Table 4.
Acceptability outcomes.
| Outcome | Study | Assessment or treatment | Main diagnosis | Intervention (number of studies) | Comparator (number of studies) | Results |
|
| Clinician satisfaction | |||||||
|
|
Garcia-Lizana and Munoiz-Mayorga (2010) [28] | Assessment and treatment | Multiple | Videoconferencing for diagnosis and follow-up (n=3); video-based evaluation of competency to stand trial (n=1); nonspecific video-based CBTa (n=5); video-based psychoeducation and counseling (n=1) | Face-to-face (n=10) | The lowest level of satisfaction was found to be in the videoconferencing group in two studies that examined clinician satisfaction. |
|
|
|
Hassan and Sharif (2019; refugee populations) [29] | Assessment and treatment | Multiple | Not specified videoconferencing treatment intervention (n=2); video-based CBT (n=7); video-based psychoeducation (n=2); video-based relapse prevention (n=1); video-based treatment management (n=1); video-based evaluation of competency to stand trial (n=1) | Face-to-face (n=14) | Clinicians tended to report higher satisfaction in the face-to-face interventions; however, most reported good satisfaction with the videoconference group. |
|
|
|
Turgoose et al (2018; veterans) [38] | Treatment | PTSDb | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | One study reported that clinicians delivering therapy found teletherapy acceptable, with no difference with in-person therapies. |
|
|
|
Harerimana et al (2019; older adults) [20] | Treatment | Depression | Telephone based (n=6); video based (n=2); web based (n=1) | Waiting list (NRc); treatment as usual (NR) | Health care providers have positive perceptions and notice practical benefits associated with the use of telehealth for delivery of community mental health care (n=1). However, nurses of a telepsychiatry consultation generally did not rate it positively (n=1). |
|
|
|
Lins et al (2014) [31] | Support for carers of people with dementia (depressive symptoms) | Carers of people with dementia (for depressive symptoms) | Telephone counseling (n=9, n=2 reporting implementation outcomes) | Friendly calls (n=3); treatment as usual (n=6) | Spatial distance could be a problem because counselors cannot see the reactions of carers (n=1). Counselors also expressed a need for a debriefing with colleagues after counseling sessions. |
|
| Therapeutic alliance | |||||||
|
|
Bolton and Dorstyn (2015) [24] | Treatment | PTSD | Internet-based CBT with therapist support via telephone calls, introductory face-to-face meetings, or emails (n=6); video-based CBT (n=5) | Face-to-face (n=5); supportive counseling (n=1); waitlist (n=1); no control (n=4) | Good therapeutic alliance reported (n=5) |
|
|
|
Christensen et al (2019, older adults) [25] | Treatment | Depression or a range of diagnoses including depression | Video consultations for telepsychiatry (n=21) | Face-to-face (11), no control (10) | Video sessions were considered better than telephone sessions because of their similarity to face-to-face sessions (n=2); however, in one study, female patients found videoconferencing interventions more impersonal than face-to-face sessions. One clinician reported reduced communication intensity because of less clear facial movements (n=1). |
|
|
|
Lin et al (2019) [30] | Treatment | Substance use disorders | Video- or telephone-based psychotherapy (n=10); remote medication management (n=3; patient presents at local clinic with nurse and are connected to a physician at a distant site via videoconference) | Face-to-face psychotherapy (n=7); telephone (n=2); treatment as usual (n=1); no control (n=3) | Participant and therapist ratings of therapeutic alliance ratings were high in both videoconference and in-person interventions (n=1). |
|
|
|
Lins et al (2014) [31] | Support for carers of people with dementia (depressive symptoms) | Carers of people with dementia (for depressive symptoms) | Telephone counseling (n=2 reporting implementation outcomes) | Friendly calls (n=3); treatment as usual (n=6) | Counselors can feel frustrated and helpless during telephone counseling because it is relatively impersonal (n=1). |
|
|
|
Norwood et al (2018) [34] | Treatment | Multiple | Video-based CBT (n=10) | Face-to-face CBT (n=10) | Six studies used a face-to-face condition as a control group, with four finding that therapeutic alliance was noninferior in the videoconferencing condition as compared with face-to-face conditions. The remaining two reported that alliance was higher in the face-to-face group, though one reported no difference in participant rated alliance, only significantly higher therapist-rated alliance for the face-to-face group. Standardized mean difference in alliance ratings –0.30 (95% CI –0.67 to 0.07), P=.11, n=4. The lower limit of the 95% CI fell outside the prespecified limit of noninferiority (Cohen d=−0.50), indicating that with respect to working alliance, videoconference interventions were inferior to face-to-face treatment. |
|
|
|
Turgoose et al (2018, veterans) [38] | Treatment | PTSD | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | Although most studies found that alliance was equivalent in teletherapy and in-person conditions, some suggested that veterans may feel more comfortable talking to therapists face-to-face. Challenges in detecting body language were reported, but overall clinicians felt that teletherapy did not affect their ability to establish rapport. |
