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Web-Based Problem-solving Training With and Without Peer Support in Veterans With Unmet Mental Health Needs: Pilot Study of Feasibility, User Acceptability, and Participant Engagement.
Possemato, Kyle; Wu, Justina; Greene, Carolyn; MacQueen, Rex; Blonigen, Daniel; Wade, Michael; Owen, Jason; Keane, Terence; Brief, Deborah; Lindley, Steven; Prins, Annabel; Mackintosh, Margaret-Anne; Carlson, Eve.
  • Possemato K; Veterans Affairs Center for Integrated Healthcare, Syracuse, NY, United States.
  • Wu J; National Center for Post Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
  • Greene C; Veterans Affairs Office of Mental Health Services and Suicide Prevention, Washington, DC, United States.
  • MacQueen R; Veterans Affairs Center for Integrated Healthcare, Syracuse, NY, United States.
  • Blonigen D; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, United States.
  • Wade M; Veterans Affairs Center for Integrated Healthcare, Syracuse, NY, United States.
  • Owen J; National Center for Post Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
  • Keane T; National Center for Post Traumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States.
  • Brief D; National Center for Post Traumatic Stress Disorder, Veterans Affairs Boston Healthcare System, Boston, MA, United States.
  • Lindley S; Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA, United States.
  • Prins A; National Center for Post Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
  • Mackintosh MA; National Center for Post Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
  • Carlson E; National Center for Post Traumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States.
J Med Internet Res ; 24(1): e29559, 2022 01 13.
Article in English | MEDLINE | ID: covidwho-1662502
ABSTRACT

BACKGROUND:

eHealth tools have the potential to meet the mental health needs of individuals who experience barriers to accessing in-person treatment. However, most users have less than optimal engagement with eHealth tools. Coaching from peer specialists may increase their engagement with eHealth.

OBJECTIVE:

This pilot study aims to test the feasibility and acceptability of a novel, completely automated web-based system to recruit, screen, enroll, assess, randomize, and then deliver an intervention to a national sample of military veterans with unmet mental health needs; investigate whether phone-based peer support increases the use of web-based problem-solving training compared with self-directed use; and generate hypotheses about potential mechanisms of action for problem-solving and peer support for future full-scale research.

METHODS:

Veterans (N=81) with unmet mental health needs were recruited via social media advertising and enrolled and randomized to the self-directed use of a web-based problem-solving training called Moving Forward (28/81, 35%), peer-supported Moving Forward (27/81, 33%), or waitlist control (26/81, 32%). The objective use of Moving Forward was measured with the number of log-ins. Participants completed pre- and poststudy measures of mental health symptoms and problem-solving confidence. Satisfaction was also assessed post treatment.

RESULTS:

Automated recruitment, enrollment, and initial assessment methods were feasible and resulted in a diverse sample of veterans with unmet mental health needs from 38 states. Automated follow-up methods resulted in 46% (37/81) of participants completing follow-up assessments. Peer support was delivered with high fidelity and was associated with favorable participant satisfaction. Participants randomized to receive peer support had significantly more Moving Forward log-ins than those of self-directed Moving Forward participants, and those who received peer support had a greater decrease in depression. Problem-solving confidence was associated with greater Moving Forward use and improvements in mental health symptoms among participants both with and without peer support.

CONCLUSIONS:

Enrolling and assessing individuals in eHealth studies without human contact is feasible; however, different methods or designs are necessary to achieve acceptable participant engagement and follow-up rates. Peer support shows potential for increasing engagement in web-based interventions and reducing symptoms. Future research should investigate when and for whom peer support for eHealth is helpful. Problem-solving confidence should be further investigated as a mechanism of action for web-based problem-solving training. TRIAL REGISTRATION ClinicalTrials.gov NCT03555435; http//clinicaltrials.gov/ct2/show/NCT03555435.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Internet-Based Intervention Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 29559

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Internet-Based Intervention Type of study: Cohort study / Experimental Studies / Prognostic study / Randomized controlled trials Limits: Humans Language: English Journal: J Med Internet Res Journal subject: Medical Informatics Year: 2022 Document Type: Article Affiliation country: 29559