Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review

Abstract

BackgroundDepression affects approximately 60% of people with aphasia 1 year post stroke and is associated with disability, lower quality of life, and mortality. Web-delivered mental health (e-mental health) programs are effective, convenient, and cost-effective for the general population and thus are increasingly used in the management of depression. However, it is unknown if such services are applicable and communicatively accessible to people with poststroke aphasia.ObjectiveThe aim of this study was to identify freely available e-mental health programs for depression and determine their applicability and accessibility for people with poststroke aphasia.MethodsA Web-based search was conducted to identify and review freely available e-mental health programs for depression. These programs were then evaluated in terms of their (1) general features via a general evaluation tool, (2) communicative accessibility for people with aphasia via an aphasia-specific communicative accessibility evaluation tool, and (3) empirical evidence for the general population and stroke survivors with and without aphasia. The program that met the most general evaluation criteria and aphasia-specific communicative accessibility evaluation criteria was then trialed by a small subgroup of people with poststroke aphasia.ResultsA total of 8 programs were identified. Of these, 4 had published evidence in support of their efficacy for use within the general population. However, no empirical evidence was identified that specifically supported any programs’ use for stroke survivors with or without aphasia. One evidence-based program scored at least 80% (16/19 and 16/20, respectively) on both the general and aphasia-specific communicative accessibility evaluation tools and was subject to a preliminary trial by 3 people with poststroke aphasia. During this trial, participants were either unable to independently use the program or gave it low usability scores on a post-trial satisfaction survey. On this basis, further evaluation was considered unwarranted.ConclusionsDespite fulfilling majority of the general evaluation and aphasia-specific evaluation criteria, the highest rated program was still found to be unsuitable for people with poststroke aphasia. Thus, e-mental health programs require substantial redevelopment if they are likely to be useful to people with poststroke aphasia.

Development and Evaluation of eHealth Services Regarding Accessibility: Scoping Literature Review

“…All studies were conducted in Global North countries, except for 1 in Ecuador [30][31][32] and 1 in Indonesia [33]. The eHealth services in the included studies targeted different types of patients or diagnoses: hip arthroplasty surgery [30][31][32], chronic kidney disease [34], depression [35,36], intellectual disability [37,38], dexterity impairments [38,39], older adults with functional limitations [33,40], acquired brain injury [41], multiple sclerosis [42], children with long-term illness [43], and heart failure and chronic obstructive pulmonary disease [44]. The eHealth interventions in the studies consisted of rehabilitation after surgery [30][31][32], self-monitoring at home [34,40], mental health programs [35,36], supporting alternative communication [37], symptom reporting [43], facilitating appointments [33,38,41,44], self-management regimens [38,39,41,44], and a precision medicine tool [42].…”

“…In 3 publications, authors defined accessibility as how people can access and use systems regardless of abilities [30,31,35]. In 1 study, accessibility was defined as when a system is able to adapt itself to the preferences and characteristics of the user [34].…”

“…Eight studies used other means than formal accessibility guidelines and standards to inform about or evaluate accessibility when developing eHealth services. These other means were as follows: text-level grading [35], literature review to inform about accessible text [40], user testing with a target group [33][34][35][38][39][40]44], user-centered design workshops with a target group of patients [37] or health professionals [43], focus groups with health professionals to gather meaningful requirements [43], focus groups with a target group of patients and their relatives to gather opinions on app content and design [41], interviews with a target group of patients regarding opinions and preferences on how and what to communicate within the eHealth service [43], a comparative analysis of existing technical solutions to inform about useful requirements [42], and the MOLD-US framework to assess usability issues [44]. Video-recorded user testing with given tasks performed by 10 people older than 60 years.…”

“…In some of the studies, usability was used as an equivalent to accessibility, although usability does not automatically cover accessibility. For example, in a publication [35], it was explained that accessibility is the ease with which patients can use the health care service in proportion to their needs, as well as the usability of the actual technology.…”

Impact of citalopram combined with mindfulness-based stress reduction on symptoms, cognitive functions and self-confidence in patients with depression

“…Patients with depression cannot be cured using medication alone. Medication combined with psychotherapy remarkably improves the efficacy of medication, improves patients' cognitive functions, and their ability to regain their self-confidence to overcome it, as well as reduce residual depressive symptoms [4].…”