Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review

Background: Depression affects approximately 60% of people with
aphasia 1 year post stroke and is associated with disability, lower
quality of life, and mortality. Web-delivered mental health
(e-mental health) programs are effective, convenient, and
cost-effective for the general population and thus are increasingly
used in the management of depression. However, it is unknown if
such services are applicable and communicatively accessible to
people with poststroke aphasia. Objective: The aim of this study
was to identify freely available e-mental health programs for
depression and determine their applicability and accessibility for
people with poststroke aphasia. Methods: A Web-based search was
conducted to identify and review freely available e-mental health
programs for depression. These programs were then evaluated in
terms of their (1) general features via a general evaluation tool,
(2) communicative accessibility for people with aphasia via an
aphasia-specific communicative accessibility evaluation tool, and
(3) empirical evidence for the general population and stroke
survivors with and without aphasia. The program that met the most
general evaluation criteria and aphasia-specific communicative
accessibility evaluation criteria was then trialed by a small
subgroup of people with poststroke aphasia. Results: A total of 8
programs were identified. Of these, 4 had published evidence in
support of their efficacy for use within the general population.
However, no empirical evidence was identified that specifically
supported any programs’ use for stroke survivors with or without
aphasia. One evidence-based program scored at least 80% (16/19 and
16/20, respectively) on both the general and aphasia-specific
communicative accessibility evaluation tools and was subject to a
preliminary trial by 3 people with poststroke aphasia. During this
trial, participants were either unable to independently use the
program or gave it low usability scores on a post-trial
satisfaction survey. On this basis, further evaluation was
considered unwarranted. Conclusions: Despite fulfilling majority of
the general evaluation and aphasia-specific evaluation criteria,
the highest rated program was still found to be unsuitable for
people with poststroke aphasia. Thus, e-mental health programs
require substantial redevelopment if they are likely to be useful
to people with poststroke aphasia.

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Accessibility and Applicability of Currently Available e-Mental Health Programs for Depression for People With Poststroke Aphasia: Scoping Review