Journal Article

Impact of a Digital Decision Aid When Choosing Between Face-to-Face and Guided Internet-Based Psychological Interventions for Depression Among Chinese-Speaking Participants in Hong Kong: Randomized Controlled Trial

Yang, Philo Liu, Tsang, Ella Zoe, Auyeung, Larry, Mak, Winnie WS

2025

Overview

The expansion of e-mental health services offers diverse treatment options. As the variety of available interventions grows, helping individuals navigate these options effectively becomes essential. This study evaluates the effects of a decision aid for users when choosing between guided internet-based psychological interventions and in-person psychotherapy. A web-based, randomized controlled trial was conducted with 148 Chinese-speaking adult participants from Hong Kong with Patient Health Questionnaire-9 (PHQ-9) scores ≥10 (indicating clinical depression). Participants were recruited by electronic direct mail, social media, university mass mail, and online advertising then randomly assigned to either the decision aid intervention group or the attention control group. The study's assessments were conducted online through self-administered questionnaires before and after the intervention, while the intervention was delivered via Zoom. The decision aid group underwent a brief interactive, self-directed, web-based decision aid. The decision aid included psychoeducation on depression and treatments, a comparison between internet-based interventions and face-to-face therapy, and personalized reports for value clarification. The attention control involved an unguided web search on mental health information. Primary outcome measures included decision conflict (measured using the SURE tool and Decision Conflict Scale), while secondary outcomes included stage of decision-making, satisfaction with decision, perceived benefits and risks, and likelihood of service utilization. Time-by-intervention interactions in ANOVA were found, which indicated that the reduction in decisional conflict was more significant in the decision aid group than in the control group, as measured using the brief SURE tool (F =6.47, P=.01; partial η  = 0.043; 95% CI 0.002-0.122) and decision conflict scale (F =9.56, P=.002; 95% CI 0.0086-0.16). Specifically, interaction effects were observed for 3 of the 5 decision conflict subscales: The decision aid group reported feeling more \"informed,\" experiencing greater \"support,\" and being better able to make \"effective decisions.\" Participants in the decision aid group also reported more advanced stages of decision-making; however, a significant difference between groups was not found for satisfaction with the decision. Although there was no significant change in perceived benefit, participants in the decision aid group had significantly greater reductions in their perceived risks associated with a guided internet-based psychological intervention. In addition, participants who used the decision aid were 2.26 times more likely to prefer (odds ratio [OR] 2.26, 95% CI 1.11-4.60; P=.02) and 2.53 times more likely to use (OR 2.53, 95% CI 1.13-4.92; P=.006) a guided internet-based psychological intervention than participants who searched for mental health information on the web by themselves. This study demonstrates the extent of the utility and value of a decision aid for assisting individuals with depressive symptoms make informed choices related to e-mental health. Decision aids may facilitate the uptake of digital mental health services. Future research should explore the behavioral and long-term impact and generalizability of decision aids in applied settings. Chinese Clinical Trial Register ChiCTR2300077323; https://tinyurl.com/2n34ea69; ClinicalTrials.gov NCT05477420; https://clinicaltrials.gov/study/NCT05477420.

• Publisher: Journal of Medical Internet Research,Gunther Eysenbach MD MPH, Associate Professor,JMIR Publications
• Subject: Adult / Advertisements / Attention / Care and treatment / Clinical research / Clinical trials / Conflict / COVID-19 / Decision making / Decision Support Techniques / Depression - therapy / Depression, Mental / Direct mail advertising / East Asian People / Female / Generalizability / Group decision making / Health behavior / Health information / Health services / Hong Kong / Humans / Hypotheses / Internet / Internet-Based Intervention / Intervention / Male / Mass media effects / Measures / Medical decision making / Medical screening / Mental depression / Mental disorders / Mental health / Mental health care / Mental health services / Methods / Middle Aged / Online advertising / Original Paper / Pandemics / Perceptions / Psychoeducational treatment / Psychological intervention / Psychotherapy / Psychotherapy - methods / Public health / Questionnaires / Registration / Satisfaction / Self evaluation / Shared decision making / Social media / Surveys and Questionnaires / Technology application / Telemedicine / Treatment methods / Uptake / Value / Variance analysis