Participants' Experiences of an Online Intervention and Randomised Control Trial
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Abstract
Background
The internet has become host to a growing variety of interventions from tools to treat depression or increase physical activity, to helping the user stop smoking. Whilst there is an expanding body of literature evaluating the effectiveness of these interventions, fewer studies have examined participants' motivations and experiences of engaging with an intervention that is delivered solely online. This can inform how we may tailor interventions to increase uptake, compliance and maximize the effects. The study aimed to explore participants’ attitudes toward partaking in a large internet based, randomized control trial and their experiences of using an online intervention through qualitative methodology. Methods The PSYWELL trial is a large randomized control trial (n = 3070), evaluating a self directed, online training tool (MoodGYM) which uses a cognitive behavioral therapy approach. In this trial we evaluated the use of MoodGYM as a tool to promote mental wellbeing in the general population. We recruited members of the general public living in the United Kingdom through the National Health Service (NHS) website ‘NHS Choices’. On entry to the trial, participants in the intervention arm were invited to take part in a telephone interview. Eighty participants allocated to the intervention arm consented to being contacted for an interview. The participants were stratified for age and gender bands and we contacted accordingly by band. This was not a representative sample, but a purposive one designed to intentionally sample a broad range of opinion from different genders and ages. Fourteen males had indicated willingness to participate and all were contacted. The stratification was conducted blinded to participants’ performance and compliance in the PSYWELL trial, with knowledge of only gender and for year age grouping prior to invitation and interview. Of those contacted (n=60), 20 were able to provide consent and time for interview (18 female, 2 male) and were invited to the interview. Twenty participants undertook a 45 minute semi-structured interview. All interviews took place after participants' involvement in the PSYWELL trial had ended. The transcripts were analyzed using the Framework Approach to identify themes characterizing the experience of participation in an internet trial and intervention.
Results
Four core themes emerged from the interviews. First: convenience, participants reported the availability of the online resource 24 hours a day, and without having to either commute to or attend appointments to be a major benefit. Second: brand reassurance, participants entered personal, intimate details onto the web, the important factor in encouraging them to do this was the ‘branding’ of the tool and trial by both the University of Warwick and the NHS, which were seen as trusted institutions. Third: positive outcome, the majority of feedback favored the intervention, with dramatic individual examples of how an online intervention impacted upon people’s lives. Fourth: the language used in the tool was important and frequently not seen as relevant to the individual within the older age group believing the tool was aimed at a younger generation, and generally participants perceiving the intervention’s language (Australian) to be ‘Americanized’.
Conclusions
The qualitative study demonstrated the potential for an online internet intervention to dramatically affect individual’s lives. It had the advantage over other intervention delivery methods in being readily accessible 24 hours a day with few barriers to access. Engagement with the tool was largely dependent on it being provided by source that was perceived to be trusted. To increase satisfaction, the importance of adapting or designing the style of language used by interventions to fit the individual user or user group should be considered as an implication for future research.
The internet has become host to a growing variety of interventions from tools to treat depression or increase physical activity, to helping the user stop smoking. Whilst there is an expanding body of literature evaluating the effectiveness of these interventions, fewer studies have examined participants' motivations and experiences of engaging with an intervention that is delivered solely online. This can inform how we may tailor interventions to increase uptake, compliance and maximize the effects. The study aimed to explore participants’ attitudes toward partaking in a large internet based, randomized control trial and their experiences of using an online intervention through qualitative methodology. Methods The PSYWELL trial is a large randomized control trial (n = 3070), evaluating a self directed, online training tool (MoodGYM) which uses a cognitive behavioral therapy approach. In this trial we evaluated the use of MoodGYM as a tool to promote mental wellbeing in the general population. We recruited members of the general public living in the United Kingdom through the National Health Service (NHS) website ‘NHS Choices’. On entry to the trial, participants in the intervention arm were invited to take part in a telephone interview. Eighty participants allocated to the intervention arm consented to being contacted for an interview. The participants were stratified for age and gender bands and we contacted accordingly by band. This was not a representative sample, but a purposive one designed to intentionally sample a broad range of opinion from different genders and ages. Fourteen males had indicated willingness to participate and all were contacted. The stratification was conducted blinded to participants’ performance and compliance in the PSYWELL trial, with knowledge of only gender and for year age grouping prior to invitation and interview. Of those contacted (n=60), 20 were able to provide consent and time for interview (18 female, 2 male) and were invited to the interview. Twenty participants undertook a 45 minute semi-structured interview. All interviews took place after participants' involvement in the PSYWELL trial had ended. The transcripts were analyzed using the Framework Approach to identify themes characterizing the experience of participation in an internet trial and intervention.
Results
Four core themes emerged from the interviews. First: convenience, participants reported the availability of the online resource 24 hours a day, and without having to either commute to or attend appointments to be a major benefit. Second: brand reassurance, participants entered personal, intimate details onto the web, the important factor in encouraging them to do this was the ‘branding’ of the tool and trial by both the University of Warwick and the NHS, which were seen as trusted institutions. Third: positive outcome, the majority of feedback favored the intervention, with dramatic individual examples of how an online intervention impacted upon people’s lives. Fourth: the language used in the tool was important and frequently not seen as relevant to the individual within the older age group believing the tool was aimed at a younger generation, and generally participants perceiving the intervention’s language (Australian) to be ‘Americanized’.
Conclusions
The qualitative study demonstrated the potential for an online internet intervention to dramatically affect individual’s lives. It had the advantage over other intervention delivery methods in being readily accessible 24 hours a day with few barriers to access. Engagement with the tool was largely dependent on it being provided by source that was perceived to be trusted. To increase satisfaction, the importance of adapting or designing the style of language used by interventions to fit the individual user or user group should be considered as an implication for future research.
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