Engagement with online psychosocial interventions for psychosis: A review and synthesis of relevant factors

Arnold, Chelsea; Farhall, John; Villagonzalo, Kristi-Ann; Sharma, Kriti; Thomas, Neil

doi:10.1016/j.invent.2021.100411

Cited by 22 publications

(15 citation statements)

References 132 publications

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“…Unavailability or lack of access to resources (technology or internet access), personal factors (confidence, concerns about privacy, digital skills, frequency of interaction, motivation, using other unnecessary websites, and other personality traits) and family-related factors (being prohibited from accessing social media or the internet) were perceived factors affecting effectiveness and implementation outcome measures. This finding was consistent with the outcomes of related studies of digital or web-based interventions, 81–85 whereby behavioural factors, 81 digital or internet literacy, 82 lack of money or internet access, 83 adherence, 84 and participant engagement, 85 were reported to be associated with the effectiveness of an intervention. Participant interest and motivation, as well as having an understanding of their concerns, emerge as key factors for effective digital or web-based intervention programs.…”

Section: Discussionsupporting

confidence: 86%

Effectiveness and Implementation Outcome Measures of Mental Health Curriculum Intervention Using Social Media to Improve the Mental Health Literacy of Adolescents

Hassen¹,

Behera²,

Jena³

et al. 2022

JMDH

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Purpose Globally, adolescent mental health problems reportedly manifest more severely in individuals with lower mental health literacy. Mental health curriculum interventions using social media have been associated with positive implementation outcomes. This study aimed to investigate whether such an intervention significantly improves adolescent mental health literacy and is associated with positive implementation outcome measures. Methods This study employed a quasi-experimental design, comparing the before-and-after difference between the intervention group (n 1 =77) and the control group (n 1 =76). A mental health literacy module was delivered using social media. Data were collected using validated questionnaires. Effect size and difference-in-differences model calculations (and associated 95% confidence intervals, CI) were conducted alongside other descriptive analyses. Results The estimated intervention effect size and difference-in-differences estimates were greater than zero. The effect was greater in the intervention than in the control group (p<0.05) despite sex and age differences. The effect size estimate provided by Cohen’s d and Hedges’ g values was medium-to-large (d/g=0.429–0.767, p<0.05). The difference-in-differences reflected a significant effect (DID=0.348, CI: 0.154–0.542, p<0.001) in increasing mental health literacy despite differences associated with sex, age, and school grade. The intervention program was acceptable, appropriate, feasible, and satisfactory, and more than 80% of participants said they agree to completely agree with these implementation outcomes. Resources and personal and family-related factors were among the perceived influencing factors determining the effectiveness and implementation outcome measures. Conclusion The intervention program effectively improved the mental health literacy of adolescents. It has been highlighted that social media interventions for mental health promotion could be practical and scalable; however, there is a need to take into account socio-demographic differences and barriers to inclusion/compliance.

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Section: Discussionsupporting

confidence: 86%

Effectiveness and Implementation Outcome Measures of Mental Health Curriculum Intervention Using Social Media to Improve the Mental Health Literacy of Adolescents

Hassen¹,

Behera²,

Jena³

et al. 2022

JMDH

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“…Internalized stigma can lead to self-esteem decline and has been linked to poorer psychosocial treatment engagement. [79][80][81] Individuals with poorer self-esteem tend to have increased feelings of hopelessness, thus believing less strongly in rehabilitation benefits. 82 Insight into cognitive functioning, and the broader illness, is intrinsically related to the perceived usefulness of rehabilitation.…”

Section: Suggestions For Future Researchmentioning

confidence: 99%

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review

2022

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Objectives Neurocognitive deficits are central in schizophrenia. Cognitive remediation has proven effective in alleviating these deficits, with medium effect sizes. However, sizeable attrition rates are reported, with the reasons still uncertain. Furthermore, cognitive remediation is not part of routine mental health care. We conducted a systematic review to investigate factors that influence access and engagement of cognitive remediation in schizophrenia. Methods We systematically searched the PubMed, Web of Science, and PsycINFO databases for peer-reviewed articles including a cognitive remediation arm, access, and engagement data, and participants with schizophrenia spectrum disorders aged 17–65 years old. Duplicates and studies without a distinct cognitive remediation component, protocol papers, single case studies, case series, and reviews/meta-analyses were excluded. Results We included 67 studies that reported data on access and engagement, and extracted quantitative and qualitative data. Access data were limited, with most interventions delivered on-site, to outpatients, and in middle- to high-income countries. We found a median dropout rate of 14.29%. Only a small number of studies explored differences between dropouts and completers ( n = 5), and engagement factors ( n = 13). Dropouts had higher negative symptomatology and baseline self-efficacy, and lower baseline neurocognitive functioning and intrinsic motivation compared to completers. The engagement was positively associated with intrinsic motivation, self-efficacy, perceived usefulness, educational level, premorbid intelligence quotient, baseline neurocognitive functioning, some neurocognitive outcomes, and therapeutic alliance; and negatively associated with subjective cognitive complaints. Qualitative results showed good acceptability of cognitive remediation, with some areas for improvement. Conclusions Overall, access and engagement results are scarce and heterogeneous. Further investigations of cognitive remediation for inpatients, as well as remote delivery, are needed. Future clinical trials should systematically explore attrition and related factors. Determining influential factors of access and engagement will help improve the implementation and efficacy of cognitive remediation, and thus the recovery of people with schizophrenia.

