Background
Methods
Recruitment of participants
Phase 1: explorative and confirmative surveys
Phase 2: interviews to translate results into practice
Data-analysis
Results
Phase 1
Respondents
Attitudes on online treatment by patients and therapists
Therapists (n = 12) | Patients (n = 8) | |||
---|---|---|---|---|
Statements | (totally) agree a
| (totally) disagree a
| (totally) agree a
| (totally) disagree a
|
Self-management
| ||||
Convenient to always have access to therapy content | 92 (11) | 8 (1) | 100 (8) | 0 (0) |
Encourages patients to take more responsibility for (succeeding of) therapy | 83 (10) | 17 (2) | 100 (8) | 0 (0) |
Therapy blends more into the patients’ home/private situation | 92 (11) | 8 (1) | 88 (7) | 13 (1) |
Sessions can be completed in own time | 92 (11) | 0 (0) | 80 (6) | 13 (1) |
Sessions can be completed in own pace | 83 (10) | 17 (2) | 80 (6) | 25 (2) |
Patients have to travel less | 67 (8) | 25 (3) | 80 (6) | 13 (1) |
Patient-provider relationship
| ||||
Ability to see a patient/therapist face-to-face | 83 (10) | 0 (0) | 100 (8) | 0 (0) |
Therapy structure becomes more transparent | 58 (7) | 17 (2) | 50 (4) | 38 (3) |
Could provide better tailoring to the individual patient | 33 (4) | 17 (2) | 88 (7) | 13 (1) |
Patient-therapist bonding could weaken | 25 (3) | 50 (6) | 50 (4) | 50 (4) |
Using online sessions is too impersonal | 0 (0) | 67 (8) | 13 (1) | 50 (4) |
Changes in face-to-face sessions
| ||||
Face-to-face sessions can be optimally used, due to preparation in the online environment | 75 (9) | 8 (1) | 88 (7) | 13 (1) |
Difficulties or indistinct matters could be more difficult to discuss | 25 (3) | 58 (7) | 50 (4) | 50 (4) |
Possible drawbacks
| ||||
It is not suitable for every patient | 92 (11) | 0 (0) | 88 (7) | 13 (1) |
It could cause interpretation problems due to the lack of non-verbal communication | 75 (9) | 0 (0) | 80 (6) | 25 (2) |
Therapists might need to invest much time to read all the online assignments | 33 (4) | 42 (5) | 25 (2) | 63 (5) |
Patients could misuse or overuse the online environment | 25 (3) | 58 (7) | 50 (4) | 50 (4) |
Personally, I lack the Internet skills | 0 (0) | 67 (8) | 0 (0) | 88 (7) |
Preferences for online and face-to-face content and process
Therapists (n = 12); % (n) a
| Patients (n = 8); % (n) a
| |||
---|---|---|---|---|
Mode of delivery | Online | Face-to-face | Online | Face-to-face |
Content | ||||
Treatment introduction | 0 (0) | 100 (12) | 0 (0) | 100 (8) |
Treatment evaluation | 17 (2) | 67 (8) | 0 (0) | 88 (7) |
Assignments | 75 (9) | 8 (1) | 63 (5) | 38 (3) |
Psycho-education | 100 (12) | 0 (0) | 75 (6) | 25 (2) |
Mood and activity diaries | 100 (12) | 0 (0) | 88 (7) | 13 (1) |
Process | ||||
Asking questions about assignments | 8 (1) | 83 (10) | 25 (2) | 75 (6) |
Expressing thoughts, feelings and difficulties on assignments | 33 (4) | 67 (8) | 0 (0) | 88 (7) |
Expressing thoughts, feelings and difficulties on diary content | 17 (2) | 83 (10) | 13 (1) | 75 (6) |
Reminders to complete assignments and diaries | 75 (9) | 17 (2) | 88 (7) | 0 (0) |
Distribution of online and face-to-face therapy in percentages
Ratio in percentages | Therapists; % (n) | Patients; % (n) |
---|---|---|
75% face-to-face/25% online | 33 (4) | 0 (0) |
60% face-to-face/40% online | 8 (1) | 13 (1) |
50% face-to-face/50% online | 25 (3) | 38 (3) |
40% face-to-face/60% online | 17 (2) | 38 (3) |
25% face-to-face/75% online | 0 (0) | 0 (0) |
Phase 2
Respondents
Applying blended care in clinical practice
Preconditions | Practical steps to incorporate this precondition |
---|---|
Flexibility in the online program | Blended therapy should be tailored to the individual patient, based on individual needs. |
Ratio of online and offline sessions should be chosen during the therapy. | |
Content of online sessions should be flexible, by working with separate online assignments or modules. | |
Take patient characteristics into account | Involve patients into the choice for (and ratio of) blended therapy. |
Consider patients’: | |
▪ Co-morbidity (rule out crises; depression should be the main focus of therapy) | |
▪ Needs and motivation | |
▪ Intelligence (can they express themselves in writing) | |
▪ Skills (can they use a computer) | |
▪ Personality (self-management, discipline) | |
Meta-communication with patients on blended care | Tell them why you work with blended therapy. |
Show them how the program works. | |
Tell them it is important to finish the whole therapy, even though they might feel better half way through. | |
Tell them it is essential that they do the work and that the therapist only plays a supporting role. | |
Use online registration and intake modules | The patient knows that online technology will be used in therapy from the start. |
Patients are offered help immediately, they can start their therapy (intake) without waiting for an available therapist. | |
Emphasis is on patient self-management from the start of the therapy. | |
Use innovations that technology offers beneficially | Do not just copy a face-to-face protocol in an online program. |
Alternate reading texts with active assignments. | |
Use animated examples and videos. | |
Use persuasive technology to motivate patients and to support discipline. | |
Create a database with varying online tools and modules that can be applied as suited on each individual patient. | |
Train and educate therapists | Therapists should be motivated to work with blended therapy. |
Workflow and time investment will change. | |
Technical and practical skills are needed (how to support patients, when and how to provide online feedback). | |
Balance in “letting patients go” and stimulating and supporting them. | |
Implementation should be initiated and stimulated from the management | Therapists need to be trained which costs time and effort, this should be accommodated by the management. |