Community-Embedded, Layperson-Supported Digital Mental Health Intervention for Homebound Older Adults with Depression

Integrating digital mental health interventions (DMHIs) into aging services agencies offers a scalable and potentially cost-effective approach to mitigating the mental health disparities experienced by homebound older adults. This process involves using aging service providers to deploy DMHIs and assist older adults in initiating and consistently using these digital tools. The long-term goal of the proposed study is to identify the features that define effective DMHIs for homebound older adults and to cultivate sustainable strategies for implementing DMHIs within community-based aging services. The specific aims are to (a) determine the clinical effects of Empower@Home—a novel DMHI explicitly designed for homebound older adults and supported by lay providers within aging service agencies—against enhanced usual care; (b) examine the intervention change mechanisms; and (c) evaluate implementation process by identifying barriers, and facilitators from multi-stakeholder perspectives. Empower@Home applies the established principles of cognitive-behavioral therapy (CBT) to address depressive symptoms prevalent in homebound older adults, enriched with engaging, character-driven storytelling conveyed through short videos. Preliminary research indicates that Empower@Home outperforms similar programs in usability and shows remarkable adherence (90% completion rate) and clinical efficacy when supported by trained research staff. The current project proposes a randomized Type I hybrid effectiveness-implementation intervention trial with 256 low-income homebound older adults served by three aging service agencies in Michigan. Participants will be allocated to receive either Empower@Home supported by agency staff or enhanced usual care. This intervention comprises nine self-help online sessions presented via short videos and text narrations on a dedicated web platform, accompanied by a physical workbook summarizing sessions and featuring worksheets for home exercises, plus weekly coaching calls conducted by trained agency staff. Enhanced usual care encompasses aging services such as case management and home support, augmented with a handout that includes psychoeducation, local resource guides, and bi-weekly depression assessments. Depression symptoms will be primarily measured using the Patient Health Questionnaire-9 (PHQ-9) at 12, 24, and 36 weeks post-baseline, complemented by five in-app assessments during sessions 1, 3, 5, 7, and 9. A combination of methods will examine and explore CBT-associated, engagement-related, and supporter-related change mechanisms. Furthermore, a qualitative assessment of the implementation process will be undertaken, with data being analyzed through traditional qualitative data analysis and natural language processing techniques. It is hypothesized that the treatment will prove superior to the enhanced usual care.