AboutFace: A Randomized Controlled Evaluation of an Online Peer-Based Intervention to Increase PTSD Treatment Engagement (Preprint)

Abstract

Posttraumatic stress disorder (PTSD) is prevalent among veterans (Greenberg et al., 2022; Harpaz-Rotem et al., 2022) and evidence-based treatments for PTSD are widely available in Veterans Affairs Healthcare Systems. However, rates of treatment seeking for PTSD remain low (Hoge et al., 2014; Lehavot et al., 2018; Maguen et al., 2020), due in part to knowledge gaps, perceived treatment readiness, shame, stigma, pride in self-reliance, and trauma-related avoidance (Zinzow et al. 2012). AboutFace is an online peer-based digital storytelling intervention that was developed to overcome many of these barriers to service seeking, including knowledge, perceived readiness, and stigma.

The current randomized controlled trial compared the efficacy of AboutFace to a psychoeducational brochure that addressed stigma and PTSD treatment engagement among veterans recommended for PTSD treatment.

A total of N=330 veterans who had presented for an intake at a PTSD specialty clinic were randomized to either AboutFace [n=165] or a a psychoeducational brochure condition [n=165] and assessed across primary outcomes of treatment engagement and secondary measures of stigma/attitudes about treatment seeking and PTSD, depression, and quality of life at baseline and at 1, 3, and 6 months.

There were no statistically significant group differences in primary or secondary outcomes at post or follow-up assessments. Among participants who spent at least 15 minutes on AboutFace, there was a marginal increase in treatment initiation. However, sensitivity analyses conducted with participants randomized before the initiation of a pre-treatment phone call suggests the potential benefit of AboutFace as a brief intervention for increasing PTSD treatment initiation among individuals considering PTSD treatment.

Within VA, AboutFace can be effective for increasing attendance even among veterans who have made initial steps to initiate treatment; and it has the potential to have an even greater clinical impact among veterans who are just beginning to contemplate if treatment is right for them. AboutFace is also cost effective and scalable relative to interventions that must be delivered by a provider.

The Use of a Novel Peer Education Program for Improving PTSD Treatment Engagement Among Veterans (AboutFace) NCT03521999 https://clinicaltrials.gov/study/NCT03521999?cond=aboutface&rank=2