Preferences for e-Mental Health Interventions in Germany: A Discrete Choice Experiment

Abstract

Objectives: Recent evidence suggests that e-mental health interventions can be effective at improving mental health but that there is still a notable hesitation among patients to use them. Previous research has revealed that they are perceived by patients as being less helpful than face-to-face psychotherapy. The reasons for this unfavorable perception are, however, not yet well understood. The aim of our study was to address this question by eliciting preferences for individual components of e-mental health interventions in a discrete choice experiment.Methods: Using a stepwise qualitative approach, we developed the following 5 attributes of eMHIs: introductory training, human contact, peer support, proven effectiveness, content delivery, and price. Additionally, we asked questions about respondents' demographics, attitudes, and previous experience of traditional psychotherapy, as well as their distress level.Results: A total of 1984 respondents completed the survey. Using mixed logit models, we found that personal contact with a psychotherapist in blended care, proven effectiveness, and low price were highly valued by participants. Participants were indifferent toward the mode of content delivery but showed a slight preference for introductory training via phone, as well as for peer support via online forum alongside coach-led group meetings on site.Discussion: Our results suggest a clear preference for blended care that includes face-to-face contact with a psychotherapist. This preference remained stable irrespective of sociodemographics, previous experience of psychotherapy, distress level, and the 2 context scenarios used in our discrete choice experiment. Further investigations looking at the potential benefits and risks of blended care are needed.

Investigating the Persuasive Effects of Testimonials on the Acceptance of Digital Stress Management Trainings Among University Students and Underlying Mechanisms: A Randomized Controlled Trial

“…Overall, the low experience rates regarding digi-MHSs in our sample (5%) correspond to earlier surveys from Germany (Webelhorst et al, 2020;Breil et al, 2021) and international findings across different populations (Toscos et al, 2018;Clough et al, 2019;Richardson et al, 2020). Although research has revealed positive attitudes and the readiness to try stand-alone digi-MHSs among university students (Hadler et al, 2021), in direct comparison face-to-face support, including blended care, have been shown to be preferred in surveys, including discrete choice experiments (Phillips et al, 2021). Future experiments on acceptance-facilitating interventions may therefore extend the scope to blended interventions.…”

Preferences of psychotherapists for blended mental health interventions in Germany: a discrete choice experiment

“…These ndings are in concordance with previous research across different countries, where fears of losing contact with patients, not offering patients the amount of help they need, or making treatment mistakes were frequently expressed [12-13, 15, 18]. A previous choice experiment from Germany among the general population also showed that accompanying in-person contact is perceived as a central need when using eMHIs [10]. The main stated advantages of BC among therapists coincide with the rst ndings referring to patient empowerment, patient training in self-management skills, and the perception of increased treatment effectiveness, which was also shown in other studies [35].…”

“…According to current evidence, patients experience blended formats positively and seem to prefer BC to the standalone use of eMHIs [9][10][11][12]. A strong preference for blended types of interventions was also con rmed in a recent study from Germany using a discrete choice experiment (DCE) [10]. Results along the same lines were found in a survey on attitudes towards digital treatment of depression in eight European countries [11].…”

“…Emerging blended care (BC) treatment formats combine the use of eMHIs and traditional face-to-face therapy, aiming to link the advantages of technology and personal contact with a therapist [8]. According to current evidence, patients experience blended formats positively and seem to prefer BC to the standalone use of eMHIs [9][10][11][12]. A strong preference for blended types of interventions was also con rmed in a recent study from Germany using a discrete choice experiment (DCE) [10].…”

“…Knowing which BC application scenarios are preferred by therapists can help policy makers and BC program developers to facilitate conditions and design BC formats that are more attractive to therapists, which could increase the acceptance and uptake of such techniques among different providers in in-and outpatient settings. With citizens and patients in Germany and elsewhere seemingly open to the use of BC [10], this could shift some parts of certain forms of mental health care to a digital format, thus freeing up therapeutic resources for other purposes.…”