Acceptability and effects of tele-delivered behavioral activation for depression in low-income homebound older adults: in their own words

Abstract

Objectives

To examine experiences and perspectives of low-income homebound older adults (N = 90) who participated in tele-delivered behavioral activation (Tele-BA) treatment for depression by bachelor’s-level lay counselors.

Methods

We used the 11-item Treatment Evaluation Inventory (TEI) to measure participants’ acceptability of Tele-BA. We used inductive thematic analysis to explore participants’ Tele-BA session goals and activities and unsolicited and solicited comments about their Tele-BA experience.

Results

Participant’s TEI score averaged 70 out of maximum possible 77. The most frequently chosen Tele-BA goals were to improve self-care management of physical and mental health, engage in self-enrichment/self-enjoyment, improve living environment and daily routine, and to increase social connectedness. The themes that emerged from participants’ comments about Tele-BA were: (1) benefits of psychoeducation; (2) importance of and gratitude for working with a counselor; (3) benefits of activity planning; (4) understanding of behavior and mood connection; (5) positive effects of increased activity on health and self-enjoyment; (6) sense of being productive and useful from accomplishing goals; (7) hope for the future; and (8) pride in tele-treatment.

Conclusion

Participants’ comments show that Tele-BA aimed at reinforcing healthy behaviors that improve both physical functioning and mood is well aligned with these older adults’ perception of what treatment should be. The findings also provide support for lay counselors’ clinical capacity. Given geriatric mental health workforce shortages, lay counselors may be able to effectively supplement existing professional mental health service systems.

Keywords:

• Homebound older adults
• depression
• mental health
• behavioral activation
• tele-delivery

Acknowledgements

Authors express their gratitude toward community partners, especially Meals on Wheels Central Texas, their case managers and all participants in the study.

Disclosure statement

The authors report no conflict of interest

Additional information

Funding

This work was supported by the National Institute on Minority Health and Health Disparities (under grant 1R01MD009675; PI: N. Choi). St. David’s Foundation also provided supplemental grant.