Community Research and Development Information Service - CORDIS

H2020

ICare Report Summary

Project ID: 634757
Funded under: H2020-EU.3.1.

Periodic Reporting for period 1 - ICare (Integrating Technology into Mental Health Care Delivery in Europe)

Reporting period: 2015-09-01 to 2017-02-28

Summary of the context and overall objectives of the project

Mental illness represents an enormous personal, social, and societal burden for European citizens. Existing models of mental health care delivery need to be expanded to reduce this burden. The need to move to novel models to reduce the mismatch between need and provision of mental health services has been recognized for decades, yet only recently have there been increasing calls for novel models of delivering mental health care, including technology-based models of health care delivery.
The aim of ICare is to establish a novel, comprehensive model of mental health service delivery covering health promotion, risk detection, disease prevention, and self-help/treatment of common mental health disorders and related conditions delivered through an online platform. ICare will be integrated into different mental health services and other settings in Europe in collaboration with a network of established stakeholders. The feasibility, acceptance, efficacy and (cost-) effectiveness, reach, and dissemination of the included online interventions on the ICare platform will be compared in this project.
The overall objectives of the project are:
1. To assess the specific needs of stakeholders for the implementation and dissemination of prioritized interventions/programs by a survey carried out in each of the participating countries and to assess needs for future programs to be developed, evaluated and disseminated.
2. To adapt and implement a comprehensive and economic (diagnostic and prognostic) online screening across multiple mental health domains (depression, anxiety, alcohol use, eating and adjustment disorders and obesity).
3. To provide the technology for a common platform for all included online interventions.
4. To adapt, disseminate, and implement evidence-based online interventions for health promotion, prevention, and treatment into health services of different EU countries and compare their acceptance, feasibility, ease of use/dissemination, adherence and efficacy/effectiveness within each country as well as across countries along the dimensions of the RE-AIM framework.
5. To reduce health economic burden of common mental health conditions and disorders in and across different European countries.
6. To identify how and for whom included interventions in and across countries are most (cost-) effective.
The ICare consortium addresses these objectives by conducting 7 multi-country, clinical studies as well as work packages across clinical studies (health economic evaluation; evaluation of moderators, mediators and adherence). ICare involves 6 countries in Europe (Germany, Austria, Switzerland, The Netherlands, Spain, UK), 8 universities, 4 research institutions and one SME.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

A comprehensive stakeholder survey involving key players which are relevant across all interventions and settings (health systems, universities, schools) was conducted. This involved 29 focus groups, 49 interviews and an online survey with more than 250 respondents.
13 different online interventions targeting depression, anxiety, disordered eating, adjustment disorders or promoting resilience were developed or adapted for new or broader target groups and implemented on the online platform. This process involved designing and developing new intervention features based on stakeholder feedback, producing videos and audios to illustrate the interventions, translating the interventions into different languages and adapting them culturally. To deliver these interventions, coaches were trained and coaching manuals were developed. Beta-tests were conducted for new intervention before the first participants were allocated.
To evaluate the online interventions, preparations for seven clinical efficacy and effectiveness studies and two additional add-on-studies across the consortium were undertaken which included 1. agreeing on common measures across all studies, 2. planning and programming the assessments, 3. obtaining approval by 6 ethics committees, 4. study registration, 5. preparation and validation of randomization lists, 6. setting up data management scripts in order to generate analyzable datasets, 7. writing statistical analysis plans for each study and 8. agreeing on and preparing plans for data quality assurance and data protection for the whole consortium.
The first participants were included in the trials in November 2016; by the end of the reporting period, 755 participants have been allocated to an intervention.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

This project will impact access to mental health interventions by offering interventions that are appropriately suited to peoples’ mental health needs across levels of mental health symptom profiles and risk conditions for these disorders. It aims to improve existing models of health services by creating independent, more cost-effective e-health services as adjunct to existing health services thus facilitating stepped-care models by integrating online interventions as first step in primary care. The integration of stakeholders from science and practice (e.g., health care providers, policy, community organizations, and non-profit organizations) will facilitate the dissemination of interventions in “real life”. The project will also provide information about the cost-effectiveness of implementing online prevention and treatment of mental health across different European countries for a range of health conditions, target group, countries, and disorder severity levels. Finally, the project will improve the theoretical conceptualization of risk and resilience by including interventions that focus on both risk and protective factors and assess interactions between both factors. This kind of research can be a keystone for the prevention and treatment of mental disorders.
ICare addresses several main goals of EU health policy, as stated by the European Commission (within the release of the eHealth Action Plan 2012-2020 [7]: 1) Improve the quality of health care – before their implementation, interventions are evaluated concerning their efficacy and/or effectiveness; 2) Improve access to health care–ICare offers interventions that suit specific risk profiles, deploying online-interventions which can be used by large parts of Europe’s population, thus mitigating health inequalities; 3) Improve effectiveness and acceptance of eHealth tools–our planned research will contribute to advance the potency of such interventions regarding therapeutic, cost-effectiveness, and user-centered aspects.
ICare addresses the need to lower the annual costs caused by mental disorders, which¬–at an estimate of 3-4% of the EU’s GDP–cause one of the largest portions of health costs and are expected to further increase, and to promote a shift to interventions that are primarily centered on prevention, health promotion, and early intervention. ICare also recognizes the need to improve current health care systems as an investment towards a strengthened prosperity in Europe in terms of societal and economical values, with public mental health being a critical precondition for these targets. Beyond barriers such as cost and access, stigma associated with mental disorders can impede help seeking behavior. Importantly, ICare will directly contribute to stigma reduction through engaging potential users and stakeholders to help frame and deliver online screening, feedback, and interventions in a normalizing and de-stigmatizing manner.

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