Acceptance of home-based telehealth problem-solving therapy for depressed, low-income homebound older adults: qualitative interviews with the participants and aging-service case managers

Gerontologist. 2014 Aug;54(4):704-13. doi: 10.1093/geront/gnt083. Epub 2013 Aug 8.


Purpose: To report low-income homebound older adults' experience of telehealth problem-solving therapy (tele-PST) and aging-service case managers' (CMs') experience/perception of client-level personal barriers to accessing psychotherapy in general and PST specifically.

Design and methods: The study sample consisted of 42 homebound older adults who participated in the feasibility and efficacy trial of tele-PST and completed 36-week follow-up assessments and 12 CMs of a large home-delivered meals program who referred their clients to the tele-PST trial. In-depth interviews with the older adults and written feedback and focus group discussions with the CMs provided the data.

Results: Older adults reported a high rate of approval of PST procedures and acknowledged its positive treatment effect. Tele-PST participants were satisfied with videoconferenced sessions because they were convenient and allowed them to see their therapist. However, CMs reported that only about 10%-20% of potentially eligible older adults gave oral consent for PST. Significant treatment engagement barriers were the older adults' lack of motivation, denial of depression, perceived stigma, and other personal attitudinal factors.

Implications: The real-world implementation of tele-PST or other psychotherapies needs to include educating and motivating depressed homebound elders to recognize their depression and accept treatment.

Keywords: Acceptance; Telepsychotherapy; Treatment engagement.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aging*
  • Depression / diagnosis
  • Depression / psychology
  • Depression / rehabilitation*
  • Female
  • Follow-Up Studies
  • Homebound Persons / rehabilitation*
  • Humans
  • Male
  • Middle Aged
  • Poverty
  • Problem Solving*
  • Psychiatric Status Rating Scales
  • Psychotherapy / methods*
  • Telemedicine / methods*
  • Time Factors
  • Treatment Outcome