and may positively impact on their self-management behaviours and quality of life. Objective: We investigated how these patients contribute to an online forum for bipolar disorder and the issues relevant for them. Methods: Participants in the intervention arm of the BIPED trial were invited to contribute to the Beating Bipolar forum alongside receiving interactive online psychoeducation modules. Within this virtual participant observation study, forum posts were analysed using thematic analysis, incorporating aspects of discourse analysis. Results: The key themes which arose from the forum posts included: medication, employment, stigma, social support, coping strategies, insight and acceptance, the life chart and negative experiences of health care. Participants frequently provided personal narratives relating to their history of bipolar disorder, life experiences and backgrounds, which often contained emotive language and humour. They regularly sought and offered advice, and expressed encouragement and empathy. The forum would have benefitted from more users to offer a greater support network with more diverse views and experiences. Conclusions: Online forums are cheap to provide and may offer peer support and the opportunity for patients to share their experiences and explore issues related to their illness anonymously. Future research should focus on how to enhance patient engagement with online healthcare forums. Clinical Trial: ISRCTN81375447