|
| Patient satisfaction | |||||||
|
|
Christensen et al (2019; older adults) [25] | Treatment | Depression or a range of diagnoses including depression | Video consultations for telepsychiatry (n=21) | Face-to-face (11), no control (10) | High levels of patient satisfaction and acceptability were frequently reported, and there were no significant differences between face-to-face and videoconferencing in RCTd studies. Patients preferred the reduced waiting time (n=1). Some patients reported initial skepticism as a reason for preference of face-to-face interventions, however this usually dissipated with use of remote technology. |
|
|
|
Dorstyn et al (2013, ethnic minorities) [21] | Treatment | Depression | Telephone CBT (n=2); telephone supportive counseling (n=1); telephone structural ecosystems therapy (n=1); internet-based CBT with weekly individual sessions (n=2); internet telepsychiatry (n=1); internet supportive counseling and personalized email correspondence (n=1) | Face-to-face (n=1); treatment as usual (n=3); minimal support control or waitlist (n=2); no control (n=2) | Consistent patient satisfaction was reported. |
|
|
|
Garcia-Lizana (2010) [28] | Assessment and treatment | Multiple | Videoconferencing for diagnosis and follow-up (n=3); video-based evaluation of competency to stand trial (n=1); nonspecific video-based CBT (n=5); video-based psychoeducation and counseling (n=1) | Face-to-face (n=10) | Patients generally appeared satisfied with the technology utilized and its quality (n=2). High satisfaction was reported in other studies; however, it is unclear if satisfaction was generated by the program or the technology (n=5). |
|
|
|
Hassan and Sharif (2019; refugee populations) [29] | Assessment and treatment | Multiple | Not specified videoconferencing treatment intervention (n=2); video-based CBT (n=7); video-based psychoeducation (n=2); video-based relapse prevention (n=1); video-based treatment management (n=1); video-based evaluation of competency to stand trial (n=1) | Face-to-face (n=14) | Most studies reported a high satisfaction with videoconference interventions (n=3) or no difference in satisfaction as compared with face-to-face groups (n=3); however, one study reported a lower satisfaction as compared with face-to-face sessions. |
|
|
|
Lin et al (2019) [30] | Treatment | Substance use disorders | Video- or telephone-based psychotherapy (n=10); remote medication management (n=3; patient presents at local clinic with nurse and are connected to a physician at a distant site via videoconference) | Face-to-face psychotherapy (n=7); telephone (n=2); treatment as usual (n=1); no control (n=3) | Satisfaction was generally quite high in videoconference interventions and that participants would recommend the intervention to others. |
|
|
|
Lins et al (2014) [31] | Support for carers of people with dementia (depressive symptoms) | Carers of people with dementia (for depressive symptoms) | Telephone counseling (n=9, n=2 reporting implementation outcomes) | Friendly calls (n=3), treatment as usual (n=6) | Reservations expressed about getting advice from an unknown person (n=1). Both studies reported that carers found the information given helpful and were grateful for it. One study found that telephone counseling helped alleviate loneliness in carers. |
|
|
|
Turgoose et al (2018; veterans) [38] | Treatment | PTSD | Video-based exposure (n=10); video-based cognitive processing therapy (n=6); video-based CBT (n=5); mixed interventions (n=11); telephone mindfulness (n=1); video-based behavioral activation (n=2); video-based eye movement desensitization and reprocessing (n=1); video-based anger management (n=2); video-based general coping and psychoeducation interventions (n=3) | Face-to-face (n=41) | Patients found teletherapy and face-to-face treatments equally satisfactory: accepting the need for treatments to be in teletherapy form was shown to be important. |
|
| Convenience | |||||||
|
|
Christensen et al (2019; older adults) [25] | Treatment | Depression or a range of diagnoses including depression | Video consultations for telepsychiatry (n=21) | Face-to-face (11), no control (10) | Patients reported that video consultations were more relaxing, and it was convenient to stay at home (n=3). |
|
|
|
Lin et al (2019) [30] | Treatment | Substance use disorders | Video or telephone-based Psychotherapy (n=10) remote medication management (n=3; patient presents at local clinic with nurse and are connected to a physician at a distant site via videoconference) | Face-to-face psychotherapy (n=7); telephone (n=2); treatment as usual (n=1); no control (n=3) | Participants found the increased convenience important as they would have had difficulty obtaining the intervention without telemental health (n=1). |
|
|
|
Lins et al (2014) [31] | Support for carers of people with dementia (depressive symptoms) | Carers of people with dementia (for depressive symptoms) | Telephone counseling (n=9, n=2 reporting implementation outcomes) | Friendly calls (n=3); treatment as usual (n=6) | Carers found telephone counseling good because it avoided the stress involved in coordinating an appointment (n=1). Needs for 24-hour counselor availability (n=1). |
|
aCBT: cognitive behavioral therapy.
bPTSD: posttraumatic stress disorder.
cNR: not recorded.
dRCT: randomized controlled trial.