Abstract South Africa has one of the largest population of adults living with HIV. About 30 to 60% of people living with HIV have been found to have HAND which can affect treatment with HAART which requires 95% compliance rate in order to be effective. Interventions that seek to alleviate the cognitive deterioration that is associated with HIV can include Internet based rehabilitation programmes. However, internet based interventions are plagued by poor adherence and attrition rates. The aim of the study was to describe the challenges and facilitating factors in the process of implementing the CogMed™ Working Memory Training Programme at a public HIV clinic for adults living with HIV. The study used a qualitative method with an ethnographic approach. Data was collected through CogMed™ administrator console, observations, interactions with gatekeepers, interactions and interviews with participants and interviews healthcare workers. The factors involved in the implementation process were categorised into the four “Stages of Use”. In the Recruitment/Consideration Stage perception of need, identifying and defining an ideal user were the main themes. Factors affecting the Initiation of Use Stage were sense of obligation, time to commit and access to suitable training environment. Utilisation of Service was influenced by ease of drop out, ease of use, perceived cost versus the perceived benefits of participating. Predisposing, enabling, and needs factors that affected adherence and participation were explored. Finally the Outcomes Stage covered the experiences and perceptions of using the rehabilitation tool. Limitations of the study were also discussed. Keywords: CogMed, Working Memory, HIV, HAND, Internet based interventions, Stages of Use

abstract: An ever expanding body of research has shown that children of divorce are at increased risk for a range of maladaptive outcomes including academic failure, behavior problems, poor psychological adjustment, reduced self-concept, and reduced social competence (Amato, 2001). Furthermore, the widespread prevalence of divorce makes preventing these poor outcomes a pressing public health concern. The Children of Divorce-Coping with Divorce (CoD-CoD) program is an internet-based selective prevention that was derived from recent research identifying modifiable protective factors in children of divorce including active and avoidant coping, divorce appraisals, and coping efficacy. CoD-CoD addresses these putative mediators through careful adaptation of intervention components previously demonstrated to be effective for children from disrupted families (Pedro-Carroll & Alpert-Gillis, 1997; Stolberg & Mahler, 1994; Sandler, et al., 2003). In the CoD-CoD efficacy trial, 147 children ages 11-16 whose family had received a divorce decree within 48 months of the intervention start date served as participants. Participants were assessed in two waves in order to test the small theory of the intervention as well as the interventions effects on internalizing and externalizing behaviors. Analyses indicated that the program effectively reduced the participants total mental health problems and emotional problems as reported on the Strengths and Difficulties Questionnaire (SDQ) (d = .37) and for total mental health problems this effect was stronger for children with greater baseline mental health problems (d = .46). The program also had mediated effects on both child and parent-reported total mental health problems whereby the program improved coping efficacy for children with low baseline coping efficacy which led to reduced parent-reported mental health problems. To the author's knowledge this is the first randomized controlled trail of internet-based mental health program for children or adolescents which utilizes an active control condition. / Dissertation/Thesis / Ph.D. Psychology 2011

Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.

