Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany

Abstract

BackgroundDespite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care.ObjectiveThis pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress.MethodsTo assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman’s rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress.ResultsDescriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled “usefulness or helpfulness,” “relative advantage or comparability,” and “accessibility or access to health care.” Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems.ConclusionsThis pilot study showed deficient “e-awareness” and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the “black box” of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs.

Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study (Preprint)

“…In accordance to the unified theory of acceptance and use of technology (UTAUT) [38], performance expectancy (i.e. how useful an individual perceives an intervention for reaching a specific goal) might thus play an important role in the adoption and acceptance of internet interventions [39,40], and provide a guideline in overcoming current limitations in the acceptability of eMHS [34,39,41,42].…”

“…Regarding health-related and help-seeking variables, using the Internet for mental health information [45,51], previous use of eMHS [31], a history of mental illness and help-seeking experience such as undergoing psychotherapy [29], knowledge about eMHS or awareness of electronic therapies ("e-awareness") [33,41,42], personality traits [28], and perceived stress [42,52] have been reported as predictors. Regarding the role of symptom severity, a recent study [12] illustrated a "help-seeking behavior paradox" in students, where individuals' readiness to seek help from face-to-face services declined with increased perceived stress.…”

“…We used a modified 17-item version of e-therapy attitudes measure (ETAM) [42] containing statements about typically cited benefits of internet therapies and its comparability to face-to-face psychotherapy as well as subjective beliefs (e.g. about data security).…”

“…Detailed information about the EFA can be found in Multimedia Appendix 1. For classification of attitudes, we used predefined cutoffs in line with previous work using the ETAM [41,42]: mean scores < 1.5 (respectively, a median score of 0 or 1) were defined as negative, values between 1.5 and 2.49 (median score of 2) as neutral, and scores ≥ 2.5 (median scores of 3 or 4) as positive attitudes toward guided internet interventions. Cronbach's alpha was excellent in the present survey ( = α .92).…”

Why urban Indians are interested in an internet based self-care app for depression? a brief pilot survey

“…[18][19] However, deficient e-awareness and ambivalent attitudes have also been reported. 20 Though several structured internet based mental health interventions have been developed and tested for efficacy, the potential public health impact of these programs is unlikely to be realized without wide-scale uptake and optimal rates of completion /adherence. 21 A scoping review meant to understand public acceptability of e-interventions concluded that these were perceived as less helpful than face-to face interventions.…”