Hernandez-Ramos Rosa, Schueller Stephen M, Borghouts Judith, Palomares Kristina, Eikey Elizabeth, Schneider Margaret, Stadnick Nicole A, Zheng Kai, Mukamel Dana B, Sorkin Dara H
Department of Psychological Science, University of California, Irvine, CA, USA.
Department of Informatics, University of California, Irvine, CA, USA.
Implement Res Pract. 2024 Oct 15;5:26334895241288571. doi: 10.1177/26334895241288571. eCollection 2024 Jan-Dec.
Technology-enabled services (TESs) have the potential to increase access to mental healthcare. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a pilot implementation of myStrength, a digital cognitive behavioral therapy platform, to explore its potential to reduce loneliness among isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
A single-site 6-month pilot implementation recruited English ( = 15) and Spanish-speaking ( = 15) isolated older adults who received a digital literacy course followed by 8 weeks of myStrength access and human support. We evaluated factors related to reach, effectiveness, adoption, and implementation using the perspectives of users and County staff. Descriptive statistics were used to examine reach, adoption, and implementation. Nonparametric tests, including Friedman and Wilcoxon signed-rank, were used to examine effectiveness.
Reach: Compared to overall county demographics, platform users were majority female (93.1% vs. 50.5%), ethnoracialized (62.1% vs. 24.2%), and of lower socioeconomic status ( = $35,000 vs. $131,008). Effectiveness: Users reported a significant ( = -2.62, < .001) decrease in loneliness. Adoption: Users logged into myStrength an average of 10 times and completed 33 activities during the 8 weeks of myStrength use. Implementation: Each pilot staff ( = 20) spent an average of 19.8 hr ( = 16.51) supporting users' use of myStrength during the pilot. Pilot staff reported several adaptations to meet the needs of users.
Successes included reaching the target population, reducing loneliness, and user adoption. However, pilot staff invested significant time to support those with lower digital literacy skills. As such, although TESs may address unmet needs, their use with underserved populations may require upfront and ongoing support provided by the settings where they are implemented.
Testing a New Digital Therapy Tool for Isolated Older Adults in County Mental Health Services.
技术支持服务（TESs）有潜力增加获得心理保健服务的机会。然而，很少有研究关注如何将TESs整合到公共资助的服务环境中。作为全州范围内“援手相助”项目的一部分，马林县对数字认知行为疗法平台myStrength进行了试点实施，以探索其减少孤立老年人孤独感的潜力。我们使用覆盖范围、有效性、采用率、实施情况和维持情况（RE-AIM）框架评估了试点的影响。
一项为期6个月的单站点试点实施招募了15名讲英语和15名讲西班牙语的孤立老年人，他们先接受了数字素养课程，随后有8周时间可以使用myStrength并获得人力支持。我们从用户和县政府工作人员的角度评估了与覆盖范围、有效性、采用率和实施情况相关的因素。描述性统计用于检验覆盖范围、采用率和实施情况。非参数检验，包括弗里德曼检验和威尔科克森符号秩检验，用于检验有效性。
覆盖范围：与全县总体人口统计数据相比，平台用户多数为女性（93.1%对50.5%）、属于少数族裔（62.1%对24.2%）且社会经济地位较低（平均收入35,000美元对131,008美元）。有效性：用户报告孤独感显著降低（平均得分=-2.62，P<0.001）。采用率：在使用myStrength的8周内，用户平均登录10次，完成33项活动。实施情况：每位试点工作人员（共20人）在试点期间平均花费19.8小时（标准差=16.51）支持用户使用myStrength。试点工作人员报告了为满足用户需求所做的几项调整。
成功之处包括覆盖目标人群、减少孤独感以及用户采用。然而，试点工作人员投入了大量时间来支持数字素养技能较低的人群。因此，尽管TESs可能满足未得到满足的需求，但在为服务不足的人群使用时，可能需要由其实施场所提供前期和持续的支持。
在县心理健康服务中测试一种针对孤立老年人的新型数字治疗工具
