Internet dissemination also does not require scheduling; there is no stigma associated with participation; it is easy to tailor; the fidelity is high; and the application is in vivo, in that the “learning and behavior changes are occurring in the patients' world of activity,” he said.
To be optimally effective, however, Internet interventions must be delivered in the context of a relationship, Dr. Van Voorhees stressed. “This can be as brief as 1–2 primary care meetings to engage the patient, or it could be with a youth minister, coach, or guidance counselor.”
Internet-based interventions will be useful only if the user can read, understand, identify with, and find personal relevance in the program in order to create a goal-directed change plan, Dr. Van Voorhees said. An interesting, media-savvy design with information presented at a 7th-grade reading level would increase the likelihood of adolescent engagement, he noted.
Patients most likely to benefit from this type of intervention are those at moderate risk for mental disorder, Dr. Van Voorhees said.
Despite the obvious benefits of these interventions, they are not immune to challenges. Among the obstacles impeding the transition of these interventions from research to clinical implementation are the lack of a viable commercial distribution model and thus the absence of marketing to build up use of the programs, Dr. Van Voorhees said.
One alternative would be delivery via a government-sponsored public health model, or a mixed government/private pay model, such as that used for vaccine distribution, he said. “Social networking would potentially boost effectiveness, but liability concerns are an issue for institutional sponsors,” he noted.
By Diana Mahoney. Share your thoughts and suggestions at cpnews@elsevier.com
Perspective
The Internet is one of the greater dissemination tools known to mankind. In many ways, it got us our new president, and if we use it as wisely as he did, we can do many things to improve the public's mental health as per the Institute of Medicine recommendations (See related article on page 2).
It is really simple. If you have an evidence-based strategy delivered via the Internet, such as the CATCH-IT depression intervention, it is easy to put it out to the public to determine whether the efficacy in the pristine academic research environment will be sustained in the real, dirty world.
Internet-based programs are inexpensive and straightforward to facilitate: Develop a Web-based interactive program, put it on the web, publicize the site in the general media, and educate primary care physicians. With the push of a button, the intervention can be disseminated automatically all over the world.
Internet-based prevention interventions also solve the thorny problem of fidelity to the proven model, as the intervention is the same everywhere it goes; you don't have to worry about different practitioners doing the intervention differently. I think of depression prevention interventions that are shown to be evidence based on the Internet as McDonald's, which has a pretty high level of fidelity: You can go any where in the United States, and a McDonald's cheeseburger is going to taste the same.
The key challenge with such interventions is not the delivery mode per se, but the model itself. Does the intervention address protective factors to prevent mental illness in the target population? Is the application user friendly and engaging? If the answers are yes, and there is public and, importantly, government support, the primary barriers to effective implementation have been removed.
Using the Internet as a delivery vehicle also is an advantage because the technology facilitates user-tracking: how often users go to the site, how long they stay there, and so forth. It also offers a great way to monitor process outcomes of the intervention in addition to adding some measures of actual efficacy of the program online.