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Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway

Lillevoll, Kjersti R; Vangberg, Hans Christian B; Griffiths, Kathleen M; Waterloo, Knut; Eisemann, Martin R

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BACKGROUND Internet-based cognitive behavioural therapy (ICBT) is a promising approach to the prevention and reduction of depressive symptoms among adolescents. This study aimed to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored and weekly e-mail reminders on initial uptake and adherence to the intervention. METHOD A baseline survey was...[Show more]

dc.contributor.authorLillevoll, Kjersti R
dc.contributor.authorVangberg, Hans Christian B
dc.contributor.authorGriffiths, Kathleen M
dc.contributor.authorWaterloo, Knut
dc.contributor.authorEisemann, Martin R
dc.date.accessioned2015-12-21T04:42:37Z
dc.date.available2015-12-21T04:42:37Z
dc.identifier.issn1471-244X
dc.identifier.urihttp://hdl.handle.net/1885/95146
dc.description.abstractBACKGROUND Internet-based cognitive behavioural therapy (ICBT) is a promising approach to the prevention and reduction of depressive symptoms among adolescents. This study aimed to evaluate the feasibility and efficacy of disseminating a self-directed internet-based mental health intervention (MoodGYM) in senior high schools. It also sought to investigate possible effects of tailored and weekly e-mail reminders on initial uptake and adherence to the intervention. METHOD A baseline survey was conducted in four senior high schools in two Norwegian municipalities (n = 1337). 52.8% (707/1337) of the students consented to further participation in the trial and were randomly allocated to one of three MoodGYM intervention groups (tailored weekly e-mail reminder (n = 175), standardized weekly e-mail reminder (n = 176 ) or no e-mail reminder (n = 175)) or a waitlist control group (n = 180). We tested for effects of the intervention on depression and self-esteem using multivariate analysis of variance, effects of tailored e-mail and self-reported current need of help on initial uptake of the intervention using logistic regression and the effect of weekly e-mails on adherence using ordinal regression. RESULTS There was substantial non-participation from the intervention, with only 8.5% (45/527) participants logging on to MoodGYM, and few proceeding beyond the first part of the programme. No significant effect on depression or self-esteem was found among the sample as a whole or among participants with elevated depression scores at baseline. Having a higher average grade in senior high school predicted initial uptake of the intervention, but tailored e-mail and self-reported current need of help did not. Weekly e-mail prompts did not predict adherence. The main reasons for non-use reported were lack of time/forgetting about it and doubt about the usefulness of the program. CONCLUSION Overall, disseminating a self-directed internet-based intervention to a school population proved difficult despite steps taken to reduce barriers in terms of tailoring feedback and dispatching weekly e-mail reminders. Providing mental health interventions within the school environment is likely to ensure better uptake among senior high school students, but there is a need to effectively communicate that such programmes can be helpful. TRIAL REGISTRATION The trial was registered retrospectively as ACTRN12612001106820.
dc.publisherBioMed Central
dc.rights© 2014 Lillevoll et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.sourceBMC Psychiatry
dc.subjectadolescent
dc.subjectcognitive therapy
dc.subjectdepressive disorder
dc.subjectfemale
dc.subjecthumans
dc.subjectmale
dc.subjectnorway
dc.subjectreminder systems
dc.subjectschools
dc.subjectself care
dc.subjectself efficacy
dc.subjectyoung adult
dc.subjectelectronic mail
dc.subjectinternet
dc.subjectpatient compliance
dc.titleUptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume14
dc.date.issued2014-01-21
local.identifier.absfor111714
local.identifier.ariespublicationu5684624xPUB11
local.type.statusPublished Version
local.contributor.affiliationLillevoll, Kjersti, University of Tromso, Norway
local.contributor.affiliationVangberg, Hans Christian B., University of Tromso, Norway
local.contributor.affiliationGriffiths, Kathleen, College of Medicine, Biology and Environment, CMBE Research School of Population Health, National Institute for Mental Health Research, The Australian National University
local.contributor.affiliationWaterloo, Knut, University of Tromso, Norway
local.contributor.affiliationEisemann, Martin, University of Tromso, Norway
local.identifier.essn1471-244X
local.bibliographicCitation.issue1
local.bibliographicCitation.startpage14
local.bibliographicCitation.lastpage11
local.identifier.doi10.1186/1471-244X-14-14
local.identifier.absseo920410
dc.date.updated2016-02-24T11:37:16Z
local.identifier.scopusID2-s2.0-84892578111
local.identifier.thomsonID000331225700001
dcterms.accessRightsOpen Access
CollectionsANU Research Publications

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