Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to design an online Direct-to-consumer marketing of internet-based cognitive behavioral therapy for people with depression: Randomized controlled trial

Abstract

Background

Given the low acceptance of Internet-based interventions for depression, finding ways to increase the acceptance and uptake is crucial for the dissemination of Internet-based cognitive behavioral therapy. Moreover, it remains unknown to what extent the Unified Theory of Acceptance and Use of Technology (UTAUT) could aid the design of Direct-to-Consumer Marketing (DTC) in psychological service.

Objectives

This study aims to explore whether the regulatory processes theorized in UTAUT (i.e., performance expectancy, effort expectancy, social influence, and facilitating condition) could be modified by DTC, and whether the changes could mediate the change in acceptance of Internet-based cognitive behavioral therapy (i.e., the behavioral intention of technology use).

Method

In this randomized controlled trial with a parallel design, we invited 219 individuals with at least mild level of depression (PHQ9≥ 5). Majority of the sample (65 %) had at least moderate level of depressive symptoms and met the clinical threshold for major depressive disorder. Upon completion of pre-assessment, participants were randomly allocated to an intervention and an active control group. The intervention group received a 7- minute UTAUT-driven promotion video on Internet-based cognitive behavioral therapy, while the control group received a video of same length with general psychoeducation. Both groups completed a post-assessment after watching the corresponding video via an online platform.

Analysis and results

Repeated measures ANOVA showed a significant time by group effect on acceptance of Internet-based cognitive behavioral therapy, perceived performance expectancy, and social influence. The video used in the intervention group, which was designed in accordance with UTAUT, was perceived to be clearer and more persuasive than that in the control group. Mediation analysis showed that the effect of intervention group was mediated by increases in perceived performance expectancy, and conditional process analysis showed that the indirect effect was conditional on participants’ level of help seeking stigma.

Conclusions

Internet-based cognitive behavioral therapy is a promising approach to improve healthcare coverage, the level of acceptance of Internet-based cognitive behavioral therapy can be improved by brief DTC promotion video that would allow for widespread and mass dissemination. The finding casts light on perceived performance expectancy of Internet-based cognitive behavioral therapy as the most modifiable regulatory processes. Its change also mediated changes in Internet treatment acceptance. Yet, such relation could be attenuated by high predisposition help-seeking stigma. Taken all together, DTC videos could be the first part of an integral, gradual, and stepped support strategy in Internet-based intervention. Effort in stigma reduction should continue to bolster the dissemination of Internet-based cognitive behavioral therapy.