Why Wait? (Cost-)effectiveness and Process Evaluation Online, Transdiagnostic Positive Psychology Intervention for Patients Awaiting Psychological Treatment and their Loved Ones: Study Protocol for a Dutch RSCD and RCT

Background: Wait-lists for psychological treatment are growing
due to imbalances between supply and demand in Dutch mental
healthcare. Time spent on a wait-list is associated with symptomatic aggravation, suboptimal recovery and increased drop-out during
treatment, causing societal expenses. An eHealth, transdiagnostic
positive psychology intervention (eHealth PPI) may increase resilience among patients awaiting psychological treatment, potentially
promoting recovery in a (cost-)effective manner. In contemporary
healthcare research, the patient’s loved ones are often underrepresented. In light of caregiver burden, loved ones will be included in
our intervention, potentially enhancing its clinical reach.
Aims of the Study: The current paper proposes a study protocol
aimed at examining the (cost-)effectiveness and process evaluation
of an eHealth PPI for patients with various mental health complaints
awaiting psychological treatment and their loved ones.
Methods: Our study protocol represents a methodological framework for two studies (study 1 and study 2) aimed at examining the
proposed eHealth PPI, using three analytical pillars: (1) clinical effectiveness, (2) economic evaluation and (3) process evaluation. In
study 1, the working mechanisms and acceptability of the eHealth
PPI will be examined, using a replicated single case design (RSCD)
with 9 measurements in 9 weeks. In study 2, a randomized control trial (RCT) will examine the (cost-)effectiveness of the eHealth
PPI, using measurements at baseline, post-intervention, after 3, 6, 9
months and 1 year following PPI completion and 1 year following
treatment completion. To assess the additional effects of including
loved ones, the RCT will employ three arms: (1) eHealth PPI during
waitlist + patient treatment, (2) eHealth PPI during waitlist for patients and loved ones + patient treatment, (3) wait-list before intake
as usual + patient treatment.
Results: Using validated questionnaires, primary outcomes will include positive mental health, mental complaints, quality of life, optimism and societal costs. Secondary outcomes include acceptability
and adherence.
Discussion and Limitations: To our knowledge, this is the first paper proposing a threefold evaluation of an eHealth PPI, using two
studies. Suboptimal intervention adherence due to low literacy must
be addressed. Likewise, patient dropout due to extensive measurements must be prevented.
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Implications for Health Care Provision and Use: Introducing the
proposed eHealth PPI to various patients awaiting psychological
treatment and their loved ones may help optimize clinical patient
outcomes of subsequent mental health treatments, while also potentially reducing societal costs.
Implications for Health Policies: Considering the broader trends
in healthcare digitization, our expected results may inform policy
decisions regarding financial resource allocation for implementing
eHealth PPIs on a larger scale in mental healthcare.
Implications for Further Research: Addressing the proposed
research gaps may enhance our academic understanding of digital
PPIs. Future studies may expand the body of evidence on (cost-)
effective PPI applications for multiple patient populations.
Source of Funding: A grant has been awarded to the current project
by the Dutch Organization for Health Research and Development
(ZonMw). The related grant number is: 06360312210054.