Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review (Preprint)

Abstract

BACKGROUND There is a growing body of evidence on eHealth interventions that are targeting substance use disorders. Development and decision-making in eHealth has been challenging due to the lack of understanding of how programs work effectively. OBJECTIVE We conducted a realist review on literature of Electronic Health Cognitive-behavioural Therapy (eCBT) programs for substance use with the goal of answering the following realist question: “how do different eCBT interventions for substance use interact with different contexts to pro-duce certain outcomes?” METHODS A literature search of published and gray literature of all eHealth programs targeting substance use was conducted. After data extraction, the scope was refined to only include literature fo-cusing on eCBT programs targeting substance use. We synthesized the available qualitative evidence from the literature into Context-Mechanism-Outcome configurations in order to bet-ter understand when and how programs work. RESULTS A total of 54 papers studying 24 programs were reviewed. Our final results identified 8 Con-text-Mechanism-Outcome configurations from 5 unique programs that met criteria for rele-vance and rigor. CONCLUSIONS 5 strategies that may be applied in future eCBT programs for substance use are discussed and may contribute to a better understanding of mechanisms and ultimately help design more ef-fective solutions in the future. Future research on eHealth CBT programs should try and under-stand mechanisms of program strategies and how they lead to outcomes in different contexts.