Optimizing Internet-Delivered Cognitive Behavioural Therapy for public safety personnel: Qualitative insights from clients and stakeholders to guide program improvements
Public Safety Personnel (PSP) (e.g., EMS/paramedics, police officers) experience high rates of clinically significant symptoms of mental health disorders. The high rates have been explained by the extraordinary occupational stressors that PSP experience. There is a need for accessible treatment options to overcome common barriers to care in PSP populations. Internet-delivered cognitive behavioural therapy (ICBT) has the potential to provide effective treatment while overcoming barriers to care. PSPNET is a clinical research unit that has adapted an ICBT program to meet the needs of PSP. The current dissertation is designed to explore the extent to which PSPNET has been optimized and can be further enhanced to meet the needs of PSP. The dissertation consists of three studies assessing stakeholder perceptions of PSPNET from both the client-level and the organizational level (i.e., PSP leaders). The studies are guided by a micro-learning health system framework that emphasizes integrating research and clinical practice to make continuous improvements to interventions. Qualitative data are used because of the substantial potential to develop specific recommendations for iterative improvements to PSPNET. The studies were conducted sequentially. In Study 1, Beahm et al. (2021) examined client communication data (i.e., client emails and feedback surveys) from 82 clients enrolled in the PSP Wellbeing Course, a core transdiagnostic ICBT course offered by PSPNET. The study shows that most clients reported benefits from the program. Results also evidenced that clients identified more aspects of the program as helpful, than they identified areas for improvement. The study results were used to make several of the proposed changes to the course (e.g., inclusion of audio and video content, inclusion of new additional resources). In study 2, Beahm et al. (2022) examined client communication data (i.e., client emails, feedback surveys, and intake screening notes) from 126 Saskatchewan-based clients to explore if PSP were seeking and using ICBT to manage occupational stressors. Results evidenced that almost all (96.8%) clients reported seeking ICBT for one or more occupational stressors. Clients noted that skills from the course helped them manage stress related to a variety of occupational stressors. The data were used to make changes to PSP specific examples and case stories in the course, as well as for identifying new additional resources that were needed for the course (e.g., health anxiety, information for families, mental health supports in the workplace). In Study 3, semi-structured interviews were conducted with 10 PSP leaders based in Saskatchewan. The study explored PSP leaders’ perceptions of PSPNET using the RE-AIM evaluation framework and assessed perceptions of the strengths and weaknesses of PSPNET along five dimensions (i.e., reach, effectiveness, adoption, implementation, maintenance). The results showed PSPNET was reaching PSP, that PSP leaders believed PSPNET was beneficial, and that they were willing to continue to support PSPNET. Leaders also offered feedback for improving reach and implementation of PSPNET (e.g., emphasizing the preventative aspects of PSPNET), some of which are under consideration by the PSPNET team. Other feedback had already been implemented by the team which signalled a need for improved communication with PSP leaders related to implementation of PSPNET (e.g., adding audio content). The collective results from the studies evidenced the value of using qualitative feedback from multiple stakeholders for program improvement. The studies evidenced that PSP value ICBT and highlighted factors that strengthen ICBT for PSP.
Networked Digital Library of Theses and Dissertations
Faculty of Graduate Studies and Research, University of Regina