Arnold Chelsea, Villagonzalo Kristi-Ann, Meyer Denny, Farhall John, Foley Fiona, Kyrios Michael, Thomas Neil
Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.
Internet Interv. 2019 Aug 15;18:100266. doi: 10.1016/j.invent.2019.100266. eCollection 2019 Dec.
Individuals with psychosis demonstrate positive attitudes towards utilising digital technology in mental health treatment. Although preliminary research suggests digital interventions are feasible and acceptable in this population, little is known about how to best promote engagement with these resources. Candidate predictors include therapist support, sources of motivation and recovery style. Understanding what factors predict engagement will aid more effective design and implementation of digital interventions to improve clinical benefits.
This study aimed to investigate demographic, psychological, and treatment variables that predict overall and type of engagement with a psychosocial, online intervention for individuals with psychosis.
Ninety-eight participants with a history of psychosis were given access to a web program containing modules on self-management and recovery, which they were asked to use flexibly at their own pace. Activity was automatically logged by the system. Baseline measures of demographics, recovery style and motivation were administered, and participants were randomised to receive either website access alone, or website access plus weekly, asynchronous emails from an online coach over 12 weeks. Log and baseline assessment data were used in negative binomial regressions to examine predictors of depth and breadth of use over the intervention period. A logistic regression was used to examine the impact of predictor variables on usage profiles (active or passive).
Depth and breadth of engagement were positively predicted by receiving email support, low levels of externally controlled motivations for website use, older age, and having a tertiary education. There was a significant interaction between level of controlled motivation and condition (+/-email) on breadth and depth of engagement: receiving asynchronous emails was associated with increased engagement for individuals with low, but not high, levels of externally controlled motivations. Receiving email support and more autonomous motivations for treatment predicted more active use of the website.
Asynchronous email support can promote engagement with online interventions for individuals with psychosis, potentially enabling self-management of illness and improving clinical outcomes. However, those using online interventions due to external motivating factors, may have low levels of engagement with the intervention, irrespective of coaching provided. These findings may guide design and implementation of future online interventions in this population.
患有精神病的个体对在心理健康治疗中使用数字技术持积极态度。尽管初步研究表明数字干预在该人群中是可行且可接受的，但对于如何最好地促进对这些资源的参与了解甚少。候选预测因素包括治疗师支持、动机来源和康复方式。了解哪些因素可预测参与度将有助于更有效地设计和实施数字干预措施，以提高临床效益。
本研究旨在调查预测患有精神病的个体对心理社会在线干预的总体参与度和参与类型的人口统计学、心理和治疗变量。
98名有精神病病史的参与者可以访问一个包含自我管理和康复模块的网络程序，要求他们按照自己的节奏灵活使用。系统自动记录活动情况。进行了人口统计学、康复方式和动机的基线测量，参与者被随机分为仅获得网站访问权限，或在12周内获得网站访问权限并加上来自在线教练的每周异步电子邮件。日志和基线评估数据用于负二项回归，以检查干预期间使用深度和广度的预测因素。使用逻辑回归来检查预测变量对使用情况（主动或被动）的影响。
收到电子邮件支持、网站使用的外部控制动机水平较低、年龄较大和拥有高等教育学历可正向预测参与的深度和广度。在参与的广度和深度方面，控制动机水平与条件（有无电子邮件）之间存在显著交互作用：对于外部控制动机水平低而非高的个体，收到异步电子邮件与参与度增加相关。收到电子邮件支持和更多自主治疗动机可预测对网站的更积极使用。
异步电子邮件支持可促进患有精神病的个体对在线干预的参与，可能有助于疾病的自我管理并改善临床结果。然而，那些由于外部激励因素而使用在线干预的人，无论提供何种指导，对干预的参与度可能都较低。这些发现可能会指导该人群未来在线干预措施的设计和实施。
