Encouraging patients with depressive symptoms to seek care: A mixed methods approach to message development

Bell, Robert A.; Paterniti, Debora A.; Azari, Rahman; Duberstein, Paul R.; Epstein, Ronald M.; Rochlen, Aaron B.; Dwight Johnson, Megan; Orrange, Sharon E.; Slee, Christina; Kravitz, Richard L.

doi:10.1016/j.pec.2009.07.007

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Volume 78, Issue 2 , Pages 198-205, February 2010

Encouraging patients with depressive symptoms to seek care: A mixed methods approach to message development

Robert A. Bell
- Department of Communication, University of California, Davis, CA, USA
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA
- Corresponding author at: Department of Communication, University of California, One Shields Avenue, Davis, CA 95616, USA. Tel.: +1 530 752 1221; fax: +1 530 752 6705.
Debora A. Paterniti
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA
- Department of Sociology, University of California, Davis, CA, USA
- Division of General Medicine, Department of Internal Medicine, University of California, Davis, USA
Rahman Azari
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA
- Department of Statistics, University of California, Davis, CA, USA
Paul R. Duberstein
- Laboratory of Personality and Development, Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
Ronald M. Epstein
- Rochester Center for the Improvement of Communication in Health Care, Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
Aaron B. Rochlen
- Department of Educational Psychology, University of Texas at Austin, TX, USA
Megan Dwight Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
Sharon E. Orrange
- Department of Internal Medicine, University of Southern California, Los Angeles, USA
Christina Slee
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA
Richard L. Kravitz
- Center for Healthcare Policy and Research, University of California, Davis, CA, USA
- Division of General Medicine, Department of Internal Medicine, University of California, Davis, USA

Received 9 February 2009; received in revised form 24 June 2009; accepted 9 July 2009. published online 12 August 2009.

Abstract

Objective

To assess the message preferences of individuals affected by depression as part of a project that will evaluate interventions to encourage at-risk patients to talk to their physicians about depression.

Methods

Adaptive Conjoint Analysis (ACA) of 32 messages defined by 10 message attributes. Messages were developed based on input from three focus groups comprised of individuals with a personal and/or family history of depression, then tested using volunteers from an Internet health community. In an online conjoint survey, 249 respondents with depression rated their liking of the messages constructed for each attribute. They were then presented with two message sets and rated their preferences. Preference utilities were generated using hierarchical Bayes estimation.

Results

The optimal communication approach described both psychological and physical symptoms of depression, recognized multiple treatment options, offered lifetime prevalence data, noted that depression can affect anyone, and acknowledged that finding an effective treatment can take time.

Conclusion

Individuals with depression respond differently to depression care messages, underscoring the need for careful message development and evaluation.

Practice implications

ACA, used in conjunction with focus groups, is a promising approach for developing and testing messages in the formative research stage of intervention development.

Keywords: Focus groups, Adaptive Conjoint Analysis, Depression, Communication, Messages, Care-seeking, Help-seeking