Xiang Xiaoling, Kayser Jay, Sun Yihang, Himle Joseph
School of Social Work, University of Michigan, Ann Arbor, MI, United States.
JMIR Aging. 2021 Nov 22;4(4):e27630. doi: 10.2196/27630.
Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities.
This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression.
The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research.
Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement.
iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence.
ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289.
抑郁症在居家的老年人中很常见。基于互联网的认知行为疗法（iCBT）是一种有前景但研究不足的治疗残疾老年人抑郁症的方法。
本研究旨在了解参与iCBT治疗抑郁症试点可行性试验的居家老年人的经历。
参与者包括21名居家老年人，他们参加了一个并非专门为老年人设计的通用iCBT项目，以及8名协助该iCBT项目的家庭护理人员。受访者完成了半结构化的个人访谈，访谈内容逐字记录，并采用扎根理论方法进行分析。在对初始编码进行不断比较和质疑的迭代过程后，形成了主题和子主题的分层编码结构。数据分析使用了dedoose，这是一个用于混合方法研究的网络应用程序。
出现了与参与者iCBT干预体验相关的三个主题和各种子主题，如下：干预影响，涉及与参与者对干预的感知影响相关的子主题；挑战与困难，涉及参与者在干预中遇到的挑战和困难的子主题；促进因素，涉及促进干预使用和参与的因素的子主题。
iCBT是一种治疗患有抑郁症的居家老年人的有前景的干预措施。家庭护理人员报告称与客户的关系有所改善，并且该项目没有增加他们的工作职责。未来的项目应具备易于使用的技术特性和适合年龄的内容，以改善用户体验、接受度和依从性。
ClinicalTrials.gov NCT04267289；https://clinicaltrials.gov/ct2/show/NCT04267289 。
