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    Mendes Santos, Cristina
    Linköping University, Department of Culture and Society, Division of Philosophy, History, Arts and Religion. Linköping University, Faculty of Arts and Sciences.
    Developing Internet Interventions to Improve Psychosocial Outcomes in Breast Cancer Survivors: Attitudes and practices in Portuguese cancer settings2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Despite the psychosocial treatment gap in cancer settings and the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, research targeting Breast Cancer Survivors (BCS) is scant, and implementation in clinical settings is limited. While the reasons for this research and implementation gaps are multifactorial, including funding, technical and organizational barriers, the attitudes of the distinct stakeholders in the internet interventions’ ecosystem have been posited to play an important role in this regard. Yet, little is known about the attitudes and practices of key stakeholders such as BCS and Mental Health Professionals (MHP) to-ward these interventions or how they should be effectively designed to be widely accepted and easily implemented.  Internet interventions’ development is often viewed as a “black box”. Important behaviour change processes and technological architecture design decisions are seldom reported, and development often neglects end-users’ perspectives or the contexts in which internet interventions will be deployed.  This lack of human-centeredness in the development process partly explains high attrition rates and poor engagement, as well as the failed implementation of internet interventions targeting cancer survivors. Hence, there is a need for methodologically sound internet interventions development research within psychosocial oncology, that is centred on the perspectives and practices of the several actors playing in the cancer setting.  

    Objectives: The current thesis attempts to answer this call and bring the perspectives of key stakeholders into the centre of survivorship internet interventions’ development.  Its overarching aim was to develop iNNOV Breast Cancer (iNNOVBC) – an internet intervention aiming at improving psychosocial outcomes in BCS - using a User-centred design approach, thereby anchoring development on the perspectives and practices of BCS and MHP. Its specific aims were i) to gather requirements for the development of iNNOVBC; ii) to prototype iNNOVBC; and iii) to evaluate iNNOVBC’s usefulness, usability, and feasibility.  

    Methods: To this end quantitative (i.e., surveys and task analysis usability tests) and qualitative methods (i.e., in-depth and debriefing semi-structured interviews, think-aloud lab-based usability tests and short-term field trials) were combined and four empirical studies were conducted. First, we assessed the attitudes of Portuguese Psychologists toward internet interventions and the potential barriers impacting its implementation (n= 1077; c.f., Study I). Second, we explored in-depth the perspectives and practices of MHP regarding Digital Mental Health (DMH), with a focus on internet interventions (n=13; c.f., Study II). Third, we characterized the attitudes of Portuguese BCS toward DMH and investigated the potential factors associated with such attitudes (n=336; c.f., Study III).   Fourth, we documented the development of iNNOVBC and evaluated its usefulness, usability, and preliminary feasibility (n=24; c.f., Study IV).  

    Main findings: Despite Portuguese BCS’ and MHP’s limited knowledge, experience, and guarded stance toward internet interventions, iNNOVBC was considered highly useful by these end-users, configuring a promising point-of-need solution to bridge the psychosocial supportive care gap experienced by BCS across survivorship. However, to fulfil its full supportive role and reach high levels of usability and feasibility, iNNOVBC requires further refinement. Alterations are necessary regarding the aesthetics, information architecture, cognitive load, interaction design, and the technological media for intervention delivery (e.g., mobile app version). In addition, iNNOVBC might require further tailoring and a more flexible implementation approach, so that it better adapts to the needs and contexts of its target users. These aspects need to be assessed in future pilot and Randomized Controlled Trial studies.   Implications: The development of internet interventions targeting BCS should, when-ever possible involve its target end-users so that interventions reflect their real needs and are more easily accepted and implemented. Furthermore, development teams should devise comprehensive plans for the translation of interventions to clinical practice, including appropriate training and communication plans, capable of overcoming potential knowledge, training, and attitudinal barriers to successful implementation. 

    List of papers
    1. Portuguese Psychologists Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study
    Open this publication in new window or tab >>Portuguese Psychologists Attitudes Toward Internet Interventions: Exploratory Cross-Sectional Study
    2020 (English)In: JMIR Mental Health, E-ISSN 2368-7959, Vol. 7, no 4, article id e16817Article in journal (Refereed) Published
    Abstract [en]

    Background: Despite the significant body of evidence on the efficacy and cost-effectiveness of internet interventions, the implementation of such programs in Portugal is virtually non-existent. In addition, Portuguese psychologists use and their attitudes towards such interventions is largely unknown. Objective: The aim of this study was to explore Portuguese psychologists knowledge, training, use and attitudes towards internet interventions; to investigate perceived advantages and limitations of such interventions; identify potential drivers and barriers impacting implementation; and study potential factors associated to previous use and attitudes towards internet interventions. Methods: An online cross-sectional survey was developed by the authors and disseminated by the Portuguese Psychologists Association to its members. Results: A total of 1077 members of the Portuguese Psychologists Association responded to the questionnaire between November 2018 and February 2019. Of these, 37.2% (N=363) were familiar with internet interventions and 19.2% (N=188) considered having the necessary training to work within the field. 29.6% (N=319) of participants reported to have used some form of digital technology to deliver care in the past. Telephone (23.8%; N=256), e-mail (16.2%; N=175) and SMS (16.1%; N=173) services were among the most adopted forms of digital technology, while guided (1.3%; N=14) and unguided (1.5%; N=16) internet interventions were rarely used. Accessibility (79.9%; N=860), convenience (45.7%; N=492) and cost-effectiveness (45.5%; N=490) were considered the most important advantages of internet interventions. Conversely, ethical concerns (40.7%; N=438), clients ICT illiteracy (43.2%; N=465) and negative attitudes towards internet interventions (37%; N=398) were identified as the main limitations. An assessment of participants attitudes towards internet interventions revealed a slightly negative/neutral stance (Median=46.21; SD=15.06) and revealed greater acceptability towards blended treatment interventions (62.9%; N=615) when compared to standalone internet interventions (18.6%; N=181). Significant associations were found between knowledge (chi(2)(4) =90.4; P<.001), training (chi(2)(4) =94.6; P<.001), attitudes (chi(2)(3) =38.4; P<.001) and previous use of internet interventions and between knowledge (chi(2)(12)= 109.7; P<.001), training (chi(2)(12) 64.7; P<.001) and attitudes towards such interventions, with psychologists reporting to be ignorant and not having adequate training in the field, being more likely to present more negative attitudes towards these interventions and not having prior experience in its implementation. Conclusions: This study revealed that most Portuguese psychologists are not familiar with and have no training or prior experience using internet interventions and had a slightly negative/neutral attitude towards such interventions. There was greater acceptability towards blended treatment interventions compared to standalone internet interventions. Lack of knowledge and training were identified as the main barriers to overcome, underlining the need of promoting awareness and training initiatives to ensure internet interventions successful implementation.

    Place, publisher, year, edition, pages
    Toronto, Canada: JMIR PUBLICATIONS, INC, 2020
    Keywords
    attitudes; psychologists; e-mental health; internet interventions; Attitudes Toward Internet Interventions Survey (ATIIS); Portugal; EU
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-165331 (URN)10.2196/16817 (DOI)000525385100001 ()32250273 (PubMedID)
    Note

    Funding Agencies|Erasmus+ Program of the European UnionEuropean Union (EU)

    Available from: 2020-04-27 Created: 2020-04-27 Last updated: 2021-11-08Bibliographically approved
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