Portuguese Psychologists' Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study

Abstract

Background Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists’ use and their attitudes towards such interventions is largely unknown. Objective The aim of this study was to explore Portuguese psychologists’ knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. Methods An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. Results A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), client’s ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (χ24=90.4; P<.001), training (χ24=94.6; P<.001), attitudes (χ23=38.4; P<.001) and previous use of internet interventions and between knowledge (χ212=109.7; P<.001), training (χ212=64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. Conclusions This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation.

The Use of New Digital Information and Communication Technologies in Psychological Counseling during the COVID-19 Pandemic

“…These results reproduce those by Mendes-Santos (2020), in which only 29.6% of the inquired Portuguese psychologists admitted to having used digital technologies in their professional practice. The results of the present study also showed that most Portuguese psychologists had never or rarely used digital technologies as a means of delivering psychological counseling and therapy before the COVID-19 pandemic [ 6 ]. There is also a high degree of similarity between the tools most frequently used in our study and the tools used, the resources that psychologists most recommend to their clients (e.g., telephone calls, e-mails, video conferences, social networks, and apps) [ 6 ], and the most used devices (e.g., computers and smart phones) reported in other research (e.g., [ 14 ]).…”

“…In several countries, an increasing number of studies have also sought to characterize the attitudes of psychologists toward the inclusion of ICTs in their professional practice and to gather evidence about the efficacy and effectiveness of psychological interventions mediated by ICTs (e.g., [ 7 , 16 , 17 , 18 , 19 , 20 , 21 ]). Regarding the psychologists’ attitudes, the results of the studies are not consistent (e.g., [ 6 , 22 ]). In Portugal, a recent study assessing psychologists’ attitudes revealed a slightly negative/neutral position regarding internet interventions and greater acceptability of blended treatment interventions when compared to standalone internet interventions.…”

“…This has implications regarding the availability of the psychological services offered, which are still quite scarce in some countries, as is the case in Portugal. For example, before the COVID-19 pandemic, few Portuguese psychologists adopted guided and unguided psychological internet interventions (1.3% and 1.5%, respectively) [ 6 ], despite the already recognized advantages of this type of intervention [ 7 , 8 , 9 , 10 , 11 ].…”

“…In Portugal, a recent study assessing psychologists’ attitudes revealed a slightly negative/neutral position regarding internet interventions and greater acceptability of blended treatment interventions when compared to standalone internet interventions. However, these attitudes seem to depend on different factors, such as knowledge and training [ 6 ]. A study in other countries revealed that, among those who have employed any online means of practicing counseling and therapy, 52.97% had a positive or very positive opinion about the use of these tools.…”

“…Regarding the effectiveness of these online means, in general, studies allow us to conclude that internet interventions may be efficacious and cost-effective [ 6 , 16 , 17 , 19 , 20 , 32 , 33 , 34 , 35 ]. They seemed to be at least as effective as face-to-face interventions in a large group of clients receiving treatment for psychological disorders, namely, for generalized anxiety and other types of anxiety disorders [ 36 , 37 , 38 , 39 , 40 , 41 , 42 ], depression [ 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], and stress [ 53 , 54 ].…”