Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACH <sub>CD</sub>): a randomized controlled pilot trial

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Abstract

Background

Adolescents and young adults (AYA) with a chronic medical condition show an increased risk for developing mental comorbidities compared to their healthy peers. Internet- and mobile-based cognitive behavioral therapy (iCBT) might be a low-threshold treatment to support affected AYA. In this randomized controlled pilot trial, the feasibility and potential efficacy of youthCOACH _CD, an iCBT targeting symptoms of anxiety and depression in AYA with chronic medical conditions, was evaluated.

Methods

A total of 30 AYA ( M _age 16.13; SD= 2.34; 73% female), aged 12-21 years either suffering from cystic fibrosis, juvenile idiopathic arthritis or type 1 diabetes, were randomly assigned to either a guided version of the iCBT youthCOACH _CD (IG, n=15) or to a waitlist control group (CG, n=15), receiving an unguided version of the iCBT six months post-randomization. Participants of the IG and the CG were assessed before (t0), twelve weeks after (t1) and six months after (t2) randomization. Primary outcome was the feasibility of the iCBT. Different parameters of feasibility e.g. acceptance, client satisfaction or potential side effects were evaluated. First indications of the possible efficacy with regard to the primary efficacy outcome, the Patient Health Questionnaire Anxiety and Depression Scale, and further outcome variables were evaluated using linear regression models, adjusting for baseline values.

Results

Regarding feasibility, intervention completion was 60%; intervention satisfaction ( M = 25.42, SD = 5.85) and perceived therapeutic alliance ( M = 2.83, SD = 1.25) were moderate and comparable to other iCBTs. No patterns emerged regarding subjective and objective negative side effects due to participation in youthCOACH _CD. Estimates of potential efficacy showed between group differences, with a potential medium-term benefit of youthCOACH _CD (β = -0.55, 95%CI: -1.17; 0.07), but probably not short-term (β = 0.20, 95%CI: -0.47; 0.88).

Conclusions

Our results point to the feasibility of youthCOACH _CD and the implementation of a future definitive randomized controlled trial addressing its effectiveness and cost-effectiveness. Due to the small sample size, conclusions are premature, however, further strategies to foster treatment adherence should be considered.

Trial registration

The trial was registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (ID: DRKS00016714, 25/03/2019).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03134-3.

Related collections

Most cited references 80

Record: found
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Article: not found

mice: Multivariate Imputation by Chained Equations inR

Stef van Buuren, Karin Groothuis-Oudshoorn (2011)

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Record: found
Abstract: found
Article: not found

The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

K Bush, D R Kivlahan, M McDonell … (1998)

To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.

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Persuasive System Design Does Matter: A Systematic Review of Adherence to Web-Based Interventions

Saskia M Kelders, Robin N Kok, Hans Ossebaard … (2013)

Background Although web-based interventions for promoting health and health-related behavior can be effective, poor adherence is a common issue that needs to be addressed. Technology as a means to communicate the content in web-based interventions has been neglected in research. Indeed, technology is often seen as a black-box, a mere tool that has no effect or value and serves only as a vehicle to deliver intervention content. In this paper we examine technology from a holistic perspective. We see it as a vital and inseparable aspect of web-based interventions to help explain and understand adherence. Objective This study aims to review the literature on web-based health interventions to investigate whether intervention characteristics and persuasive design affect adherence to a web-based intervention. Methods We conducted a systematic review of studies into web-based health interventions. Per intervention, intervention characteristics, persuasive technology elements and adherence were coded. We performed a multiple regression analysis to investigate whether these variables could predict adherence. Results We included 101 articles on 83 interventions. The typical web-based intervention is meant to be used once a week, is modular in set-up, is updated once a week, lasts for 10 weeks, includes interaction with the system and a counselor and peers on the web, includes some persuasive technology elements, and about 50% of the participants adhere to the intervention. Regarding persuasive technology, we see that primary task support elements are most commonly employed (mean 2.9 out of a possible 7.0). Dialogue support and social support are less commonly employed (mean 1.5 and 1.2 out of a possible 7.0, respectively). When comparing the interventions of the different health care areas, we find significant differences in intended usage (p = .004), setup (p < .001), updates (p < .001), frequency of interaction with a counselor (p < .001), the system (p = .003) and peers (p = .017), duration (F = 6.068, p = .004), adherence (F = 4.833, p = .010) and the number of primary task support elements (F = 5.631, p = .005). Our final regression model explained 55% of the variance in adherence. In this model, a RCT study as opposed to an observational study, increased interaction with a counselor, more frequent intended usage, more frequent updates and more extensive employment of dialogue support significantly predicted better adherence. Conclusions Using intervention characteristics and persuasive technology elements, a substantial amount of variance in adherence can be explained. Although there are differences between health care areas on intervention characteristics, health care area per se does not predict adherence. Rather, the differences in technology and interaction predict adherence. The results of this study can be used to make an informed decision about how to design a web-based intervention to which patients are more likely to adhere.

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Author and article information

Contributors

A. Geirhos: agnes.geirhos@uni-ulm.de

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 29 January 2022

Publication date PMC-release: 29 January 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 69

Affiliations

[1 ]GRID grid.6582.9, ISNI 0000 0004 1936 9748, Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, , Ulm University, ; Ulm, Germany

[2 ]GRID grid.6582.9, ISNI 0000 0004 1936 9748, Faculty of Engineering, Computer Science and Psychology Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy, , Ulm University, ; Lise-Meitner-Straße 16, 89081 Ulm, Germany

[3 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, , Charité Universitätsmedizin Berlin, ; Berlin, Germany

[4 ]GRID grid.6582.9, ISNI 0000 0004 1936 9748, Institute for Epidemiology and Medical Biometry, , ZIBMT, Ulm University, ; Ulm, Germany

[5 ]GRID grid.6363.0, ISNI 0000 0001 2218 4662, Charité University Medicine Berlin, ; Berlin, Germany

[6 ]GRID grid.418217.9, ISNI 0000 0000 9323 8675, German Rheumatism Research Centre, ; Berlin, Germany

[7 ]GRID grid.11348.3f, ISNI 0000 0001 0942 1117, Department of Psychology, Counseling Psychology, , University of Potsdam, ; Potsdam, Germany

[8 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of General, Paediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, , University Hospital Düsseldorf, Heinrich-Heine-University, ; Düsseldorf, Germany

[9 ]GRID grid.6582.9, ISNI 0000 0004 1936 9748, Department of Psychiatry and Psychotherapy II, BKH Günzburg, , Ulm University, ; Günzburg, Germany

Article

Publisher ID: 3134

DOI: 10.1186/s12887-022-03134-3

PMC ID: 8800235

PubMed ID: 35093047

SO-VID: 384b507e-9c0c-4c0b-a011-e5967fd031ca

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 May 2021

Date accepted : 11 January 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;

Award ID: 01GL1740E

Funded by: Universität Ulm (1055)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Pediatrics

Keywords: chronic medical condition,depression,anxiety,internet- and mobile based intervention,cognitive behavioral therapy,randomized controlled pilot trial,type 1 diabetes,cystic fibrosis,juvenile idiopathic arthritis

Data availability:

ScienceOpen disciplines: Pediatrics

Keywords: chronic medical condition, depression, anxiety, internet- and mobile based intervention, cognitive behavioral therapy, randomized controlled pilot trial, type 1 diabetes, cystic fibrosis, juvenile idiopathic arthritis