An evaluation of stakeholder needs for gambling E-mental health services in Aotearoa New Zealand

Abstract

Background: Gambling-related harm is a major public health issue in Aotearoa, New Zealand but expert treatment services are under-subscribed. E-mental health could be a way to expand the stepped care model and increase access to services and expert clinicians. A blended approach that involves e-mental health and expert support could also be a way of increasing client engagement and retention. This thesis sought to determine the needs and preferences for gambling specific e-mental health in New Zealand with a focus on self-help screening and internet delivered CBT (i-CBT). Methods: A series of iterative and interconnected activities were undertaken. A needs analysis was conducted with 47 gambling providers and consumers in New Zealand. The needs analysis delivered a survey via Qualtrics to understand service provider and consumer experiences and preferences towards e-mental health and preferences for the configuration of two e-mental health tools. The second activity involved a co-design Hui that brought together gambling experts from across New Zealand to finalise the configuration of the two new e-mental health tools. Thematic analysis was used to code extensive notes taken during the co-design Hui. Results: The needs analysis found high agreement that e-mental health tools were helpful, valuable and relatively easy to use. The main benefits were increased access and reduced barriers to treatment. The main disadvantages were perceived loss of face-to-face time/resources. In terms of the self-help screener, participants reported a preference for it to be around 10 minutes in duration with support delivered by email, chat, and phone or face-to-face. Implementation issues included technical and clinical training, mentoring and supervision as well as cultural competence. In terms of a blended approach for i-CBT, participants reported it was feasible and the preferred duration of i-CBT was around 30 minutes per week. Findings from the co-design Hui suggested most support for a partial blend whereby clinicians and counsellors selected intervention content at each episode of care. Conclusions: Gambling treatment services in New Zealand are ready and willing to introduce a blended model into face-to-face services. This study found support for both a self-help screening tool and blended i-CBT as part of treatment as usual. The findings from this study will inform a new co-designed e-mental health programme for gambling harm reduction.