title: An Online Health Prevention Intervention for Youth with Addicted or Mentally Ill Parents: Experiences and Perspectives of Participants and Providers from a Randomized Controlled Trial.
abstract: BACKGROUND
  Mental illnesses affect many people around the world, either directly or indirectly. Families of persons suffering from mental illness or addiction suffer too, especially their children. In the Netherlands, 864,000 parents meet the diagnostic criteria for a mental illness or addiction. Evidence shows that offspring of mentally ill or addicted parents are at risk for developing mental disorders or illnesses themselves. The Kopstoring course is an online 8-week group course with supervision by 2 trained psychologists or social workers, aimed to prevent behavioral and psychological problems for children (aged 16 to 25 years) of parents with mental health problems or addictions. The course addresses themes such as roles in the family and mastery skills. An online randomized controlled trial (RCT) was conducted to assess the effectiveness of the Kopstoring course.
  
  
  OBJECTIVE
  The aim was to gain knowledge about expectations, experiences, and perspectives of participants and providers of the online Kopstoring course.
  
  
  METHODS
  A process evaluation was performed to evaluate the online delivery of Kopstoring and the experiences and perspectives of participants and providers of Kopstoring. Interviews were performed with members from both groups. Participants were drawn from a sample from the Kopstoring RCT.
  
  
  RESULTS
  Thirteen participants and 4 providers were interviewed. Five main themes emerged from these interviews: background, the requirements for the intervention, experience with the intervention, technical aspects, and research aspects. Overall, participants and providers found the intervention to be valuable because it was online; therefore, protecting their anonymity was considered a key component. Most barriers existed in the technical sphere. Additional barriers existed with conducting the RCT, namely gathering informed consent and gathering parental consent in the case of minors.
  
  
  CONCLUSIONS
  This study provides valuable insight into participants' and providers' experiences and expectations with the online preventive intervention Kopstoring. It also sheds light on the process of the online provision of Kopstoring and the accompanying RCT. The findings of this study may partly explain dropout rates when delivering online interventions. The change in the (financial) structure of the youth mental health care system in the Netherlands has financial implications for the delivery of prevention programs for youth. Lastly, there are few RCTs that assess the effectiveness and cost-effectiveness of online prevention programs in the field of (youth) mental health care and not many process evaluations of these programs exist. This hampers a good comparison between online interventions and the expectations and experiences of the participants and providers.
  
  
  BACKGROUND
  Nederlands Trial Register: NTR1982; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1982 (Archived by WebCite® at http://www.webcitation.org/6d8xYDQbB).
authors.affiliation: Clinical Epidemiology and Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands. m.woolderink@maastrichtuniversity.nl.
authors.forename: Marla
authors.identifier: http://orcid.org/0000-0001-7943-4001
authors.initials: M
authors.lastname: Woolderink
authors.forename: Jill A P M
authors.identifier: http://orcid.org/0000-0003-0900-4924
authors.initials: JA
authors.lastname: Bindels
authors.forename: Silvia M A A
authors.identifier: http://orcid.org/0000-0003-1026-570X
authors.initials: SM
authors.lastname: Evers
authors.forename: Aggie T G
authors.identifier: http://orcid.org/0000-0002-2086-6106
authors.initials: AT
authors.lastname: Paulus
authors.forename: Antoinette D I
authors.identifier: http://orcid.org/0000-0001-7705-9906
authors.initials: AD
authors.lastname: van Asselt
authors.forename: Onno C P
authors.identifier: http://orcid.org/0000-0002-3016-1476
authors.initials: OC
authors.lastname: van Schayck
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D001523:Mental Disorders / Q000517:prevention & control*; D028642:Persons with Psychiatric Disorders / Q000523:psychology*; D010290:Parents; D055815:Young Adult
keywords: adolescents; mental health; online-delivered course; prevention; process assessment; qualitative research