Examining Initial Perception of Internet-Delivered Cognitive Behavioural Therapy Through Lens of Attutinal Structural, and Computer Barriers

Abstract

Interned Cognitive Behavioural Therapy (ICBT) for depressive and anxiety symptoms provides flexibility, decrease in labour intensity, and improved cost-effectiveness. Understanding barriers to interest in ICBT is beneficial to effectively inform policy with regards to expanding this innovative therapeutic approach. To our knowledge no research has been conducted to look at the relationship between barriers and interest in ICBT. The objective of this study was to understand associations between common attitudinal and structural barriers, and ICBT-specific barriers on interest in ICBT as well as to understand direct and mediating association of barriers with interest in ICBT. This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n=200) in Saskatchewan, Canada. Data were collected through an online survey that contained 27 constructs measuring barriers and interest in ICBT. Multivariable linear regression analyses were conducted with interest in ICBT as the dependent variable and barriers as independent variables after controlling for age, gender, residency (urban/rural), and depression or generalized anxiety symptoms. Utilizing structural equation modeling, a path analysis framework was developed by incorporating previously established associations from multivariable regression analyses to model direct and indirect associations through path analysis. The path analysis framework showed that perceived access to care played a mediating role in mitigating the negative association of life chaos and financial concerns on interest in ICBT. Similarly, computer self-efficacy was a significant mediator in negative association of computer anxiety on interest in ICBT. In the context of the framework, significant direct effect on interest in ICBT held to be true for observed attitudinal barriers: self-stigma of seeking help and perceived need for help. The findings of this study pointed towards several policy implications, including aligning ICBT towards communities with lower access to care and higher need for intervention. To our knowledge, this study is the first to empirically show direct and indirect associations of barriers with interest in ICBT utilizing path analysis. In informing health care policy decisions, path analysis could be a useful technique in analyzing complex relationships and prioritize intervention factors, an approach which would not be possible to implement using traditional regressions analyses.