Decision-making processes and experiences of older people using the Beating the Blues computerised cognitive behavioural self-help programme: a qualitative study
Introduction: Current recommendations by National Institute of Clinical Excellence (Technology Appraisal 51) emphasise the need for future research to examine the effectiveness of CCBT across the age span. Kaltenthaler et al. (2008) recommended future research focuses on acceptability of CCBT through using ‘survey and intensive qualitative methods, include the process of initial engagement, continuation versus drop-out, and in those completing, satisfaction or regret undertaking CCBT’ (p.1528). The pilot study by McMurchie (2011) was the first to explore the acceptability and effectiveness of the CCBT package Beating the Blues (BTB) solely with older people. Using qualitative methodology, the aim of the current study was to explore the experiences of older people who, when participating in the pilot study chose to use BTB compared to those who chose to remain with their treatment as usual (TAU). The current study aimed to gain a deeper understanding of the acceptability of BTB as well as factors that influence decisionmaking in terms of uptake to BTB and discontinuation from BTB. Method: Individual semi-structured interviews were carried out with 20 older people who took part in the pilot study (McMurchie, 2011). Participants were in one of three groups, these were: BTB-completers, BTB-discontinuers and TAU. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA) (Smith et al., 2009). Findings: Five master themes emerged from the interviews: Beating the Blues as a Process of Change; Relevance of Beating the Blues to Older People; Challenges of Using Beating the Blues; Motivation to Try Something New and Barriers to Beating the Blues at Time of Uptake. Conclusions: Overall, the master themes reflected the experiences of either “regaining control” or a sense of “hopelessness” when opting whether or not to use BTB in the first instance and to then continue with the treatment. Experiences of using BTB appeared to be linked to the outlook participants had about using a novel treatment with either a sense of hope or impending failure. Participants who chose BTB had a more positive outlook which impacted their ability to manage perceived challenges and work towards recovery. The sense of impending failure seemed to be linked to participants perceiving more barriers to using BTB and struggling to overcome these challenges, resulting in them either declining BTB or feeling they were not benefiting from BTB and therefore discontinuing it.