Based on the knowledge acquired after the marketplace event where 1st wavers shared with 2nd wavers their experience of rolling out cCBT, these pilot sites followed a similar procedure to decide the cCBT programme to be used in their regions, in order to adapt the cCBT solutions to their context.
The efforts were focused on analysing the programmes available in the market, the adaptation to local cultural context required (from technical and economic perspective) and the validation of the programme by healthcare professionals.
Different key factors were considered in each pilot site to select the cCBT programme to be implemented in its region.
In Wales, where cCBT is recognized by NICE (National Institute for Health and care Excellence) guidance (2009) as a proven online treatment for depression, it was decided to use the “Beating the Blues” programme. This programme is a British developed and validated product (no further local validation was required) and the cultural context meets local requirements.
On the other hand, Piedmonte and Treviso decided to use the iFight Depression programme. Both Italian partners chose this solution mainly due to two reasons: (i) storage and management of their own data and (ii) affordable costs ensuring the continuity of the service beyond Mastermind project. Besides, Estonia decided to use iFight Depression too because was already translated to Estonian.
Alternatively, in Turkey the “Top Sende” tool is being used, which was developed and tested by the Middle East Technical University). To make the intervention modules Turkish pilot had on-site, suitable for use with the e-learning programme, slightly modifications of the e-learning platform had been done.
Then again, the Spanish cluster formed by Badalona, Aragón, Galicia and the Basque Country, developed the “Super@ tu depresión” programme based on existing therapies. “Super@ tu depresión” was defined by the agreement on homogeneous clinical content at national level and by designing an intervention tailored to Spanish cultural needs.
All localized cCBT programmes have been validated and tested, by collecting the feedback of healthcare professionals, and redefining the adapted versions until all needs are met.
Finally, a description of the lessons learned have been done by the pilot sites during the localisation and validation processes, which might be of great benefit for those regions outside the MasterMind project that have planned to adopt cCBT programmes. Some of the lessons learned are:
- Close and intensive communication and coordination between healthcare professionals is mandatory to ensure a high quality clinical content of the therapy.
- The length of the contents has to be limited in order to facilitate patients’ understanding. Similarly, the number of activities / questionnaires to be carried out by patients has to be reduced, since these patients require more effort than non-depressive people.
- The technological platform and the interfaces have to be user-friendly to avoid difficulties in their use. Elements such as a user guide, or a status bar showing the overall progress within a given module, are of great importance for acceptance.
- Patients’ perspective has to be taken into account to ensure the online therapy meets their needs, and consequently improves their adherence; modules have to be easy to understand..
- A rigorous and continuous monitoring of the treatment over time by a core working group is necessary, especially in regions without experience in this type of online programme.
- Collaborative work between pilot sites of the same country (Italy and Spain) reinforces the validity of the online programme, and probably facilitates a wider use of the programme across regions of these countries who are not MasterMind partners.
- Integration of the cCBT programme into corporate platforms facilitates the sustainability of the therapy after the project ends.