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Sustainable Upscaling of Depression Prevention - finding the optimal balance between investment and benefit (The SPRINT project) TGiven the substantial prevalence rate of Major Depression and its extreme burden on the society in terms of human suffering and economic costs, depression prevention has a high priority on the Dutch public health agenda. Preventive interventions for adult subclinical depression are found to be effective in terms of decreasing depressive symptoms and preventing or delaying a full-blown depressive disorder with effects in the small to moderate range. However, preventive interventions are not successfully rolled out on a large scale yet. Reasons for this gap include that many individuals may lack awareness of being at risk; or think these interventions are not effective. From a system perspective these interventions may be too costly to upscale such as is the case with face-to-face preventive interventions for the general population. Preventive internet interventions may overcome a number of these barriers as they they can be reach out to target populations on a large scale. Internet interventions do face however a number of upscaling challenges as well. For example, how can they engage end users in such a way that they can be tailored to the personalised needs of these users and can be integrated in their daily routine patterns easily. The adherence to internet intervention by these end users could be improved as well and thereby their potential effectiveness. Given the aim of reaching out to large populations the question is also how do we get the best prevention value against affordable costs.

The SPRINT project aims at optimizing Moodbuster-Lite which is a cognitive hehavioural preventive self-guided intervention for individuals with subclinical depressive complaints. It consists of four lifestyle-related modules: psychoeducation, behavioural activation, physical activity, and problem-solving. The aim of SPRINT is to optimize Moodbuster-Lite by (1) improving its adherence and effectiveness, and by (2) facilitating the scalability of the intervention to (3) ultimately be able to successfully roll-out the intervention among the general population on a large scale. Four add-on intervention components and their interactions will be evaluated, being personalization, motivational interviewing, ecological momentary assessment, and guidance. These components are thought to improve uptake of and adherence to the intervention by increasing user satisfaction and motivation, decreasing resource investments, and facilitating the incorporation of Moodbuster-Lite in daily routines by personalizing it to target group specific needs. We will evaluted whether the add-on components contribute to higher effectiveness of the intervention either alone or in interaction in terms of improved mood. Secondly, effectiveness of these specific components will be weight with the demands of the target group in terms of costs, time investment, and implementation in daily life.

We will make use of an innovative research framework (the Multiphase Optimization Strategy (MOST)) which enables us to answer our research questions in a relatively brief period of two years and against relatively low budget when compared with more traditional methods such as a randomized controlled trial when applied to the same research questions. The results of SPRINT will result in knowledge that contributes to the succesfull upscaling of eMental health prevention for subclinical depression. Following MOST we will use the preparation phase to gather input from a wide variety of end users and stakeholders regarding the add on components and their applicability. In the optimization phase, the effects of the add-on components are evaluated by using a 24 full factorial design. The Moodbuster-Lite intervention will be implemented as a constant component and combined with all possible combinations of the add-on components resulting in 16 experimental conditions (sample size N - 304 participants). The results of the optimization phase will be an overview of which components or their combinations are active, the degree of their effectiveness, as well as the resources (cost/time investments) involved in the different combinations will be demonstrated. In phase 3 of the project we will develop, based on these results, several upscaling scenarios in close collaboration with the end-users and relevant stakeholders as well. The SPRINT project thus develops a variety of implementation scenarios as a final step of the project. Policy decisions can be made on the allocation of intervention packages to different target groups and their demands based on a trade-off between effectiveness and cost/time investments representing an optimal balance between monetary investment and expected effects.


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