Positive aging: feasibility and acceptability of an eHealth ACT module for middle-aged and older adults

Figures & data

Table 1. Overview of the nine sessions in the ACT module.

Sessions	Content
1. Introduction to ACT	Brief introduction of ACT and its core processes Explanation of the structure of the module and the sessions Introduction to the use of exercises and metaphors
2. Creative hopelessness	What is creative hopelessness? Metaphor: boomerang Exercises: experiencing hopelessness Practice: repeat the exercise experiencing hopelessness
3. Acceptance	What is acceptance and what is it not? Metaphor: Chinese finger trap Exercises: pain and suffering; visualize your pain; allowing emotions Practice: pause at an unpleasant thought and try to accept that it is there,repeat the exercise allowing emotions
4. Defusion	What is defusion? Metaphor: waterfall Exercises: fusion and defusion; name your mind; look at your thinking Practice: repeat the techniques to distance yourself from your thoughts
5. Self as context	Advantages and disadvantages of our self-image Metaphor: suits Exercises: suits; lifeline Practice: focus on one of your imaginary suits that is hindering you in your functioning and act against the expectations of the suit
6. Contact with the present moment	Explanation living in the present moment Metaphor: time machine Bodyscan Exercises: record your surroundings; focus in action Practice: daily bodyscan and record your surroundings
7. Values	Reflection on values and their significance Metaphor: compass Exercises: values sorting task; top three dreams; life compass Practice: take time to think about what you want in life
8. Committed action	How to manifest your values more in your live? Getting active with your values Metaphor: contest Exercises: smallest step and follow-up; steps and barriers Practice: daily value-based action
9. Psychological flexibility	Completion by bringing all components together Metaphor: learn to dance Exercises: make an ACTion-plan; continue using ACT in my life

Table 2. Statements about the course content and self-evaluation.

Statements about the course content

The videos in the online course were useful for me

The exercises in the online course were useful for me

The illustrated metaphors in the online course were useful for me

I feel that I now have a good idea of what ACT is about

I would recommend the course to others

Statements self-evaluation

The course has helped me in dealing with my thoughts and feelings (acceptance part of ACT)

The course has helped me to start invest in the things that are important to me (commitment part of ACT)

I will continue to use what I have learned in the course in the future

Table 3. Demographic characteristics of the participants at baseline.

Baseline characteristics (N = 313)	N	%
Gender
Female	238	76
Male	74	23.6
Other	1	0.3
Mean age in years (SD)	53.9 (SD = 8.3)
Marital state
Married or cohabiting	192	61.3
In a relation without cohabitation	47	15
Single	71	22.6
Education level
Low	56	17.8
High	257	82.1
Work situation
Full time	61	19.5
Part time	128	40.9
Not working	100	32.1
Retired	34	10.9

Table 4. Comparison of demographics at baseline between completers, semi-completers, and dropouts.

Baseline characteristics	Completers		Semi-completers		Dropouts		χ2 or Cramer’s V or F	p value
	n	%	n	%	n	%
Gender							.06	.34
Female	278	73.7	40	62.5	143	74.1
Male	98	26	24	37.5	50	25.9
Age (years) Mean (SD)	54.29 (SD = 8.5)		55.84 (SD = 9.34)		53.67 (SD = 9.18)		1.5	.23
Education level							3.92	.14
Low	69	18.3	13	20.3	49	25.4
High	308	81.7	51	79.9	144	74.6
Work situation							2.45	.65
Full time	79	22.7	18	30.5	47	26.4
Part time	150	43.1	22	37.3	69	38.8
Not working	119	34.2	19	32.2	62	34.8
Marital state							1.26	.87
Married or cohabiting	270	72.6	47	75.8	140	72.9
In a relation without cohabitation	17	4.6	1	1.6	9	4.7
Single	85	22.8	14	22.6	43	22.4

Table 5. Strengths and limitations of the eHealth ACT module.

Most frequently reported strengths

Clear explanation of the ACT-components Meaningful, provides insight, food for thought and recognizable Comprehensible ACT-metaphors and eye-openers Applicable and practical ACT-exercises Being able to do the online training in my own time and pace The videos are clear and add variation to the structure of the course

Most frequently reported limitations

Missing personal guidance by a therapist Missing interaction with a therapist and other participants Missing personal feedback on fill-in exercises Absence of weekly reminders No information available on paper and difficult to print myself Limited accessibility of the training (8 weeks)

Table 6. Means and standard deviations time spent online on each session and in total (hh:mm:ss).

Session	Means
1. Introduction to ACT (n = 224)	0:11:13(SD = 0:09:36)
2. Creative hopelessness (n = 263)	0:19:44(SD = 0:13:22)
3. Acceptance (n = 258)	0:31:47(SD = 0:22:30)
4. Defusion (n = 250)	0:25:45(SD = 0:16:18)
5. Self as context (n = 247)	0:26:01(SD = 0:17:11)
6. Contact with the present moment (n = 230)	0:26:47(SD = 0:18:52)
7. Values (n = 220)	0:36:26(SD = 0:31:07)
8. Committed action (n = 190)	0:22:54(SD = 0:17:18)
9. Psychological flexibility (n = 160)	0:25:15(SD = 0:24:53)
Total (n = 259)	3:18:44(SD = 1:43:41)

Due to a technical problem, online activity was not recorded for all participants and therefore sample sizes vary across the different sessions.

Figure 1. Rating Percentages per session.

Figure 2. Results of the content evaluation statements.

Figure 3. Results of the statements relating to the self-evaluation.

Figure A1. Instruction video.

Figure A2. Illustrated metaphor.

Figure A3. Guided exercise.

Figure A4. Fill in exercise.

Figure A5. Practical exercise.