TY  - JOUR
AU  - Xiang, Xiaoling
AU  - Kayser, Jay
AU  - Ash, Samson
AU  - Zheng, Chuxuan
AU  - Sun, Yihang
AU  - Weaver, Addie
AU  - Dunkle, Ruth
AU  - Blackburn, James A
AU  - Halavanau, Alex
AU  - Xue, Jia
AU  - Himle, Joseph A
PY  - 2023
DA  - 2023/9/19
TI  - Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study
JO  - JMIR Aging
SP  - e47691
VL  - 6
KW  - internet-based cognitive behavioral therapy
KW  - usability
KW  - geriatric depression
KW  - community-engaged research
KW  - web-based
KW  - geriatrics
KW  - geriatric
KW  - depression
KW  - psychotherapy
KW  - mental health
KW  - older adults
KW  - older adult
KW  - cognitive behavioral therapy
KW  - CBT
KW  - design
KW  - development
KW  - community
KW  - user centered design
KW  - digital health
KW  - aging
KW  - old age
KW  - digital mental health
KW  - web-based health
KW  - internet
AB  - 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. 
SN  - 2561-7605
UR  - https://aging.jmir.org/2023/1/e47691
UR  - https://doi.org/10.2196/47691
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37725423
DO  - 10.2196/47691
ID  - info:doi/10.2196/47691
ER  -