Hintergrund: Das Internet spielt heutzutage in Gesundheitsfragen eine große Rolle. Fast alle Internetnutzer greifen im Zusammenhang mit Erkrankungen auf Onlineangebote zurück, um beispielsweise Informationen über Krankheitsbilder oder Medikamente zu suchen. Speziell für den Bereich seelische Gesundheit verfügt das Internet darüber hinaus noch über weiteres Potential: Mit der Entwicklung von Online-Programmen wurden in den letzten Jahren neue Behandlungsmöglichkeiten für psychische Erkrankungen geschaffen. Diese verwenden die multimedialen Möglichkeiten des Internets zu therapeutischen Zwecken und konnten in zahlreichen Studien vielversprechende Ergebnisse zeigen. Für die Nutzung der Programme sind dabei regelmäßiger Internetzugang und Routine im Umgang mit unterschiedlichen Internetfunktionen notwendig - insbesondere mit sozialen Medien. Ausmaß und Muster der Internetnutzung psychiatrischer Patienten im Zusammenhang mit ihrer Erkrankung sind jedoch bislang kaum erforscht. Ziel der vorliegenden Arbeit ist es, das erkrankungsbezogene Internetnutzungsverhalten dieser Patientengruppe zu erfassen und zu analysieren. Methode: Patienten aller Stationen und Ambulanzen der Klinik und Poliklinik für Psychiatrie und Psychotherapie des Universitätsklinikums Leipzig wurden mit Hilfe eines Fragebogens zu ihrem Internetnutzungsverhalten befragt. Anhand von 29 Items wurden soziodemographische Daten, das allgemeine Internetnutzungsverhalten und die erkrankungsbezogene Internetnutzung (mental-health related Internet use) erfasst. Die Datenanalyse beinhaltete die Bestimmung von Häufigkeiten und Gruppenvergleiche. Hierzu wurde vornehmlich der Chi-Quadrat-Test verwendet. Ergebnisse: 337 Patienten nahmen an der Studie teil. 79.5% von ihnen waren Internetnutzer und wurden in Abhängigkeit von ihrer wöchentlichen Nutzungsdauer in die Subgruppen Wenig-, Mittel- und Vielnutzer eingeteilt. Soziale Medien wurden von weniger als der Hälfte der Nutzer verwendet: Soziale Netzwerke (47.8%), Foren (19.4%), Chats (18.7%), Blogs (12.3%). 70.9% nutzten das Internet im Kontext ihrer psychischen Erkrankung. Hierbei handelte es sich um folgende Inhalte: Informationen zu psychischen Erkrankungen (57.8%), Informationen zu Medikamenten (43.7%), Suche nach Psychiatern bzw. psychiatrischen Kliniken (38.8%), Erfahrungsaustausch mit anderen Betroffenen (19.8%), Nutzung von Foren mit Psychiatern (17.2%). Unterschiede im Nutzungsmuster zwischen Wenig-, Mittel- und Vielnutzern waren statistisch signifikant für alle Formen sozialer Medien (p<0.01), für die Suche nach Psychiatern und Kliniken (p=0.017) und für die Nutzung von Foren mit Psychiatern (p=0.048). Die Analyse der Internetnutzung in Abhängigkeit von der psychiatrischen Diagnose zeigte mit einer Ausnahme (Suche nach Psychiatern bzw. psychiatrischen Kliniken) keine statistisch signifikanten Ergebnisse. Die Rolle des Internets im Zusammenhang mit psychischen Erkrankungen wurde von den Studienteilnehmern unterschiedlich eingeschätzt: 36.2% waren der Meinung, dass das Internet bei der Bewältigung ihrer psychischen Erkrankungen eine Hilfe war oder sein könnte, während 38.4% das Gegenteil behaupteten. 27.6% der Befragten hatten Interesse an internetbasierten Selbstmanagementprogrammen teilzunehmen. Schlussfolgerung: Die Mehrzahl der psychiatrischen Patienten nutzt das Internet. Die Internetnutzung im Zusammenhang mit psychischen Erkrankungen ist verbreitet und dient vor allem der Informationssuche. Soziale Medien werden generell weniger genutzt, hierbei bestehen jedoch signifikante Unterschiede zwischen den einzelnen Nutzergruppen. Die Möglichkeiten des Internets im Zusammenhang mit Krankheitsbewältigung und Selbstmanagement werden von Studienteilnehmern unterschiedlich bewertet. Die psychiatrische Diagnose und die Krankheitsschwere scheinen auf das Internetnutzungsverhalten einen vergleichsweise geringen Einfluss zu haben. Die Ergebnisse der Arbeit zeigen die Bedeutung des Internets im Kontext psychischer Erkrankungen und könnten bei der weiteren Entwicklung von Internetangeboten für psychisch Erkrankte Berücksichtigung finden.

