Pathways and Barriers to Access and Utilization of Internet-Delivered Cognitive Behaviour Therapy (ICBT) by Diverse Ethnocultural People of Saskatchewan

Ram Sapkota

Heather Hadjistavropoulos

Impact

  • Positive feedback on the course, combined with suggestions for audiovisual materials and relatable case-stories, provided clear direction for enhancing content for the iCBT course.

  • Knowledge generated through research is effectively disseminated and utilized to community organizations and healthcare centres.

  • The insights into the diverse experiences and barriers faced by clients from varied ethnocultural backgrounds guided tailored interventions, ensuring that mental health services are more inclusive and effective.

  • Ongoing collaborations with community organizations, particularly involving PORDI-WG members, ensured the continuous benefit of our work to a broader audience. Specifically, this allowed integration of cultural issues into course materials, which underscored the importance of cultural competency in mental health services.

  • Saskatchewan

  • Grant

  • University of Regina

  • Online Therapy Unit (OTU)

  • Saskatchewan Health Research Foundation

  • 2021

  • Acessibility of Internet-delivered Cognitive Behaviour Therapy (ICBT)

  • Ethnocultural People of Saskatchewan

About the Project

The COVID-19 pandemic led to complex life situations, resulting in an increase in mental health issues and service demands in Saskatchewan. The Online Therapy Unit (OTU) in Saskatchewan has been offering online mental health care, including Internet-Delivered Cognitive Behaviour Therapy (iCBT). This therapy is provided over the internet to address specific issues, with therapists assisting patients in developing strategies to change their thinking patterns and behaviors. However, participation among diverse ethnocultural groups and communities remained consistently low. This project focused on making iCBT more accessible to diverse ethnocultural groups in Saskatchewan and identifying potential pathways and barriers from utilizing this treatment.

Methodology

The researchers analyzed archival data from 341 past iCBT clients who self-identified as being from diverse ethno-cultural backgrounds. They then interviewed 7 members of community-based organizations who serve people of diverse ethnic backgrounds and 16 active clients of iCBT. The researchers then formed the Patient-Oriented Research in Diversity Impact Working Group (PORDI-WG), a patient-oriented research committee. The findings helped gather insights to further develop and modify the Standard iCBT Wellbeing Course.

The researchers then adapted the Wellbeing Course to the Diversity Enhanced Wellbeing Course (DEWC) based on feedback analysis, qualitative interviews and PORDI-WG recommendations. They then trained ICBT service providers on the new DEWC and Cultural Concepts of Distress, recruited clients for the DEWC pilot project and conducted interviews with 13 active clients for feedback. Additionally, they reviewed ICBT promotional materials with PORDI-WG to implement cultural adaptations.

Findings

  • Archival Data Analysis Findings:

    • 11% of clients identified as having a diverse ethnocultural background

    • Majority liked the course and found it helpful for managing symptoms.

    • There was an increased demand for more audiovisual materials in the course.

    • Some case-stories were seen as lengthy and not relatable.

  • Diverse ethnocultural groups approach mental health differently.

    • The three most identified barriers to accessing mental health treatment were: stigma, language barriers and deprioritization of mental health.

    • Clients provided overwhelmingly positive feedback on the course but noted some case-stories were not relatable and requested more audiovisual elements.

    • Most participants were referred by medical professionals for convenience, but many remained unaware of the course. There were suggestions of  increased promotion via social media and schools.

  • Collaboration with PORDI-WG:

    • Developed interview questions and simplified course content.

    • Focused on integrating diverse cultural issues into new case-stories.

    • Created the Story Feedback Questionnaire and new audiovisual materials.

    • Authored the Culture and Emotional Wellbeing resource for the course.

Project Outreach

As the implementation of the Wellbeing Course was funded by Saskatchewan Ministry of Health, the course was only implemented in Saskatchewan.

Resources Created

  • 2 papers:

    • Sapkota, R. P., Valli, E., Wilhelms, A., Adlam, K., Bourgeault, L., Heron, V., Dickerson, K., Nugent, M., & Hadjistavropoulos, H. D. (2023). Patient-Oriented Research to Improve Internet-Delivered Cognitive Behavioural Therapy for People of Diverse Ethnocultural Groups in Routine Practice. Healthcare, 11(15), 2135. https://doi.org/10.3390/healthcare11152135

    • Sapkota, R. P., Valli, E., Dear, B. F., Titov, N., & Hadjistavropoulos, H. D. (2024). Satisfaction, engagement, and outcomes in internet-delivered cognitive behaviour therapy adapted for people of diverse ethnocultural groups: an observational trial with benchmarking. Frontiers in Psychiatry, 15, 1270543. https://doi.org/10.3389/fpsyt.2024.1270543

  • Presentation on the Cultural Concepts of Distress to the Online Therapy Unit and Saskatchewan Health Authority online therapists (June 2022)

  • Presentation online to the Online Therapy Unit clinical team

  • Recorded presentation about the Online Therapy Unit services was sent to two Saskatchewan community-based organizations to circulate to their staff and community members.

  • Promotional material (posters, brochures and cards) was available to the public at community organizations and healthcare centres throughout Saskatchewan

  • An additional resource on Culture and Emotional Wellbeing for the ICBT Wellbeing course was developed

  • Presentation to the mental and emotional wellbeing working group of Regina Region Local Immigration Partnership (RRLIP)

  • MHRC Spotlight on Research Webinar: