Centre for Mental Health Research, The Australian National University, Canberra, Australia.
Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
J Med Internet Res. 2022 May 6;24(5):e34769. doi: 10.2196/34769.
Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community.
This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies.
Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program-a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants.
Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity.
The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions.
Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113.
自我指导的网络程序是有效的；然而，这些程序的实施不足限制了它们在大规模提供常见心理健康问题的有效和低成本治疗方面的潜力。缺乏研究来检验在社区中传播网络程序的最佳方法。
本研究旨在比较 3 种基于社区的途径在提供低强度基于网络的跨诊断心理健康计划方面的参与度、覆盖范围、相对成本和依从性。3 种传播途径包括社交媒体广告、全科医生广告和药店广告。
参与者通过网络、全科医生或社区药店招募；完成心理困扰的筛选；并提供为期 4 周的 FitMindKit 计划——12 个模块的心理治疗干预。参与度定义为注册网络计划的参与者人数；覆盖率定义为每暴露一次的参与率；成本根据员工时间、设备和广告计算。依从性评估为参与者完成的 FitMindKit 模块数量。
通过 3 种传播途径招募了 1014 名参与者：网络（991/1014，97.73%）、全科医生（16/1014，1.58%）和药店（7/1014，0.69%）。社交媒体的参与度最高：每 50 人中有 1 人接触到网络广告，就有 1 人参与干预，而在全科医生诊所每 441 人中有 1 人，在药店每 1708 人中有 1 人。社交媒体的传播成本为每位用户 4.87 美元，全科医生诊所为每位用户 557 美元，药店为每位用户 1272 美元。在依从性方面，没有观察到条件之间的显著差异，而所有途径都显示男性和语言多样性的代表性不足。
基于网络的传播途径是向社区中的人提供自我指导的基于互联网的心理健康计划的最有效和最具成本效益的途径。需要更多的研究来确定如何最好地让男性和具有文化多样性背景的人参与基于网络的干预。
澳大利亚新西兰临床试验注册 ACTRN12618001688279；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113。
