%0 Journal Article
%@ 2561-7605
%I JMIR Publications
%V 6
%N 
%P e47691
%T Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study
%A Xiang,Xiaoling
%A Kayser,Jay
%A Ash,Samson
%A Zheng,Chuxuan
%A Sun,Yihang
%A Weaver,Addie
%A Dunkle,Ruth
%A Blackburn,James A
%A Halavanau,Alex
%A Xue,Jia
%A Himle,Joseph A
%+ School of Social Work, University of Michigan-Ann Arbor, 1080 S University Avenue, Ann Arbor, MI, 48109, United States, 1 7347636581, xiangxi@umich.edu
%K internet-based cognitive behavioral therapy
%K usability
%K geriatric depression
%K community-engaged research
%K web-based
%K geriatrics
%K geriatric
%K depression
%K psychotherapy
%K mental health
%K older adults
%K older adult
%K cognitive behavioral therapy
%K CBT
%K design
%K development
%K community
%K user centered design
%K digital health
%K aging
%K old age
%K digital mental health
%K web-based health
%K internet
%D 2023
%7 19.9.2023
%9 Original Paper
%J JMIR Aging
%G English
%X 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. 
%M 37725423
%R 10.2196/47691
%U https://aging.jmir.org/2023/1/e47691
%U https://doi.org/10.2196/47691
%U http://www.ncbi.nlm.nih.gov/pubmed/37725423