Internet-based interventions for education and behavior change have proliferated, but most adolescents may not be sufficiently motivated to engage in Internet-based behavior change interventions. We sought to determine how two different forms of primary care physician engagement, brief advice (BA) versus motivational interview (MI), could enhance participation outcomes in an Internet-based depression prevention intervention.
Eighty-three adolescents at risk for developing major depression were recruited by screening in primary care and randomized to two groups: BA (1-2 minutes) + Internet program versus MI (10-15 minutes) + Internet program. We compared measures of participation and satisfaction for the two groups for a minimum of 12 months after enrollment.
Both groups engaged the site actively (MI: 90% versus BA: 78%, p=0.12). MI had significantly higher levels of engagement than BA for measures including total time on site (143.7 minutes versus 100.2 minutes, p=0.03), number of sessions (8.16 versus 6.00, p=0.04), longer duration of session activity on Internet site (46.2 days versus 29.34 days, p=0.04), and with more characters typed into exercises (3532 versus 2004, p=0.01). Adolescents in the MI group reported higher trust in their physician (4.18 versus 3.74, p=0.05) and greater satisfaction with the Internet-based component (7.92 versus 6.66, p=0.01).
Our results indicate that primary care engagement, particularly using motivational interviewing, may increase Internet use dose, and some elements enhance and intensify adolescent use of an Internet-based intervention over a one to two month period. Primary care engagement may be a useful method to facilitate adolescent involvement in preventive mental health interventions.
Keywords: depressive disorder, adolescents, prevention, Internet, primary care, intervention, motivational interview, brief advice
The Internet is a promising modality for delivery of preventive interventions for adolescents in primary care (Crutzen et al., 2008; Van Voorhees et al., 2007). Adolescents with obesity, smoking, alcohol use, HIV/AIDS risk, and sexual risk taking have achieved website visit rates of 45% to 96% and favorable behavior change in studies of motivated volunteers (Kirk et al. 2003; Lou, Zhao, Gao, & Shah, 2006; Patten et al., 2006; Ybarra, Kiwanuka, Emenyonu, & Bangsberg, 2006). Similar interventions may be effective in increasing levels of exercise, adopting a more favorable diet, stopping smoking, and reducing depressed mood in adults (Van den Berg, Schoones, & Vliet Vlieland, 2007; Walters, Wright, & Shegog, 2006; Wantland, Portillo, Holzemer, Slaughter, & McGhee, 2004a). However, unlike motivated study participants, less than 20% of the general population are interested in Internet-based lifestyle change and as few as 10% may visit such websites (Evers, Cummins, Prochaska, & Prochaska, 2005; Verheijden, Jans, Hildebrandt, & Hopman-Rock, 2007). Use of mental health related websites by adolescents is similarly low (Clarke et al., 2002; Patten, 2003; Santor, Poulin, LeBlanc, & Kusumakar, 2007). Determining how to successfully engage adolescents in primary care with behavior change programs on the Internet could both augment the influence of the primary care physician in encouraging pro-health behaviors in youth and also offer another approach for disseminating public health interventions.
Prevention of depression has become a world health priority, (Asarnow et al., 2005) and the low cost, accessibility, and privacy of the Internet make it an ideal dissemination modality (Bramesfeld, Platt, & Schwartz, 2006; Saxena, Jane- Llopis, & Hosman, 2006). We developed a primary care/Internet-based depression prevention intervention intended to reach the broad audience of adolescents in primary care with early depression symptoms who are at risk for progression to major depression as a model of such an approach. …