Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell

Kate M Gunn; Gemma Skaczkowski; James Dollman; Andrew D Vincent; Camille E Short; Susan Brumby; Alison Barrett; Nathan Harrison; Deborah Turnbull

doi:10.2196/27631

Combining Farmers' Preferences With Evidence-Based Strategies to Prevent and Lower Farmers' Distress: Co-design and Acceptability Testing of ifarmwell

JMIR Hum Factors. 2022 Jan 11;9(1):e27631. doi: 10.2196/27631.

Authors

Kate M Gunn^{1

2}, Gemma Skaczkowski¹, James Dollman³, Andrew D Vincent², Camille E Short⁴, Susan Brumby^{5

6}, Alison Barrett¹, Nathan Harrison¹, Deborah Turnbull^{2

7}

Affiliations

¹ Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
² Freemason's Centre for Male Health and Wellbeing, The University of Adelaide, Adelaide, Australia.
³ Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia.
⁴ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences and Melbourne School of Health Sciences, University of Melbourne, Melbourne, Australia.
⁵ National Centre for Farmer Health, Western District Health Service, Hamilton, Australia.
⁶ School of Medicine, Deakin University, Melbourne, Australia.
⁷ School of Psychology, The University of Adelaide, Adelaide, Australia.

PMID: 35014963
PMCID: PMC8790695
DOI: 10.2196/27631

Abstract

Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support.

Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population.

Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) "sheep, cattle and/or grain farmers." Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology.

Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies-ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health-related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion.

Conclusions: Sequential integration of research evidence, expert knowledge, and farmers' preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526.

Keywords: acceptance and commitment therapy; agriculture; coping; drought; farm; mental health; online intervention; rural; stress.

©Kate M Gunn, Gemma Skaczkowski, James Dollman, Andrew D Vincent, Camille E Short, Susan Brumby, Alison Barrett, Nathan Harrison, Deborah Turnbull. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 11.01.2022.