title: Acceptability of online self-help to people with depression: users' views of MoodGYM versus informational websites.
abstract: BACKGROUND
  Little is known about the factors that influence acceptability of and adherence to online psychological interventions. Evidence is needed to guide further development of promising programs.
  
  
  OBJECTIVE
  Our goal was to investigate users' views of two online approaches to self-help for depression: computerized cognitive behavior therapy (cCBT) and informational websites, in a workplace context. Computerized CBT offers an inexpensive and accessible alternative to face-to-face therapy, and employers have an interest in reducing the working time lost to depression or stress. Yet little is known about how employees, who have actual experience of using online approaches, judge the intervention as a process.
  
  
  METHODS
  The qualitative data reported here were collected within an online randomized controlled trial whose participants had diagnosable depression. The experimental intervention was a 5-week cCBT program called MoodGYM, and the control condition was five informational websites about mental health. Data were collected via online questionnaires. There was no evidence of the superiority of either in terms of treatment outcomes. In parallel, using brief rating scales and open-ended questions designed for this purpose, we examined the relative acceptability of each approach over time, including perceptions of cCBT compared to seeing a health care professional.
  
  
  RESULTS
  At least 60% of participants held online therapy to be at least as acceptable as seeing a professional about mental health issues, and they were more likely to retain this opinion over time if they used the interactive program, MoodGYM, rather than informational websites alone. Barriers to cCBT use fell into four categories: intrinsic, intrapersonal problems; extrinsic technical problems; generic issues mostly pertaining to perceptions of cCBT; and specific issues about the intervention or control condition. These indicate strategies for improving engagement.
  
  
  CONCLUSIONS
  As first-aid for mild to moderate mental health problems, evidence-based computerized approaches have broad acceptability. This could be increased by attending to the barriers noted here and by proactively managing users' expectations at individual and organizational levels. The findings have implications for occupational health providers and others addressing the needs of working-age adults with depression. They also raise methodological issues for online research.
  
  
  BACKGROUND
  International Standard Randomized Controlled Trial Number (ISRCTN): 24529487; http://www.controlled-trials.com/ISRCTN24529487 (Archived by Webcite at http://www.webcitation.org/6O8cCL4mh).
authors.affiliation: Institute of Mental Health & School of Sociology & Social Policy, University of Nottingham, Nottingham, United Kingdom. Justine.Schneider@nottingham.ac.uk.
authors.forename: Justine
authors.initials: J
authors.lastname: Schneider
authors.forename: Pooria
authors.initials: P
authors.lastname: Sarrami Foroushani
authors.forename: Paul
authors.initials: P
authors.lastname: Grime
authors.forename: Graham
authors.initials: G
authors.lastname: Thornicroft
mesh_terms: D000328:Adult; D001292:Attitude to Computers; D001294:Attitude to Health; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D012648:Self Care; D011795:Surveys and Questionnaires; D017216:Telemedicine; D017132:Workplace
keywords: computers, cognitive therapy; depression; method acceptability; qualitative evaluation; workplace