Using technology to support engagement and self-disclosure in face-to-face mental healthcare : promoting integrated systems of care

Abstract

Young people are at the greatest risk of developing mental disorders and engaging in behaviours that place them at significant risk of harm; however, they are unlikely to seek professional help or disclose all relevant areas of risk when they do seek help. This thesis by published works makes an original contribution to this field by showing how technology can support young people’s engagement in therapy, increase their self-disclosure, and provide greater control in their health decision-making. The overarching research goal was to develop an electronic psychosocial assessment that could be integrated into the initial stages of face to- face therapy with young people. The research also had a goal of developing implementation strategies for wider utilisation of technology in clinical practice. The research aimed to achieve these goals by identifying the most appropriate psychosocial assessment for adaptation into an electronic version, identifying all user attitudes to using technology for assessment purposes, involving users throughout the development process, and evaluating any benefits or barriers to using the psychosocial mobile application (app) in clinical practice. The research used a mixed-method design with three broad phases. The first phase was a systematic literature review to identify the most appropriate psychosocial assessment for adaptation into an electronic version. Phase II—participatory design—had three sub-phases, with the goals of identifying user attitudes, developing the application concept to ensure user acceptance and ease of use, and identifying an initial implementation strategy. The first and second sub-phases involved interviews with 129 young people and 46 clinicians from across Canberra (Australian Capital Territory—ACT),and Melbourne, Victoria to identify user attitudes and required functionalities. Thematic analysis was employed to identify the main themes from the interview transcripts. The psychosocial app was subsequently developed based on these interviews. The third sub-phase had 12 young people from Canberra rate the developed psychosocial app against a standardised measure used to rate health apps. The final phase involved testing the app using a two-phase quasi-experimental design at headspace Canberra. This pilot trial included 339 young people and 13 clinicians. Five research papers were compiled across the three research phases, each addressing a specific research aim. The systematic review discussed in Paper 1 found that the most appropriate instrument in terms of acceptability, engagement and disclosure was one that was self-administered and then appropriately followed up by the clinician. The review also provided support for the adaptation of the HEEADSSS assessment. In identifying the attitudes of young people and clinicians, Papers 2 and 3 showed that young people primarily believed that technology could support their self-disclosure, particularly in the domains they considered most embarrassing or personal, whereas clinicians primarily believed that the use of technology for psychosocial assessments would be a barrier to engagement. The 4th paper highlighted the functionalities both groups of users identified as necessary to ensure widespread acceptance and utilisation. Functionalities included response logic, ‘flagging’ capabilities, multiple responding options, and automated identification of risk levels. The 5th paper primarily showed that the psychosocial assessment app was widely accepted by users, resulted in equal or greater rates of self-disclosure, and did not detrimentally affect the therapeutic alliance. The thesis shows that technology can support the provision of evidence-based practice in psychology by supporting engagement, increasing self-disclosure and offering young people greater input in their healthcare. Further, it offers a hypothetical model of the underlying psychological processes that lead to greater self-disclosure. The research also highlights the current mismatch between young people’s and clinicians’ preferences in using technology in healthcare. Additionally, the research showed that clinicians continue to hold negative attitudes towards shared decision-making approaches with young people, indicating a negative attitude towards providing patient-centred care more generally. The thesis concludes by offering a range of targeted approaches that can support the future implementation of new technologies into practice.

Date of Award	2016
Original language	English
Supervisor	Debra RICKWOOD (Supervisor), Douglas BOER (Supervisor) & Alexandra G. Parker (Supervisor)