Project Summary:
Integrating digital mental health interventions (DMHIs) into aging services agencies offers a scalable and
potentially cost-effective approach to mitigating the mental health disparities experienced by homebound older
adults. This process involves using aging service providers to deploy DMHIs and assist older adults in initiating
and consistently using these digital tools. The long-term goal of the proposed study is to identify the features
that define effective DMHIs for homebound older adults and to cultivate sustainable strategies for implementing
DMHIs within community-based aging services. The specific aims are to (a) determine the clinical effects of
Empower@Home—a novel DMHI explicitly designed for homebound older adults and supported by lay
providers within aging service agencies—against enhanced usual care; (b) examine the intervention change
mechanisms; and (c) evaluate implementation process by identifying barriers, and facilitators from multi-
stakeholder perspectives. Empower@Home applies the established principles of cognitive-behavioral therapy
(CBT) to address depressive symptoms prevalent in homebound older adults, enriched with engaging,
character-driven storytelling conveyed through short videos. Preliminary research indicates that
Empower@Home outperforms similar programs in usability and shows remarkable adherence (90%
completion rate) and clinical efficacy when supported by trained research staff. The current project proposes a
randomized Type I hybrid effectiveness-implementation intervention trial with 256 low-income homebound
older adults served by three aging service agencies in Michigan. Participants will be allocated to receive either
Empower@Home supported by agency staff or enhanced usual care. This intervention comprises nine self-
help online sessions presented via short videos and text narrations on a dedicated web platform, accompanied
by a physical workbook summarizing sessions and featuring worksheets for home exercises, plus weekly
coaching calls conducted by trained agency staff. Enhanced usual care encompasses aging services such as
case management and home support, augmented with a handout that includes psychoeducation, local
resource guides, and bi-weekly depression assessments. Depression symptoms will be primarily measured
using the Patient Health Questionnaire-9 (PHQ-9) at 12, 24, and 36 weeks post-baseline, complemented by
five in-app assessments during sessions 1, 3, 5, 7, and 9. A combination of methods will examine and explore
CBT-associated, engagement-related, and supporter-related change mechanisms. Furthermore, a qualitative
assessment of the implementation process will be undertaken, with data being analyzed through traditional
qualitative data analysis and natural language processing techniques. It is hypothesized that the treatment will
prove superior to the enhanced usual care.
