Treatment Activity, User Satisfaction, and Experienced Usability of Internet-Based Cognitive Behavioral Therapy for Adults With Depression and Anxiety After a Myocardial Infarction: Mixed-Methods Study

Abstract

BackgroundKnowledge about user experiences may lead to insights about how to improve treatment activity in Internet-based cognitive behavioral therapy (iCBT) to reduce symptoms of depression and anxiety among people with a somatic disease. There is a need for studies conducted alongside randomized trials, to explore treatment activity and user experiences related to such interventions, especially among people with older age who are recruited in routine care.ObjectiveThe aim of the study was to explore treatment activity, user satisfaction, and usability experiences among patients allocated to treatment in the U-CARE Heart study, a randomized clinical trial of an iCBT intervention for treatment of depression and anxiety following a recent myocardial infarction.MethodsThis was a mixed methods study where quantitative and qualitative approaches were used. Patients were recruited consecutively from 25 cardiac clinics in Sweden. The study included 117 patients allocated to 14 weeks of an iCBT intervention in the U-CARE Heart study. Quantitative data about treatment activity and therapist communication were collected through logged user patterns, which were analyzed with descriptive statistics. Qualitative data with regard to positive and negative experiences, and suggestions for improvements concerning the intervention, were collected through semistructured interviews with 21 patients in the treatment arm after follow-up. The interviews were analyzed with qualitative manifest content analysis.ResultsTreatment activity was low with regard to number of completed modules (mean 0.76, SD 0.93, range 0-5) and completed assignments (mean 3.09, SD 4.05, range 0-29). Most of the participants initiated the introduction module (113/117, 96.6%), and about half (63/117, 53.9%) of all participants completed the introductory module, but only 18 (15.4%, 18/117) continued to work with any of the remaining 10 modules, and each of the remaining modules was completed by 7 or less of the participants. On average, patients sent less than 2 internal messages to their therapist during the intervention (mean 1.42, SD 2.56, range 0-16). Interviews revealed different preferences with regard to the internet-based portal, the content of the treatment program, and the therapist communication. Aspects related to the personal situation and required skills included unpleasant emotions evoked by the intervention, lack of time, and technical difficulties.ConclusionsPatients with a recent myocardial infarction and symptoms of depression and anxiety showed low treatment activity in this guided iCBT intervention with regard to completed modules, completed assignments, and internal messages sent to their therapist. The findings call attention to the need for researchers to carefully consider the preferences, personal situation, and technical skills of the end users during the development of these interventions. The study indicates several challenges that need to be addressed to improve treatment activity, user satisfaction, and usability in internet-based ...

Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial

“…In interviews with participants in this study, some challenges have been identified. These are described elsewhere [ 27 ]. Finally, our results support the notion that systematic development and feasibility testing, in close collaboration with potential end users, should be undertaken to improve treatment relevance and acceptability [ 51 ].…”

“…Adherence was defined as the proportion of treated patients completing the prescribed amount of content within the treatment period [ 26 ]. More data on usage and user experience of the intervention were collected, and a detailed analysis of these is presented elsewhere [ 27 ].…”

Predicting Adherence to Internet-Delivered Psychotherapy for Symptoms of Depression and Anxiety After Myocardial Infarction: Machine Learning Insights From the U-CARE Heart Randomized Controlled Trial

“…Considering clinical needs and data availability, the patients were selected on completion of the initial standardized homework module—the optimal time to predict treatment adherence if one wants to also use linguistic predictors derived from written treatment response to make early in-treatment prediction of treatment adherence. There are also qualitative approaches to investigate adherence to iCBT [ 25 ] that might augment our understanding of adherence if combined with the current data-driven approach. Furthermore, the purpose of studying linguistic predictors automatically excluded 27 patients who were randomized to treatment but did not complete any homework assignment.…”

“…The recruitment, treatment, and follow-up of patients has been described in detail elsewhere [ 13 , 14 , 25 ]. In summary, the trial recruited 239 patients from 25 Swedish hospitals and randomized 122 patients to a control group and 117 patients to therapist-guided and self-tailored 14-weeks of iCBT.…”

Dangerous depression in cardiac patients: What can we do about it?

“…The researchers conducted an interview study with participants, which showed, among other things, that many patients experienced a lack of personal communication with the therapists. 12 However, despite the somewhat disappointing results of several attempts, with varying types of psychological treatment, a recent review showed that the general picture is promising. A recent review with the purpose to determine if interventions, which are specifically designed to assess or treat mental health symptoms, can effectively reduce risk of readmission following hospitalization for physical health conditions.…”