Yeager Carolyn M, Shoji Kotaro, Luszczynska Aleksandra, Benight Charles C
Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, United States.
Trauma Health and Hazards Center, University of Colorado Colorado Springs, Colorado Springs, CO, United States.
JMIR Ment Health. 2018 Apr 10;5(2):e29. doi: 10.2196/mental.9449.
There has been a growing trend in the delivery of mental health treatment via technology (ie, electronic health, eHealth). However, engagement with eHealth interventions is a concern, and theoretically based research in this area is sparse. Factors that influence engagement are poorly understood, especially in trauma survivors with symptoms of posttraumatic stress.
The aim of this study was to examine engagement with a trauma recovery eHealth intervention using the Health Action Process Approach theoretical model. Outcome expectancy, perceived need, pretreatment self-efficacy, and trauma symptoms influence the formation of intentions (motivational phase), followed by planning, which mediates the translation of intentions into engagement (volitional phase). We hypothesized the mediational effect of planning would be moderated by level of treatment self-efficacy.
Trauma survivors from around the United States used the eHealth intervention for 2 weeks. We collected baseline demographic, social cognitive predictors, and distress symptoms and measured engagement subjectively and objectively throughout the intervention.
The motivational phase model explained 48% of the variance, and outcome expectations (beta=.36), perceived need (beta=.32), pretreatment self-efficacy (beta=.13), and trauma symptoms (beta=.21) were significant predictors of intention (N=440). In the volitional phase, results of the moderated mediation model indicated for low levels of treatment self-efficacy, planning mediated the effects of intention on levels of engagement (B=0.89, 95% CI 0.143-2.605; N=115).
Though many factors can affect engagement, these results offer a theoretical framework for understanding engagement with an eHealth intervention. This study highlighted the importance of perceived need, outcome expectations, self-efficacy, and baseline distress symptoms in the formation of intentions to use the intervention. For those low in treatment self-efficacy, planning may play an important role in the translation of intentions into engagement. Results of this study may help bring some clarification to the question of what makes eHealth interventions work.
通过技术手段（即电子健康，eHealth）提供心理健康治疗的趋势日益增长。然而，参与电子健康干预是一个令人担忧的问题，并且该领域基于理论的研究很少。影响参与度的因素知之甚少，尤其是在有创伤后应激症状的创伤幸存者中。
本研究的目的是使用健康行动过程方法理论模型来检验对创伤恢复电子健康干预的参与度。结果期望、感知需求、治疗前自我效能感和创伤症状会影响意图的形成（动机阶段），随后是计划，计划介导意图转化为参与度（意志阶段）。我们假设计划的中介作用会受到治疗自我效能感水平的调节。
来自美国各地的创伤幸存者使用该电子健康干预措施两周。我们收集了基线人口统计学、社会认知预测因素和痛苦症状，并在整个干预过程中主观和客观地测量了参与度。
动机阶段模型解释了48%的方差，结果期望（β = 0.36）、感知需求（β = 0.32）、治疗前自我效能感（β = 0.13）和创伤症状（β = 0.21）是意图的显著预测因素（N = 440）。在意志阶段，调节中介模型的结果表明，对于治疗自我效能感水平较低的人，计划介导了意图对参与度水平的影响（B = 0.89，95% CI 0.143 - 2.605；N = 115）。
尽管许多因素会影响参与度，但这些结果为理解电子健康干预的参与度提供了一个理论框架。本研究强调了感知需求、结果期望、自我效能感和基线痛苦症状在形成使用干预措施意图方面的重要性。对于治疗自我效能感较低的人，计划可能在将意图转化为参与度方面发挥重要作用。本研究结果可能有助于澄清使电子健康干预措施起作用的因素这一问题。