Bakgrund: Långvarig smärta är en av de främsta orsakerna till varaktigt lidande och funktionsnedsättning både i Sverige och globalt. Dagens behandlingsmetoder anses i många fall bristfälliga. I ett allt mer högteknologiskt samhälle utvecklas elektroniska hjälpmedel som stöd till personer med olika sjukdomstillstånd. Tidigare studier visar att internetbaserade interventioner främjar hälsa, lindrar lidande och ökar egenmakten, dock är området fortfarande under snabb utvecklig. Syfte: Att beskriva effekterna av internetbaserade interventioner riktade mot långvarig smärta. Metod: Begränsad systematisk litteraturöversikt med elva kvantitativa artiklar.  Resultat: Fem av artiklarna använde KBT, tre artiklar använde ACT och tre artiklar använde självhanteringsmetoder. Fyra effekter av interventionerna framkom; smärtreducering, smärthantering, livskvalitet och psykisk hälsa. Smärthantering förbättrades signifikant, resterande förbättrades, dock ej signifikant. Effekterna är förbättrade till signifikant förbättrade vid uppföljningar efter avslutad behandling. Slutsats: Att införa internetbaserade interventioner som tillägg till klinisk omvårdnad kan innebära hälsovinster för enskild person samt för samhället. Dock ses svårigheter att implementera den här typen av intervention på en större befolkning då faktorer som tillgänglighet och könsfördelning påverkar negativt. Fortsatt forskning: Jämnare könsfördelning i studier, större geografisk utbredning samt långtidsuppföljningar bör ligga i fokus för framtida forskning. / Background: Chronic pain is one of the primary causes to abiding suffering and disabilities in Sweden and globally. Today’s treatment methods are somewhat considered lacking. In a high technology society, as the one we are living in today, the developing of electronic aids for persons with different disease states increases. Internet-based interventions is considered a part of the future in health care. Aim: The aim of this study was to describe the effects of Internet-based interventions designed for people with chronic pain. Method: A rapid systematic review with eleven quantitative studies. Result: Five studies used CBT, three studies used ACT and three is denominated as self-management. Four effects became clear; mental health, pain management, pain reducing, and quality of life. Pain management showed significant improvement, the other three effects showed improvement, although no significant improvement. At follow-up after post intervention the effects improved, some with significance. Conclusion: To implement internet-based interventions as an addition to clinical care could mean health benefits for the community as well as the individual person. However, this intervention type is not accessible on a larger population. Further Research: There should be focus on gender equality, broader geographic areas and longer follow-ups in future research.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-06-26T11:37:53Z No. of bitstreams: 1 rafaelarussiervilha.pdf: 864688 bytes, checksum: f2556d9167ddf31606e364b302e6154b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-06-27T10:44:26Z (GMT) No. of bitstreams: 1 rafaelarussiervilha.pdf: 864688 bytes, checksum: f2556d9167ddf31606e364b302e6154b (MD5) / Made available in DSpace on 2018-06-27T10:44:26Z (GMT). No. of bitstreams: 1 rafaelarussiervilha.pdf: 864688 bytes, checksum: f2556d9167ddf31606e364b302e6154b (MD5) Previous issue date: 2018-03-23 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O tabagismo é considerado a principal causa de morte evitável no mundo, sendo responsável por cerca de seis milhões de óbitos por ano e também é reconhecido como uma doença epidêmica que causa dependência física, psicológica e comportamental. Dados da Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico de 2017, apontaram uma prevalência de 12,7% de homens e 8% de mulheres fumantes no Brasil. Formas inovadoras de tecnologia de comunicação, como a internet, estão sendo cada vez mais utilizadas para fornecer informações e apoio aos fumantes que desejam parar de fumar. As intervenções mediadas por internet apresentam muitas vantagens quando comparadas às intervenções tradicionais. O objetivo do estudo foi analisar e descrever quais são as melhores estratégias para auxiliar os fumantes que querem parar de fumar através de um serviço de intervenção computadorizado. Foi realizado um estudo qualitativo, no qual foram analisadas mensagens de 270 usuários da intervenção Viva sem Tabaco. As mensagens foram coletadas através do