The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis

Abstract

BackgroundThe use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified.ObjectiveThe aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions.MethodsTwo convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods.ResultsThe preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished communication between therapist and client, fear of negative side effects, requirements of computer literacy, and concerns about confidentiality.ConclusionsInternet-based interventions were reported as the preferred choice by a minority of participants. The results suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may restrict its use. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study.

Public Attitudes Toward Guided Internet-Based Therapies: Web-Based Survey Study (Preprint)

“…This is supported by previous German surveys reporting even lower rates of e-awareness (14.0-27.3%; [42,52,64,74]). Experience with seeking psychological help formats was also a determinant of preferences, which is consistent with other studies [29,31]. Results also suggest that attachment avoidance was associated with a higher preference for guided and unguided self-help via internet interventions, and very low preference for VCP.…”

“…Some recent studies identified a preference for traditional (face-to-face) over internet-based treatment (e.g. [28,29,31,[44][45][46][47]) and for therapist-guided over unguided eMHS (e.g. [28,29,33]).…”

“…Regarding health-related and help-seeking variables, using the Internet for mental health information [45,51], previous use of eMHS [31], a history of mental illness and help-seeking experience such as undergoing psychotherapy [29], knowledge about eMHS or awareness of electronic therapies ("e-awareness") [33,41,42], personality traits [28], and perceived stress [42,52] have been reported as predictors. Regarding the role of symptom severity, a recent study [12] illustrated a "help-seeking behavior paradox" in students, where individuals' readiness to seek help from face-to-face services declined with increased perceived stress.…”

“…However, the poor adoption of eMHS worldwide indicates that low acceptability and intention to use might constitute a barrier in reaching the full potential of internetbased approaches (cf. [28][29][30][31][32].…”

The case for developing an online intervention to support midwives in work-related psychological distress

“…Other populations have reported a preference for internet-based mental health support interventions, citing that these are better able to assure anonymity, easier and more flexible to access, and less embarrassing and shameful to use (Wallin, Mattsson et al 2016). Additionally, these populations also report that they feel more able to express feelings, self-disclose and be honest within an online intervention.…”