City Research Online

Abstract

Background: Internet-based cognitive behavioural therapy (iCBT) interventions are effective in clinical trials; however, iCBT implementation data are seldom reported.

Objective: To evaluate uptake, adherence and changes in symptoms of depression for 12–19-year-olds using an unguided pure self-help iCBT intervention (‘SPARX’) during the first seven years of it being publicly available without referral in Aotearoa New Zealand (NZ).

Methods: SPARX is a seven-module, self-help intervention designed for adolescents with mild to moderate depression. It is freely accessible to anyone with a NZ Internet Protocol (IP) address, without the need for a referral, and is delivered in an unguided ‘serious game’ format. The NZ implementation of SPARX includes one symptom measure—the Patient Health Questionnaire adapted for Adolescents (PHQ-A)—which is embedded at the start of modules 1, 4, and 7. We report on uptake, the number of modules completed, and changes in depressive symptoms as measured by the PHQ-A.

Results: In total, 21,320 12–19-year-olds (approximately 2% of NZ 12-19-year-olds) registered to use SPARX. Of these, 63.6% started SPARX (n=13,564; 62.7% female, 31.4% male and 5.9% another gender identity or gender not specified; 64.4% New Zealand European, 14.3% Māori, 8.9% Asian, 3.7% Pacific, and 8.4% another ethnic identity; mean age 14.9 years). The mean PHQ-A at baseline was 13.6 (SD=7.7) with 16.1% reporting no or minimal symptoms, 37.4% reporting mild to moderate symptoms (i.e., the target group) and 46.7% reporting moderately severe or severe symptoms. Among those who started, 51% completed Module 1; 7% completed at least 4 modules and 3% completed all 7 modules. The severity of symptoms reduced from baseline to module 4 and 7. Mean and standard deviation PHQ-A scores for baseline, module 4 and module 7 for those who completed 2 or more assessments were 14.0 (7.0); 11.8 (7.9); and 10.5 (8.5) respectively; mean difference module 1 to 4, 2.2, p<0.0001; mean difference module 1 to 7, 3.6 p<0.0001. Corresponding effect sizes were 0.38 (Module 1 to 4) and 0.51 (Module 1 to 7).

Conclusions: SPARX reached a meaningful proportion of the adolescent population. The effect size for those who engaged with it was comparable to trial results. However, completion was low. Key challenges included logistical barriers such as slow download speeds and compatibility with some devices. Ongoing attention to rapidly evolving technologies and engagement are required. Real-world implementation analyses offer important insights for understanding and improving the impact of evidence-based digital tools and should be routinely reported.

Publication Type:	Article
Subjects:	B Philosophy. Psychology. Religion > BF Psychology H Social Sciences > HN Social history and conditions. Social problems. Social reform R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Departments:	School of Health & Medical Sciences School of Health & Medical Sciences > Nursing
SWORD Depositor:	Symplectic Administrator

Export

Downloads