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“…Such low engagement rates threaten the clinical viability of these treatments. DMHI engagement has been defined as a patient's initial adoption and sustained interactions with an intervention [8][9][10]. Within the broader construct of engagement, intervention adherence refers to the extent to which participants engage in the content of the intervention as intended.…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, user-rated acceptability and feasibility have been evaluated as proxies for engagement [ 19 ]. Finally, several recent reviews have explored variables related to user engagement with DMHIs [ 8 , 9 , 18 ]. However, to date, no review to our knowledge has explored the actual level of user engagement in RCTs of DMHIs.…”

Section: Introductionmentioning

confidence: 99%

Digital Mental Health Interventions for Depression: Scoping Review of User Engagement

Lipschitz¹,

Boxtel²,

Torous³

et al. 2022

J Med Internet Res

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Background While many digital mental health interventions (DMHIs) have been found to be efficacious, patient engagement with DMHIs has increasingly emerged as a concern for implementation in real-world clinical settings. To address engagement, we must first understand what standard engagement levels are in the context of randomized controlled trials (RCTs) and how these compare with other treatments. Objective This scoping review aims to examine the state of reporting on intervention engagement in RCTs of mobile app–based interventions intended to treat symptoms of depression. We sought to identify what engagement metrics are and are not routinely reported as well as what the metrics that are reported reflect about standard engagement levels. Methods We conducted a systematic search of 7 databases to identify studies meeting our eligibility criteria, namely, RCTs that evaluated use of a mobile app–based intervention in adults, for which depressive symptoms were a primary outcome of interest. We then extracted 2 kinds of information from each article: intervention details and indices of DMHI engagement. A 5-element framework of minimum necessary DMHI engagement reporting was derived by our team and guided our data extraction. This framework included (1) recommended app use as communicated to participants at enrollment and, when reported, app adherence criteria; (2) rate of intervention uptake among those assigned to the intervention; (3) level of app use metrics reported, specifically number of uses and time spent using the app; (4) duration of app use metrics (ie, weekly use patterns); and (5) number of intervention completers. Results Database searching yielded 2083 unique records. Of these, 22 studies were eligible for inclusion. Only 64% (14/22) of studies included in this review specified rate of intervention uptake. Level of use metrics was only reported in 59% (13/22) of the studies reviewed. Approximately one-quarter of the studies (5/22, 23%) reported duration of use metrics. Only half (11/22, 50%) of the studies reported the number of participants who completed the app-based components of the intervention as intended or other metrics related to completion. Findings in those studies reporting metrics related to intervention completion indicated that between 14.4% and 93.0% of participants randomized to a DMHI condition completed the intervention as intended or according to a specified adherence criteria. Conclusions Findings suggest that engagement was underreported and widely varied. It was not uncommon to see completion rates at or below 50% (11/22) of those participants randomized to a treatment condition or to simply see completion rates not reported at all. This variability in reporting suggests a failure to establish sufficient reporting standards and limits the conclusions that can be drawn about level of engagement with DMHIs. Based on these findings, the 5-element framework applied in this review may be useful as a minimum necessary standard for DMHI engagement reporting.

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Engagement with online psychosocial interventions for psychosis: A review and synthesis of relevant factors

Cited by 22 publications

References 132 publications

Effectiveness and Implementation Outcome Measures of Mental Health Curriculum Intervention Using Social Media to Improve the Mental Health Literacy of Adolescents

Effectiveness and Implementation Outcome Measures of Mental Health Curriculum Intervention Using Social Media to Improve the Mental Health Literacy of Adolescents

Factors Impacting Access and Engagement of Cognitive Remediation Therapy for People with Schizophrenia: A Systematic Review

Digital Mental Health Interventions for Depression: Scoping Review of User Engagement

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