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.

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Journal Description

JMIR Mental Health (JMH, ISSN 2368-7959) 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 now 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:

  • (cc) Forchuk et al. CC-BY-SA-2.0, please cite as (http://mental.jmir.org/article/viewFile/3926/1/51898). Mental Health Engagement Network Image.

    Client Perceptions of the Mental Health Engagement Network: A Secondary Analysis of an Intervention Using Smartphones and Desktop Devices for Individuals...

    Abstract:

    Background: The use of innovative technologies in mental health care has the potential to improve system efficiency, enhance quality of care, and increase patient engagement. The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients’ perceptions of technology and the use of these technologies in their care. Objective: We aimed to answer six questions: (1) What is the level of comfort with technology within a sample of individuals experiencing mood or psychotic disorders? (2) How easy to use and helpful are the MHEN technologies from the perspective of individuals experiencing a mental illness? (3) Are there differences in how helpful or useful individuals find the smartphone compared to the LSR? (4) Are there specific functions of MHEN technologies (eg, reminders for medications or appointments) that are more valued than others? (5) What are the other ways that individuals are using MHEN technologies in their daily lives? (6) How likely are individuals to be able to retain and maintain their smartphone? Methods: Mental health clients aged 18-80 (N=400) and diagnosed with a mood or psychotic disorder were provided with a smartphone (iPhone 4S) and participating care providers (n=52) were provided with a tablet (iPad) in order to access and engage with the LSR. A delayed implementation design with mixed methods was used. Survey and interview data were collected over the course of 18 months through semistructured interviews conducted by experienced research assistants every 6 months post-implementation of the intervention. Paired t tests were used to determine differences between 6 and 12-month data for perceptions of the MHEN technologies. A paired t test was used to examine whether differences existed between perceptions of the smartphone and the LSR at 12 months post-implementation. Results: Due to dropout or loss of contact, 394 out of 400 individuals completed the study. At the end of the study, 52 devices were lost or unusable. Prior to the intervention, participants reported being comfortable using technology. Perceptions of the MHEN technologies and their functions were generally positive. Positive perceptions of the smartphone increased over time (P=.002), while positive perceptions of the LSR decreased over time (P<.001). Conclusions: Quantitative and qualitative findings from this analysis demonstrated that these technologies positively impacted the lives of individuals experiencing severe mental illnesses and dispeled some of the myths regarding retention of technology among marginalized populations. This secondary analysis supported the acceptability of using mental health technologies within this population and provided considerations for future development. Trial Registration: ClinicalTrials.gov NCT01473550; http://clinicaltrials.gov/show/NCT01473550 (Archived by WebCite at http://www.webcitation.org/6SLNcoKb8).

  • Image created by John Torous, using an image from http://pixabay.com/en/iphone-cellphone-smartphone-mobile-37856/ which is available free for commercial use and with no attribution required.

    Patient Smartphone Ownership and Interest in Mobile Apps to Monitor Symptoms of Mental Health Conditions: A Survey in Four Geographically Distinct...

    Abstract:

    Background: Despite growing interest in mobile mental health and utilization of smartphone technology to monitor psychiatric symptoms, there remains a lack of knowledge both regarding patient ownership of smartphones and their interest in using such to monitor their mental health. Objective: To provide data on psychiatric outpatients’ prevalence of smartphone ownership and interest in using their smartphones to run applications to monitor their mental health. Methods: We surveyed 320 psychiatric outpatients from four clinics around the United States in order to capture a geographically and socioeconomically diverse patient population. These comprised a state clinic in Massachusetts (n=108), a county clinic in California (n=56), a hybrid public and private clinic in Louisiana (n=50), and a private/university clinic in Wisconsin (n=106). Results: Smartphone ownership and interest in utilizing such to monitor mental health varied by both clinic type and age with overall ownership of 62.5% (200/320), which is slightly higher than the average United States’ rate of ownership of 58% in January 2014. Overall patient interest in utilizing smartphones to monitor symptoms was 70.6% (226/320). Conclusions: These results suggest that psychiatric outpatients are interested in using their smartphones to monitor their mental health and own the smartphones capable of running mental healthcare related mobile applications.

  • Screenshot of the BrainyApp.

    Randomized Comparison of Mobile and Web-Tools to Provide Dementia Risk Reduction Education: Use, Engagement and Participant Satisfaction

    Abstract:

    Background: Encouraging middle-aged adults to maintain their physical and cognitive health may have a significant impact on reducing the prevalence of dementia in the future. Mobile phone apps and interactive websites may be one effective way to target this age group. However, to date there has been little research investigating the user experience of dementia risk reduction tools delivered in this way. Objective: The aim of this study was to explore participant engagement and evaluations of three different targeted smartphone and Web-based dementia risk reduction tools following a four-week intervention. Methods: Participants completed a Web-based screening questionnaire to collect eligibility information. Eligible participants were asked to complete a Web-based baseline questionnaire and were then randomly assigned to use one of the three dementia risk reduction tools for a period of four weeks: (1) a mobile phone application; (2) an information-based website; and (3) an interactive website. User evaluations were obtained via a Web-based follow-up questionnaire after completion of the intervention. Results: Of 415 eligible participants, 370 (89.16%) completed the baseline questionnaire and were assigned to an intervention group; 200 (54.05%) completed the post-intervention questionnaire. The average age of participants was 52 years, and 149 (75%) were female. Findings indicated that participants from all three intervention groups reported a generally positive impression of the tools across a range of domains. Participants using the information-based website reported higher ratings of their overall impression of the tool, F2,191=4.12, P=.02; how interesting the information was, F2,189=3.53, P=.03; how helpful the information was, F2,192=4.15, P=.02; and how much they learned, F2,188=3.86, P=.02. Group differences were significant between the mobile phone app and information-based website users, but not between the interactive website users and the other two groups. Additionally, participants using the information-based website reported significantly higher scores on their ratings of the ease of navigation, F2,190=4.20, P=.02, than those using the mobile phone app and the interactive website. There were no significant differences between groups on ratings of ease of understanding the information, F2,188=0.27, P=.76. Most participants from each of the three intervention groups indicated that they intended to keep using the dementia risk reduction eHealth tool. Conclusions: Overall, results indicated that while participants across all three intervention groups reported a generally positive experience with the targeted dementia risk reduction tools, participants using the information-based website provided a more favorable evaluation across a range of areas than participants using the mobile phone app. Further research is required to investigate whether targeted dementia risk reduction tools, in the form of interactive websites and mobile apps, can be improved to provide benefits above those gained by providing static information alone.

  • 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).

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  • 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.