the acceptability of e-mental health services
struthers, et al.
The Acceptability of E-mental Health Services for Children, Adolescents, and Young Adults: A Systematic Search and Review Ashley Struthers, Catherine Charette, Sunita Bayyavarapu Bapuji, and Shannon Winters Centre for Healthcare Innovation
Xibiao Ye, Colleen Metge, and Sara Kreindler
Centre for Healthcare Innovation and University of Manitoba
Melissa Raynard
Concordia Hospital Library
Jacqueline Lemaire
Addictions Foundation of Manitoba
Margaret Synyshyn and Karen Sutherland Manitoba Adolescent Treatment Centre
Abstract This paper presents the findings of a systematic search and review examining the acceptability of e-mental health services for children, adolescents, and young adults and their parents and healthcare providers. Multiple databases were searched and abstracts were screened to determine if they met study inclusion criteria. Findings from included studies were synthesized within five dimensions of acceptability: satisfaction, client expectations, uptake, adherence and patient/provider experiences. Twenty-four studies were included, and findings suggest that although clients are generally satisfied with e-mental health and report positive experiences, adherence and uptake can be challenges. In conclusion, e-mental health appears to be an acceptable intervention option for children, adolescents, and young adults and their parents and healthcare providers. Further research is needed to better understand the effectiveness and acceptability of e-mental health for this population, including adherence, patient and provider experiences and integration into existing health systems. Keywords: e-mental health, acceptability, children, adolescent, young adult The authors would like to thank Noah Star (N. S.) for his assistance with this research. This research was funded by the Canadian Institutes of Health Research (CIHR). Correspondence concerning this paper should be addressed to Ashley Struthers, Centre for Healthcare Innovation, 2nd Floor, 1155 Concordia Ave., Winnipeg, MB, R2K 2M9. Contact:
[email protected] doi:10.7870/cjcmh-2015-006 Published by Canadian Periodical for Community Studies Inc.
1
CANADIAN JOURNAL OF COMMUNITY MENTAL HEALTH, vol. 34, no. 2, 2015
canadian journal of community mental health
vol. 34, no. 2, 2015
RÉSUMÉ Dans cet article, nous présentons les résultats d’une recherche et d’une analyse systématiques de la littérature portant sur l’acceptabilité des cyber-interventions en santé mentale pour les enfants, les adolescents et les jeunes adultes ainsi que que pour leurs parents et les prestataires de soins. Nous avons examiné plusieurs banques de données de même que des résumés d’études pour déterminer si leur contenu correspondait aux critères que nous avions choisis. À partir des 24 sources que nous avons retenues, nous avons synthétisé l’acceptabilité en 5 aspects : la satisfaction des usagers, les attentes des usagers, la compréhension des interventions, l’adhésion et la participation aux interventions, et la façon dont les usagers et les prestataires de soins ont perçue ce type d’interventions. Nos résultats indiquent que les usagers sont généralement satisfaits des interventions et portent un jugement positif sur leur utilisation, mais l’évaluation est moins claire quand on considère deux autres aspects : la compréhension des interventions, et l’adhésion et la participation aux interventions. Nous concluons quand même que ce type d’interventions doit être considéré comme acceptable. Toutefois, de nouvelles études seraient nécessaires – notamment sur l’adhésion et la participation des usagers, la façon dont les usagers et les prestataires de soins vivent ces interventions, et l’intégration de ces interventions dans le système de santé – pour que nous puissions mieux comprendre leur efficacité et l’acceptabilité des cyber-interventions en santé mentale auprès de cette population. Mots clés : cyber-interventions en santé mentale, acceptabilité, enfants, adolescents, jeunes adultes
Mental illness has a serious impact on individuals, families and communities. According to the Canadian Mental Health Association (Canadian Mental Health Association, 2013), between 10 and 20% of youth are affected by a mental illness, but only 20% of those who need services receive them. Barriers to helpseeking and treatment for young people include stigma, embarrassment, poor mental health literacy, lack of knowledge about how or where to access treatment and a preference for self-reliance (Anderson, Fuhrer, & Malla, 2013; Christensen, Reynolds, & Griffiths, 2011; Gulliver, Griffiths, & Christensen, 2010, LingleyPottie & McGrath, 2013; Marcus & Westra, 2012), in addition to geographic barriers for those living in rural settings with limited access to resources (Griffiths & Christensen, 2007; Lingley-Pottie & McGrath, 2013). Innovations such as e-mental health may serve to reduce or eliminate some of these barriers (Christensen & Hickie, 2010). However, there are gaps in our understanding of the effectiveness and acceptability of these services, especially for children, adolescents, and young adults. E-mental health has been defined as “mental health services and information delivered or enhanced through the Internet and related technologies” (Christensen, Griffiths, & Evans, 2002, p. 5). In this study, we limited our definition of e-mental health to the use of communication technologies that are Internet- or mobile phone-based to provide mental health services. There is emerging evidence that e-mental health interventions are effective in adult populations, especially related to anxiety and depression (Calear & Christensen, 2010; Griffiths, Farrer, & Christensen, 2010). Adherence to e-therapies in adult populations has been the subject of a review (Donkin, et al., 2011), but the evidence related to the broader concept of the acceptability of e-mental health services has not been reviewed. Further evidence is needed to better understand the acceptability of these services for the younger population, as well as their parents and healthcare providers. This paper is part of a Canadian Institutes of Health Research (CIHR)-funded systematic review entitled “The Availability, Effectiveness, Cost-Effectiveness, Acceptability and Equity of E-Mental Health Services
2
the acceptability of e-mental health services
struthers, et al.