banco de dados do servidor do programa e examinadas através da técnica da análise de conteúdo de Bardin, por meio de pré-análise, exploração do material e tratamento dos resultados. Os resultados sugerem que as estratégias relatadas pelos usuários da intervenção online, podem auxiliar no processo de cessação do tabagismo. Além disso, as estratégias também podem ser expandidas para a Atenção Primária à Saúde, de forma a colaborar com o tratamento oferecido pelos profissionais da rede pública de saúde no Brasil. / Smoking is the leading cause of preventable death, accounting for about six million deaths per year and also recognized as an epidemic disease that causes physical, psychological and behavioral dependence. Data from the Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey of 2017, indicate a prevalence of 12.7% male and 8% female smokers in Brazil. Innovative forms of communication technologies, such as internet are increasingly being used to provide information and support to smokers who want to quit. Internet-based interventions have many advantages compared to traditional interventions. This study aimed to analyze and describe the best strategies to help smokers who want to quit through a interner-based intervention. Qualitative study, in which messages from 270 users of the “Viva sem Tabaco” intervention were analyzed. The messages were collected through the server’s database of the program and examined through the Content Analysis technique by Bardin, according to the following steps: pre-analysis, exploration of the material and treatment of the results. The results suggested that the use of strategies reported by the users of “Viva sem Tabaco” online intervention can help in the process of smoking cessation. Furthermore, strategies can be expanded to Primary Care, in order to collaborate with the treatment to smokers by professionals of the Public Health network in Brazil.

Background: It is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. Method: The ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorderspecific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. Discussion/conclusion: Existing research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.

Background: The Internet is of great importance in today’s health sector, as most Internet users utilize online functions for health related purposes. Concerning the mental health care sector, little data exist about the Internet use of psychiatric patients. It is the scope of this current study to analyze the quantity and pattern of Internet usage among mental health patients. Methods: Patients from all services of the Department of Psychiatry at a university hospital were surveyed by completing a 29-item questionnaire. The data analysis included evaluation of frequencies, as well as group comparisons. Results: 337 patients participated in the survey, of whom 79.5% were Internet users. Social media was utilized by less than half of the users: social networks (47.8%), forums (19.4%), chats (18.7%), blogs (12.3%). 70.9% used the Internet for mental health related reasons. The contents accessed by the patients included: information on mental disorders (57.8%), information on medication (43.7%), search for mental health services (38.8%), platforms with other patients (19.8%) and platforms with mental health professionals (17.2%). Differences in the pattern of use between users with low, medium and high frequency of Internet use were statistically significant for all entities of social media (p < 0.01), search for mental health services (p = 0.017) and usage of platforms with mental health professionals (p = 0. 048). The analysis of differences in Internet use depending on the participants’ type of mental disorder revealed no statistically significant differences, with one exception. Regarding the Internet’s role in mental health care, the participants showed differing opinions: 36.2% believe that the Internet has or may have helped them in coping with their mental disorder, while 38.4% stated the contrary. Conclusions: Most psychiatric patients are Internet users. Mental health related Internet use is common among patients, mainly for information seeking. The use of social media is generally less frequent. It varies significantly between different user types and was shown to be associated with high frequency of Internet use. The results illustrate the importance of the Internet in mental health related contexts and may contribute to the further development of mental health related online offers.

