Western Norway University of Applied Sciences, Bergen, Norway.
NORCE Norwegian Research Centre, Bergen, Norway.
J Med Internet Res. 2020 Nov 27;22(11):e21066. doi: 10.2196/21066.
Internet-delivered psychological treatments (IDPTs) are built on evidence-based psychological treatment models, such as cognitive behavioral therapy, and are adjusted for internet use. The use of internet technologies has the potential to increase access to evidence-based mental health services for a larger proportion of the population with the use of fewer resources. However, despite extensive evidence that internet interventions can be effective in the treatment of mental health disorders, user adherence to such internet intervention is suboptimal.
This review aimed to (1) inspect and identify the adaptive elements of IDPT for mental health disorders, (2) examine how system adaptation influences the efficacy of IDPT on mental health treatments, (3) identify the information architecture, adaptive dimensions, and strategies for implementing these interventions for mental illness, and (4) use the findings to create a conceptual framework that provides better user adherence and adaptiveness in IDPT for mental health issues.
The review followed the guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The research databases Medline (PubMed), ACM Digital Library, PsycINFO, CINAHL, and Cochrane were searched for studies dating from January 2000 to January 2020. Based on predetermined selection criteria, data from eligible studies were analyzed.
A total of 3341 studies were initially identified based on the inclusion criteria. Following a review of the title, abstract, and full text, 31 studies that fulfilled the inclusion criteria were selected, most of which described attempts to tailor interventions for mental health disorders. The most common adaptive elements were feedback messages to patients from therapists and intervention content. However, how these elements contribute to the efficacy of IDPT in mental health were not reported. The most common information architecture used by studies was tunnel-based, although a number of studies did not report the choice of information architecture used. Rule-based strategies were the most common adaptive strategies used by these studies. All of the studies were broadly grouped into two adaptive dimensions based on user preferences or using performance measures, such as psychometric tests.
Several studies suggest that adaptive IDPT has the potential to enhance intervention outcomes and increase user adherence. There is a lack of studies reporting design elements, adaptive elements, and adaptive strategies in IDPT systems. Hence, focused research on adaptive IDPT systems and clinical trials to assess their effectiveness are needed.
互联网心理治疗（IDPT）是建立在循证心理治疗模型（如认知行为疗法）的基础上，并针对互联网使用进行了调整。使用互联网技术有可能以更少的资源为更多的人提供基于证据的心理健康服务。然而，尽管有大量证据表明互联网干预措施在治疗心理健康障碍方面是有效的，但用户对这些互联网干预措施的依从性并不理想。
本综述旨在：（1）检查并确定 IDPT 用于心理健康障碍的适应性元素；（2）研究系统适应性如何影响 IDPT 对心理健康治疗的效果；（3）确定用于治疗精神疾病的信息架构、适应性维度和实施这些干预措施的策略；（4）利用这些发现创建一个概念框架，以提高 IDPT 治疗心理健康问题时的用户依从性和适应性。
本综述遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。从 2000 年 1 月至 2020 年 1 月，在 Medline（PubMed）、ACM 数字图书馆、PsycINFO、CINAHL 和 Cochrane 研究数据库中搜索研究。根据预先确定的选择标准，对符合条件的研究进行了数据分析。
根据纳入标准，最初确定了 3341 项研究。在审查了标题、摘要和全文之后，选择了 31 项符合纳入标准的研究，其中大多数研究描述了针对心理健康障碍进行干预调整的尝试。最常见的适应性元素是治疗师向患者发送的反馈信息和干预内容。然而，这些元素如何有助于 IDPT 在心理健康方面的疗效并没有被报道。研究中使用最常见的信息架构是隧道式，尽管有一些研究没有报告所使用的信息架构选择。基于规则的策略是这些研究中最常用的适应性策略。所有的研究都根据用户偏好或使用心理测量测试等绩效指标，大致分为两个适应性维度。
有几项研究表明，适应性 IDPT 有可能提高干预效果并提高用户依从性。缺乏关于 IDPT 系统的设计元素、适应性元素和适应性策略的研究报告。因此，需要对适应性 IDPT 系统进行有针对性的研究，并开展临床试验以评估其有效性。
