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Validation and digital interventions

For us, validation is all about understanding what works, for who, under what circumstances, and potentially why. When we understand what works for a given client, we will be able to do a better job at helping to personalise interventions. That means learning about the effect of a specific ehealth intervention or blended treatment on an individual level.

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Randomised-controlled trials are used for evaluating effects on a group level in controlled settings. However, results may not generalise to everyday use and actual treatment settings. Randomisation is great if you can do it, but sometimes you can’t or it might be neither cost- nor time-effective. That’s why next to RCTs, we are working towards a system that validates continuously in real life, not only in a specific research setting. For this, we enter the world of RWE (Real-World Evidence) and use causal inference to explore the existence of effects. This approach not only makes learning from large numbers possible for health care institutions, but it will also provide tools to mental health experts that help to improve the effectiveness of their blended treatment.

Validation also includes how we develop our products, using evidence-based methods. Our interventions are developed using the intervention mapping method. This means doing extensive target group research, using the latest insights on mechanisms of action (MOAs) and behavioural change techniques (BCTs) (The Theory and Techniques Tool), validating ideas in user tests, interviews, and organising focus groups with clients and professionals to improve the functionality, safety, and user-friendliness of products.

We like to learn together with other knowledgeable partners as much as we can. It is why universities were part of our platform from day one and why we find collaboration with customers so important.

What is known about the effectiveness of ehealth in general?

Does ehealth work? Yes, ehealth interventions work. Many clinical trials described ehealth interventions as an effective addition to the traditional healthcare system. The evidence base for their effectiveness, in general, has increased rapidly (for example, Andrews et al., 2018). Early reviews tended to focus more broadly on the effects of internet interventions in general, mixing different technologies in the review. Now, many research trends are focusing separately on, for example, interventions for specific conditions or target groups, or on specific forms of psychological treatments such as cognitive-behavioural or acceptance and commitment therapy. “ICBT (Internet-delivered Cognitive Behaviour Therapy) has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT” (Andersson et al, 2019). Overall, guided interventions tend to be more effective than self-guided (Holländare et al., 2015).

See the videos of Prof.Dr. Heleen Riper, a prominent researcher in the field of ehealth, for more information.

What is known about the effectiveness of modules in Minddistrict?

A lot of our customers, among which are universities, use our platform for treatment and research. Some of the results have been published, including:

  • The depression module used in blended CBT treatment was found to be as effective as standard CBT (Kooistra et al., 2019).
  • Addiction modules by Tactus “Alcohol de baas” and “Eten de baas” were found to be effective (Postel et al., 2010 and ter Huurne et al., 2015).
  • The I-sleep module by Vrije Universiteit was found to be effective for breast cancer patients who suffer from insomnia (Dozeman et al., 2017).
  • The rumination module MindReSolve when used guided is found effective in reducing the onset of depression in high-risk young people reporting high levels of worry/rumination and stress (Cook et al., 2019).
  • The sleep module for patients with acquired brain injury used in guided eCBT appeared to be more effective in reducing sleeping problems than treatment as usual (Ford et al., 2022).

What's next?

RCTs are still the most common type of research to grow the body of evidence for ehealth. There are many research projects running that have not yet published their results. For example on the effectiveness and engagement of forensic modules.

We work towards validating interventions continuously, instead of taking a snapshot. We are developing towards more data-informed features in our platform. For example, data on when and which clients are improving, can support the treatment process and shared decision making.

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