Hintergrund: Das Internet spielt heutzutage in Gesundheitsfragen eine große Rolle. Fast alle Internetnutzer greifen im Zusammenhang mit Erkrankungen auf Onlineangebote zurück, um beispielsweise Informationen über Krankheitsbilder oder Medikamente zu suchen. Speziell für den Bereich seelische Gesundheit verfügt das Internet darüber hinaus noch über weiteres Potential: Mit der Entwicklung von Online-Programmen wurden in den letzten Jahren neue Behandlungsmöglichkeiten für psychische Erkrankungen geschaffen. Diese verwenden die multimedialen Möglichkeiten des Internets zu therapeutischen Zwecken und konnten in zahlreichen Studien vielversprechende Ergebnisse zeigen. Für die Nutzung der Programme sind dabei regelmäßiger Internetzugang und Routine im Umgang mit unterschiedlichen Internetfunktionen notwendig - insbesondere mit sozialen Medien. Ausmaß und Muster der Internetnutzung psychiatrischer Patienten im Zusammenhang mit ihrer Erkrankung sind jedoch bislang kaum erforscht. Ziel der vorliegenden Arbeit ist es, das erkrankungsbezogene Internetnutzungsverhalten dieser Patientengruppe zu erfassen und zu analysieren. Methode: Patienten aller Stationen und Ambulanzen der Klinik und Poliklinik für Psychiatrie und Psychotherapie des Universitätsklinikums Leipzig wurden mit Hilfe eines Fragebogens zu ihrem Internetnutzungsverhalten befragt. Anhand von 29 Items wurden soziodemographische Daten, das allgemeine Internetnutzungsverhalten und die erkrankungsbezogene Internetnutzung (mental-health related Internet use) erfasst. Die Datenanalyse beinhaltete die Bestimmung von Häufigkeiten und Gruppenvergleiche. Hierzu wurde vornehmlich der Chi-Quadrat-Test verwendet. Ergebnisse: 337 Patienten nahmen an der Studie teil. 79.5% von ihnen waren Internetnutzer und wurden in Abhängigkeit von ihrer wöchentlichen Nutzungsdauer in die Subgruppen Wenig-, Mittel- und Vielnutzer eingeteilt. Soziale Medien wurden von weniger als der Hälfte der Nutzer verwendet: Soziale Netzwerke (47.8%), Foren (19.4%), Chats (18.7%), Blogs (12.3%). 70.9% nutzten das Internet im Kontext ihrer psychischen Erkrankung. Hierbei handelte es sich um folgende Inhalte: Informationen zu psychischen Erkrankungen (57.8%), Informationen zu Medikamenten (43.7%), Suche nach Psychiatern bzw. psychiatrischen Kliniken (38.8%), Erfahrungsaustausch mit anderen Betroffenen (19.8%), Nutzung von Foren mit Psychiatern (17.2%). Unterschiede im Nutzungsmuster zwischen Wenig-, Mittel- und Vielnutzern waren statistisch signifikant für alle Formen sozialer Medien (p<0.01), für die Suche nach Psychiatern und Kliniken (p=0.017) und für die Nutzung von Foren mit Psychiatern (p=0.048). Die Analyse der Internetnutzung in Abhängigkeit von der psychiatrischen Diagnose zeigte mit einer Ausnahme (Suche nach Psychiatern bzw. psychiatrischen Kliniken) keine statistisch signifikanten Ergebnisse. Die Rolle des Internets im Zusammenhang mit psychischen Erkrankungen wurde von den Studienteilnehmern unterschiedlich eingeschätzt: 36.2% waren der Meinung, dass das Internet bei der Bewältigung ihrer psychischen Erkrankungen eine Hilfe war oder sein könnte, während 38.4% das Gegenteil behaupteten. 27.6% der Befragten hatten Interesse an internetbasierten Selbstmanagementprogrammen teilzunehmen. Schlussfolgerung: Die Mehrzahl der psychiatrischen Patienten nutzt das Internet. Die Internetnutzung im Zusammenhang mit psychischen Erkrankungen ist verbreitet und dient vor allem der Informationssuche. Soziale Medien werden generell weniger genutzt, hierbei bestehen jedoch signifikante Unterschiede zwischen den einzelnen Nutzergruppen. Die Möglichkeiten des Internets im Zusammenhang mit Krankheitsbewältigung und Selbstmanagement werden von Studienteilnehmern unterschiedlich bewertet. Die psychiatrische Diagnose und die Krankheitsschwere scheinen auf das Internetnutzungsverhalten einen vergleichsweise geringen Einfluss zu haben. Die Ergebnisse der Arbeit zeigen die Bedeutung des Internets im Kontext psychischer Erkrankungen und könnten bei der weiteren Entwicklung von Internetangeboten für psychisch Erkrankte Berücksichtigung finden.

Background: Eating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based selfhelp intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol. Methods: A multi-country randomized controlled trial will be conducted in Germany and the UK. N=275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention “everyBody Plus” or a waitlist control group condition without access to the intervention. everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. Discussion: To the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health care providers.