Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country (Preprint)

Abstract

BACKGROUND Web-based interventions can offer effective and accessible help for depression to large numbers of people at low cost. While these interventions have a long history in high-income countries, they are at an early stage in non-English-speaking low- and middle- income countries, where they remain relatively new and scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. It is multimodal and based on the cognitive behavioral therapy (CBT) approach. The results of a usage/usability analysis of the original version of HDep served as the basis for generating a more user-friendly second version, freely available since 2014. OBJECTIVE The aim of this study was to explore participants’ satisfaction and acceptability ratings for the HDep, second version. METHODS A retrospective, cross-sectional design was used. An email invitation to complete an online survey was sent to all the people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 67 from those who visited only the home page (HPUs) and 124 from those who registered to use the program (PUs). RESULTS In all groups, users experienced high levels of depressive symptoms (98.9% CES-D > 16). Moderate levels of satisfaction (HPUs M = 21.90, SD = 6.7; PUs M = 21.10, SD = 5.8; range: 8-32) and acceptability (HPUs M = 13.84, SD = 3.97; PUs M = 13.97, SD = 3.29; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (OR = 3.44; 95% CI: 1.16-10.0), while among PUs, older respondents (OR = 1.04; 95% CI: 1.01-1.08), those with paid work (OR = 3.12; 95% CI: 2.40-7.69) those who had not been in therapy (OR = 2.42; 95% CI: 1.09-5.98), and those who had not attempted suicide (OR = 3.44; 95% CI: 1.08-11.11) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished acceptability ratings among HPUs. Among PUs, those with paid work (OR = 2.50; 95% CI: 1.16-5.55), those who had not been in therapy (OR = 3.17; 95% CI: 1.38-7.30), those without disability (OR = 2.94; 95% CI: 1.35-6.66), and those who had not attempted suicide (OR = 2.63; 95% CI: 1.03-6.66) showed higher acceptability. CONCLUSIONS HDep has good levels of satisfaction and acceptability for just over half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative-quantitative study from a low/middle-income non-English speaking country adds to existing knowledge regarding acceptance and satisfaction with CBT-based programs for depression in high-income countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and online prevention and treatment programs can help to deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive the intervention might suggest modifications to increase adherence.