Making good decisions is hard when you are at your worst: Investigating the degree of users’ decision-making in an e-Mental health service

Abstract

Abstract Background. Empowering people to decide on their health has proven to be beneficial and to enable the creation of a therapeutic alliance. This could be the same in an e-Mental health service. However, little is known about the degree of decision-making people should have when using such services and when they are seriously depressed or in a life-threatening situation. Method. The topic was explored through two studies. The first study was a quantitative study to investigate how much decision-making freedom the self-help e-Mental health service allowed and in what situation (serious or less serious mental complaints) the service could be used. Participants were randomly assigned to one of four prototypes of a self-help e-Mental health service (for elderly people) with a different degree of decision-making and level of gravity of the situation. Afterwards, they were asked to fill in a survey to measure autonomy, competence, relatedness, privacy, safety, patient-technology alliance and intention to use. To analyse the data, ANOVAs and regression analyses were performed. In a second, qualitative study, 10 (clinical) experts with different backgrounds were interviewed about the degree of decision-making elderly people should have when using an e-Mental health service. The interviews were analysed via open and axial coding. Results. For the first study, 72 elderly people were recruited. No significant effect of decision-making and level of gravity was found. Relatedness significantly influences patient-technology alliance and intention to use. Additionally, patient-technology alliance significantly influences intention to use. For the second study, it was found that control is central for users, even if it is more difficult for people who are seriously depressed or in a critical situation. Nonetheless, design and technical suggestions on how to support users of e-Mental health services who have more serious symptoms are presented, including personalization, a three-steps approach to control, and setting goals. Conclusions. The results of this study can be applied to other self-help e-Mental health services with therapeutic purposes. Additionally, further research is needed to understand which other factors, together with relatedness, can influence the creation of a therapeutic alliance and how to foster intention to use.