Impact of an acceptance facilitating intervention on diabetes patients' acceptance of Internet-based interventions for depression: a randomized controlled trial

Diabetes Res Clin Pract. 2014 Jul;105(1):30-9. doi: 10.1016/j.diabres.2014.04.031. Epub 2014 May 10.


Aims: To (1) determine diabetes patients' acceptance of Internet-based interventions (IBIs) for depression, to (2) examine the effectiveness of an acceptance facilitating intervention (AFI) and to (3) explore subgroup specific effects.

Methods: 141 diabetes patients from two inpatient rehabilitation units and one outpatient clinic in Germany were randomly allocated to an intervention (IG) and a no-intervention control group (CG). The IG received an AFI consisting of a personal information session before filling-out a questionnaire on patients' acceptance of IBIs, predictors of acceptance (performance expectancy, effort expectancy, social influence, facilitating conditions, and Internet anxiety) as well as sociodemographic, depression-related and diabetes-related variables. The CG filled out the questionnaire immediately. Patients' acceptance of IBIs was measured with a four-item scale (sum-score ranging from 4 to 20).

Results: The CG showed a low (50.7%) to medium (40.8%) acceptance with only 8.5% of all diabetes patients reporting a high acceptance of IBIs for depression. The AFI had no significant effect on acceptance (IG: M=10.55, SD=4.69, n=70; KG: M=9.65, SD=4.27, n=71; d=0.20 [95%-CI: -0.13;0.53]) and the predictors of acceptance. Yet, subgroup analyses yielded a trend for depressed, diabetes-related distressed, female and younger (<59) participants and for those who do not frequently use the Internet to profit from the AFI.

Conclusion: Diabetes patients show a rather low acceptance toward IBIs for depression. Findings indicate that the AFI is likely to be effective in the subgroup of depressed, diabetes-related distressed, female or younger diabetes patients, but not in the whole target population. Hence, AFIs might need to be tailored to the specific needs of subpopulations.

Keywords: Acceptance; Depression; Diabetes; E-health; Psychotherapy.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anxiety / etiology
  • Anxiety / prevention & control
  • Case-Control Studies
  • Depressive Disorder / etiology
  • Depressive Disorder / prevention & control*
  • Depressive Disorder / psychology
  • Diabetes Complications / etiology
  • Diabetes Complications / prevention & control*
  • Diabetes Complications / psychology
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / psychology
  • Diabetes Mellitus, Type 2 / rehabilitation*
  • Female
  • Follow-Up Studies
  • Germany
  • Humans
  • Internet / statistics & numerical data*
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Surveys and Questionnaires
  • Therapy, Computer-Assisted / methods*