J. Med. Internet Res. - Internal versus external motivation in referral of primary care patients with depression to an internet support group: randomized controlled trial.

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Resumo

CKGROUND: Depressive disorders and symptoms affect more than one-third of primary care patients, many of whom do not receive or do not complete treatment. Internet-based social support from peers could sustain depression treatment engagement and adherence. We do not know whether primary care patients will accept referral to such websites nor do we know which methods of referral would be most effective.OBJECTIVE: We conducted a randomized clinical trial to determine whether (1) a simple generic referral card (control), (2) a patient-oriented brochure that provided examples of online postings and experience (internal motivation), or (3) a physician letter of recommendation (external motivation) would generate the greatest participation in a primary care Internet depression treatment support portal focused around an Internet support group (ISG).METHODS: We used 3 offline methods to identify potential participants who had not used an ISG in the past 6 months. Eligibility was determined in part by a brief structured psychiatric interview based on the Patient Health Questionnaire-9 (PHQ-9). After consent and enrollment, participants were randomly assigned to 1 of 3 groups (control, internal motivation, or external motivation). We constructed a portal to connect primary care patients to both fact-based information and an established ISG (Psycho-Babble). The ISG allowed participants to view messages and then decide if they actually wished to register there. Participation in the portal and the ISG was assessed via automated activity tracking.RESULTS: Fifty participants were assigned to the 3 groups: a motivation-neutral control group (n=18), an internal motivation group (n=19), and an external motivation group (n=13). Of these participants, 31 (62%) visited the portal; 27 (54%) visited the ISG itself. The internal motivation group showed significantly greater participation than the control group on several measures. The external motivation group spent significantly less time logged onto the portal than the control group. The internal motivation group showed significantly greater participation than the external motivation group on several measures.CONCLUSIONS: Referral of primary care patients with depressive disorders and symptoms to an ISG is feasible even if they have never previously used one. This may best be accomplished by enhancing their internal motivation.

Resumo Limpo

ckground depress disord symptom affect onethird primari care patient mani receiv complet treatment internetbas social support peer sustain depress treatment engag adher know whether primari care patient will accept referr websit know method referr effectiveobject conduct random clinic trial determin whether simpl generic referr card control patientori brochur provid exampl onlin post experi intern motiv physician letter recommend extern motiv generat greatest particip primari care internet depress treatment support portal focus around internet support group isgmethod use offlin method identifi potenti particip use isg past month elig determin part brief structur psychiatr interview base patient health questionnair phq consent enrol particip random assign group control intern motiv extern motiv construct portal connect primari care patient factbas inform establish isg psychobabbl isg allow particip view messag decid actual wish regist particip portal isg assess via autom activ trackingresult fifti particip assign group motivationneutr control group n intern motiv group n extern motiv group n particip visit portal visit isg intern motiv group show signific greater particip control group sever measur extern motiv group spent signific less time log onto portal control group intern motiv group show signific greater particip extern motiv group sever measuresconclus referr primari care patient depress disord symptom isg feasibl even never previous use one may best accomplish enhanc intern motiv

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