Abstract
BACKGROUND: Improving mental health treatment within the collaborative care model (CoCM) may be achieved by using e-mental health (e-MH) tools and addressing the challenges to their integration. OBJECTIVE: This study aims to understand how patients select, engage, and use three self-help e-MH tools for depression, and to explore satisfaction with e-MH tools, with a particular emphasis on care manager interactions. METHODS: This was a single-center, nonrandomized, preferred assignment study of two cognitive behavioral therapy-based tools (Moodkit and moodgym) and an educational website (the Depression Center Toolkit). The tools were recommended for use in 15-minute sessions 3 times a week, for 6 weeks, coupled with low-intensity care manager coaching. Utilization of e-MH was also captured during an additional 4 weeks without coaching. Self-report outcome measures were gathered at baseline, weekly for 6 weeks, at week 10, and through activities suggested by the tool. RESULTS: The 32 participants enrolled were predominantly female (n=27, 84%), non-Hispanic Caucasian (n=29, 91%), with a mean age of 41.8 (SD 16.1; range 20 to 78) years. Most participants (n=26, 81%) presented with moderate to moderately severe depression (Patient Health Questionnaire-9=11-19) and a marked level of impairment in different areas of functioning. About 81% (n=26) of the participants initially selected a cognitive behavioral therapy-based tool, and 19% (n=6) selected the educational website. In total, 4 of 32 (12%) participants switched tools within the first week, 6 of 32 (22%) participants dropped out, and one was removed. The remaining 25 active individuals used tools on average 3.0 (SD 2.4) times per week, most time (67%), for 11 to 20 minutes or more at a time. Of the 19 participants reached and surveyed at week 6, 52% (16/31) remained actively engaged with their tools, including 2 users who had switched tools and 8 between 45 and 78 years old. At week 10, about 75% (12/16) of this subgroup were using their tools with no coaching; this represented 49% of the cohort. Satisfaction increased with progressive use of the tool. The care manager's low-intensity coaching lasted on average 7.9 (SD 3.9) minutes and promoted better understanding and greater use of the tools. Other facilitators to adherence consisted of organization, convenience, ease, accessibility, and privacy policies of the tools, while barriers included time constraints, depressive symptoms, and uncertainty about the efficacy of the tool. CONCLUSIONS: Uptake of e-MH tools for depression is feasible and associated with significant user satisfaction in CoCM. Low-intensity care manager coaching is consistent with the CoCM and is associated with uptake and ongoing use of e-MH tools. To our knowledge, this is the first study to leverage the care manager's proactive outreach to and routine follow-ups with patients toward engagement in self-help digital tools.