for Children and Youth”. The funding for this research is through the priority area of access to mental health services for children and youth (ResearchNet, 2011). The overall questions for this systematic review were: (1) What e-mental health services are currently available for children and youth? (2) Are these services effective and cost-effective? and (3) How acceptable are these services to providers and clients (including parents)? Although acceptability may be related to client perceptions of effectiveness, our systematic review findings on effectiveness have been published elsewhere (Ye et al., 2014) and in this paper we focus only on acceptability. Treatment acceptability has been defined as “the extent to which consumers of treatment … view the treatment as reasonable, justified, fair, and palatable” (Kazdin, 2000, p. 158). Indicators of acceptability in the e-mental health literature have included uptake and completion rates, client expectations, credibility, stakeholder perceptions, and satisfaction (de Graaf, Huibers, Riper, Gerhards, & Arntz, 2009; Gun, Titov, & Andrews, 2011; Todd, Solis-Trapala, Jones, & Lobban, 2012). Based on the above definition of acceptability and the work of other authors in this area, we explored five dimensions of acceptability of e-mental health interventions: satisfaction, client expectations, uptake, adherence, and patient/provider experiences. Methods Systematic review methods (Grant & Booth, 2009) were used for our review of the effectiveness of e-mental health. However, these were modified slightly to answer our question related to acceptability. This difference is described under the Quality assessment below. Search Strategy The published literature was searched by a health science librarian (M.R.) using PubMed/Medline, EMBASE, CINAHL, PsycInfo, GoogleScholar, Science Citation Index/Science Citation Index Expanded, Web of Science, ProQuest, www.clinicaltrials.gov, Cochrane Central Register of Controlled Trials and Google. Both MeSH and free-text search terms were used to represent e-mental health including e-mental health, e-health, Internet, mobile health, m-health, mobile phone, smartphone, information communication technology, and telemedicine. These terms were then combined with terms that described mental health services such as mental health/illness, mental health services, effectiveness, accessibility, acceptability, prevention, promotion, treatment, and maintenance and those describing children, adolescents, and young adults. The strategy was first designed for PubMed/Medline and then modified for application to the other databases, including Google, which was searched to find grey literature. The search was limited to papers published between January 1990 and December 2012. In addition, the reference lists of included papers were hand-searched. Study Selection The literature search returned 2,683 papers (the selection of studies for inclusion is shown in Figure 1). Relevant studies were identified from the published and grey literature based on the P.I.C.O.S. (Population, Interventions, Comparators, Outcomes and Study Design) framework (McKibbon & Marks, 2001). Abstracts (and full text if necessary) were screened by two reviewers (S. B. B. and S. W.) and papers were included 3
canadian journal of community mental health
vol. 34, no. 2, 2015
Figure 1 Study Selection and Exclusion Flow Diagram
Multiple database searching: 2,645
Other sources (grey literature, manual searching of references): 38
Total number of papers: 2,683 Not relevant based on abstract/title: 2,313 Relevant papers based on abstract/title: 370 (but, not clear about population age) Full text NOT available: 1 Full text available: 369
(but, not clear about population age)
Not relevant after full text review: 273 Studies assessed for quality: 96 Average age
