Using Qualitative Methods to Complement Randomized Controlled Trials: Researching Mental Health Interventions

Qualitative methods are underutilized in health intervention evaluation, and overshadowed by the importance placed on randomized controlled trials (RCTs). This Commentary describes how innovative qualitative methods are being used as part of RCTs, drawing on articles included in a special issue of Qualitative Health Research on this topic. The articles’ insights and a review of innovative qualitative methods described in trial protocols highlights a lack of attention to structural inequalities as a causal mechanism for understanding human behavior. We situate this gap within some well-known constraints of RCT methodologies, and a discussion of alternative RCT approaches that hold promise for bringing qualitative methods center stage in intervention evaluation, including adaptive designs, pragmatic trials, and realist RCTs. To address the power hierarchies of health evaluation research, however, we argue that a fundamental shift needs to take place away from a focus on RCTs and toward studies of health interventions.

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Are online mental health interventions for youth effective? A systematic review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x211047285 ◽

2021 ◽

Vol 27 (10) ◽

pp. 638-666

Author(s):

Xiaoyun Zhou ◽

Sisira Edirippulige ◽

Xuejun Bai ◽

Matthew Bambling

Keyword(s):

Mental Health ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Health Interventions ◽

Controlled Trials ◽

Web Based ◽

Randomized Controlled ◽

Self Help ◽

Cognitive Behavioural ◽

Mental Health Interventions

Objectives This systematic review aims to examine the effectiveness of online mental health interventions for youth. Methods We searched seven electronic databases (PubMed, PsycINFO, Medline, Embase, CINAHL, Web of Science and SCOPUS) for the past 10 years to identify randomized controlled trials which have evaluated the use of telehealth interventions for young people with mental health problems. The included studies were assessed for quality and risk of bias. Results Forty-five randomized controlled trials ( n = 13,291 participants) were eligible for this review. Most studies (35 trials) evaluated the use of web-based self-help platforms to deliver cognitive behavioural therapy (14 trials), mindfulness (four trials), acceptance commitment therapy (five trials) and positive psychology (two trials). Mobile/computer applications were used to deliver cognitive behavioural therapy (four trials) and coping strategies training (two trials). Web-based synchronous chat (one trial) was used to assist communication between counsellors and participants. Three studies used artificial intelligence-based conversational agents to deliver cognitive behavioural therapy (two trials) and problem-solving-strategy training (one trial). Eighty-two percent ( n = 37) identified the participants as student population (i.e. university students, high school students). Sixty-four percent ( n = 29) of the telehealth interventions were found to be effective in managing depression, anxiety, stress, insomnia and improving quality of life when compared with control conditions. Conclusions Online mental health interventions were found to be effective in managing diverse mental health conditions among youth. Online self-help platforms were the most frequently used modality and artificial intelligence-based chatbots are merging as potential solutions. Future research is warranted to investigate the solutions to improve the retention rate and satisfaction of telehealth interventions among this population.

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