@Article{info:doi/10.2196/47691,
author="Xiang, Xiaoling
and Kayser, Jay
and Ash, Samson
and Zheng, Chuxuan
and Sun, Yihang
and Weaver, Addie
and Dunkle, Ruth
and Blackburn, James A
and Halavanau, Alex
and Xue, Jia
and Himle, Joseph A",
title="Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study",
journal="JMIR Aging",
year="2023",
month="Sep",
day="19",
volume="6",
pages="e47691",
keywords="internet-based cognitive behavioral therapy; usability; geriatric depression; community-engaged research; web-based; geriatrics; geriatric; depression; psychotherapy; mental health; older adults; older adult; cognitive behavioral therapy; CBT; design; development; community; user centered design; digital health; aging; old age; digital mental health; web-based health; internet",
abstract="Background: Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. Objective: This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. Methods: Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. Results: Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80{\%} (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention's potential effects. Conclusions: Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions. ",
issn="2561-7605",
doi="10.2196/47691",
url="https://aging.jmir.org/2023/1/e47691",
url="https://doi.org/10.2196/47691",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725423"
}