Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study

Xiaoling Xiang; Jay Kayser; Samson Ash; Chuxuan Zheng; Yihang Sun; Addie Weaver; Ruth Dunkle; James A Blackburn; Alex Halavanau; Jia Xue; Joseph A Himle

doi:10.2196/47691

Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study

JMIR Aging. 2023 Sep 19:6:e47691. doi: 10.2196/47691.

Authors

Xiaoling Xiang¹, Jay Kayser¹, Samson Ash¹, Chuxuan Zheng², Yihang Sun³, Addie Weaver¹, Ruth Dunkle¹, James A Blackburn¹, Alex Halavanau⁴, Jia Xue^{5

6}, Joseph A Himle¹

Affiliations

¹ School of Social Work, University of Michigan-Ann Arbor, Ann Arbor, MI, United States.
² Department of Psychology, University of Michigan-Ann Arbor, Ann Arbor, MI, United States.
³ School of Social Work, Columbia University, New York City, NY, United States.
⁴ SLAC National Accelerator Laboratory, Stanford University, Menlo Park, CA, United States.
⁵ Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
⁶ Faculty of Information, University of Toronto, Toronto, ON, Canada.

PMID: 37725423
PMCID: PMC10548322
DOI: 10.2196/47691

Abstract

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.

Keywords: CBT; aging; cognitive behavioral therapy; community; community-engaged research; depression; design; development; digital health; digital mental health; geriatric; geriatric depression; geriatrics; internet; internet-based cognitive behavioral therapy; mental health; old age; older adult; older adults; psychotherapy; usability; user centered design; web-based; web-based health.

©Xiaoling Xiang, Jay Kayser, Samson Ash, Chuxuan Zheng, Yihang Sun, Addie Weaver, Ruth Dunkle, James A Blackburn, Alex Halavanau, Jia Xue, Joseph A Himle. Originally published in JMIR Aging (https://aging.jmir.org), 19.09.2023.