Engagement and Clinical Improvement Among Older Adult Primary Care Patients Using a Mobile Intervention for Depression and Anxiety: Case Studies

Abstract

<jats:sec> <jats:title>Background</jats:title> <jats:p>Technology-based mental health interventions are an increasingly attractive option for expanding access to mental health services within the primary care system. Older adults are among the groups that could potentially benefit from the growing ubiquity of technology-based mental health interventions; however, older adults are perceived to be averse to using technology and have reported barriers to use.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>The aim of this paper is to present a case study of 3 participants from a clinical trial evaluating IntelliCare, an evidence-based mobile intervention for depression and anxiety, among adults recruited from primary care clinics. Our report of these 3 participants, who were aged 60 years or older, focuses on their engagement with the IntelliCare service (ie, app use, coach communication) and clinical changes in depression or anxiety symptoms over the intervention period.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The 3 case study participants were offered IntelliCare with coaching for 8 weeks. The intervention consisted of 5 treatment intervention apps that support a variety of psychological skills, a Hub app that contained psychoeducational content and administered weekly assessments, and coaching for encouragement, accountability, and technical assistance as needed. The 3 case study participants were selected to reflect the overall demographics of participants within the trial and because their interactions with IntelliCare provided a good illustration of varied experiences regarding engagement with the intervention.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The 3 participants’ unique experiences with the intervention are described. Despite potential barriers and experiencing some technical glitches, the participants showed proficient ability to use the apps, high levels of participation through frequent app use and coach interaction, and decreased depression and anxiety scores. At the end of the 8-week intervention, each of these 3 participants expressed great enthusiasm for the benefit of this program through feedback to their coach, and they each identified a number of ways they had seen improvements in themselves.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>These 3 cases provide examples of older individuals who engaged with and benefitted from the IntelliCare service. Although the results from these 3 cases may not generalize to others, they provide an important, informed perspective of the experiences that can contribute to our understanding of how older adults use and overcome barriers to mental health technologies. The findings also contribute toward the ultimate goal of ensuring that the IntelliCare intervention is appropriate for individuals of all ages.</jats:p> </jats:sec>

The use of coaching in smartphone app-based cognitive behavioral therapy for body dysmorphic disorder

“…Interestingly, the only baseline factor associated with pattern of communication frequency was age; older participants were more likely to be in the first group (i.e., messaged coach more at the beginning and/or end of treatment). This is consistent with past literature suggesting that older users prefer—and may therefore benefit from— more human contact in digital therapies ( Orr et al, 2020 ; Wildenbos et al, 2019 ). Notably, we did not find that this was driven by technology or usability concerns.…”

Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review

“…For example, quantity of coaching could be more important to older adults than to their younger counterparts. Studies have found that desire for human contact and technology literacy barriers can be deterrents for mental health app use, particularly among older adults; thus, more coaching may be beneficial for these users [ 55 , 109 ]. Moreover, others have found older adults to be more engaged with digital coaches than younger ones [ 110 ].…”

Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series

“…Examining affective and cognitive engagement is crucial for developing a more thorough and nuanced understanding of the way people interact with apps. An idiographic approach was preferred to achieve a rich understanding of patterns of engagement [ 39 , 40 ] with this new app and as research on other apps has highlighted the heterogeneity in the preference of app features [ 26 ]. Exploring individual patterns of engagement with HabitWorks may inform further tailoring of the app to enhance its efficacy for high-risk populations, as well as inform the development of similar types of mental health apps.…”