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Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial

BACKGROUND: Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. OBJECTIVE: To pilot a cluster randomized contro...

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Autores principales: Jones, Ray B, Goldsmith, Lesley, Hewson, Paul, Williams, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Gunther Eysenbach 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636297/
https://www.ncbi.nlm.nih.gov/pubmed/23462072
http://dx.doi.org/10.2196/jmir.2367
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author Jones, Ray B
Goldsmith, Lesley
Hewson, Paul
Williams, Christopher J
author_facet Jones, Ray B
Goldsmith, Lesley
Hewson, Paul
Williams, Christopher J
author_sort Jones, Ray B
collection PubMed
description BACKGROUND: Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. OBJECTIVE: To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. METHODS: We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. RESULTS: Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting “leaked” and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. CONCLUSIONS: Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). TRIAL REGISTRATION: clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp)
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spelling pubmed-36362972013-04-26 Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial Jones, Ray B Goldsmith, Lesley Hewson, Paul Williams, Christopher J J Med Internet Res Original Paper BACKGROUND: Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. OBJECTIVE: To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. METHODS: We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. RESULTS: Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting “leaked” and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. CONCLUSIONS: Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). TRIAL REGISTRATION: clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp) Gunther Eysenbach 2013-03-05 /pmc/articles/PMC3636297/ /pubmed/23462072 http://dx.doi.org/10.2196/jmir.2367 Text en ©Ray B Jones, Lesley Goldsmith, Paul Hewson, Christopher J Williams. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.03.2013. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Jones, Ray B
Goldsmith, Lesley
Hewson, Paul
Williams, Christopher J
Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title_full Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title_fullStr Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title_full_unstemmed Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title_short Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial
title_sort recruitment to online therapies for depression: pilot cluster randomized controlled trial
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3636297/
https://www.ncbi.nlm.nih.gov/pubmed/23462072
http://dx.doi.org/10.2196/jmir.2367
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