Barriers to patient interest in internet-based cognitive behavioral therapy: Informing e-health policies through quantitative analysis

Objective: There is growing interest in expanding patient access to Internet-Based Cognitive Behavioral Therapy (ICBT). In order to inform policies to improve ICBT access, this study explored attitudinal (e.g., stigma), structural (e.g., access to care) and ICBT specific (e.g., computer anxiety) barriers to rural and urban patient interest in ICBT. Methods: This cross-sectional observational study was conducted among adult (>18 years) urban and rural residents (n = 200) in Saskatchewan, Canada. An online survey assessed interest in ICBT, nine barriers to ICBT, demographics, and depression and anxiety symptoms. Results: Multivariable linear regression analyses were conducted and revealed that participants with lower self-stigma of seeking help and higher perceived need for mental health treatment (attitudinal barriers), and participants with lower access to care (structural barrier) and lower computer anxiety (ICBTspecific barrier) showed significantly greater interest in ICBT. Participants with financial concerns, life chaos, and participants who reported greater preference for autonomy (attitudinal barrier) did not report significant interest in ICBT. Conclusions: To increase uptake of ICBT, the findings point towards several policy implications, including aligning ICBT towards individuals with lower access to care and higher perceived needs, and allocating resources for strategies to decrease computer anxiety and self-stigma of seeking help. (C) 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.