Why Did Our Trial Not Work Out? A Qualitative Analysis

Authors

  • Eva Heim Orcid
    Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  • Bleta Ademi
    Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  • Ardiana Dacaj
    Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  • Nadine Hosny Orcid
    Institute of Psychology, University of Lausanne, Lausanne, Switzerland
  • Sebastian Burchert Orcid
    Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
  • Arlinda Cerga Pashoja Orcid
    Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; St Marys University, Twickenham, London, United Kingdom
  • Anna Hoxha
    Department of Psychology, University of Zurich, Zurich, Switzerland
  • Mirëlinda Shala Orcid
    Department of Economics, Lucerne University of Applied Sciences and Arts, Lucerne, Switzerland

Abstract

Background: An online self-help programme for the treatment of depression called Hap-pas-Hapi was tested among Albanian-speaking immigrants in Switzerland and Germany, and two different levels of cultural adaptation were compared. Despite a massive recruitment effort, an insufficient number of participants could be recruited, and the drop-out rate was over 90%. Aims: We conducted a qualitative study to better understand the reasons for the non-use of Hap-pas-Hapi. Method: Eleven interviews were conducted with 17 Albanian-speaking participants aged 19-59. Participants were recruited for the purpose of this study and were not participants from the trial. They went through the recruitment material and the Hap-pas-Hapi introduction module, commented on the graphic design, usability, content, and shared their views about mental health and self-help. Results: Participants criticised the lack of a “design system” (i.e., a clearly identifiable and consistent graphic design) on social media for Hap-pas-Hapi, and the recruitment messages were unclear. The programme itself was perceived to be important and helpful for the community at large, but most participants said that they would not use it for themselves. The younger generation would have preferred an application in German or French, while the older generation did not see a benefit in using an online self-help programme to manage their psychological distress. Negative beliefs about mental disorders and psychological interventions were perceived to be common in this target group. Discussion: A professional recruitment strategy, a more careful selection of the target population (e.g., age groups) and different kinds of adaptations might have resulted in a better acceptance of the intervention. At the same time, anti-stigma campaigns and psychoeducation are needed to enhance treatment motivation.

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