U-CARE brings psychology into the digital age

As the resources of the traditional healthcare system grow increasingly strained, the need for economical perspectives on healthcare is greater than ever. The effect of treatments must be weighed against their costs and new, more cost-efficient alternatives are being tested. In 2010, the government assigned Louise von Essen, psychologist and Professor of Health Sciences, the task of creating the foundation for a new research platform for psychological support and treatment via the internet. This resulted in the U-CARE portal, a digital infrastructure which offers patients psychological treatment and support for issues resulting from physical illnesses, while also providing a chance to study the effectiveness of the aid provided.

‘Treatment is exclusively administered online, and revolves around exchanges between patient and portal. Of course, we also include a certain amount of human contact, practically a necessity if good results are to be achieved, but the time our therapists spend on each patient is only about 10-20 percent of that of traditional treatment,’ says Sven Alfonsson, psychologist and doctoral student at the Department of Public Health and Caring Sciences.

The treatment provided through U-CARE is thus far primarily conducted within the framework of research at Uppsala University. Today, the portal is used for some ten studiesof various groups, and the Swedish Research Council concludes in an evaluation from 2015 that U-CARE has made good use of its resources in the process of establishing itself as a research environment – yet the road to a functional tool has not been an altogether straight one.

‘In a pilot study of cancer-stricken young adults, we found it difficult to attract participants, and it was not until we conducted panel discussions with the target group that we realised what sort of modifications we needed to make in order to interest teenagers. This also underlined the importance of working together with our target groups, and ever since, we make it a point to involve the prospective users throughout the entire process. This has been immensely helpful as we develop the portal and its associated treatments to meet user needs,’ says Helena Grönqvist, researcher at the Department of Public Health and Caring Sciences.

Not even a well-designed infrastructure can guarantee therapeutic success, however. Despite its emphasis on user friendliness and relevance, about one in every five participants opts out of treatment after the first session. The underlying reasons have not yet been established, but U-CARE is clear on the fact that online therapy is not a perfect fit for everyone.

‘Our statistics show that middle-aged, highly-educated and female users are most likely to make it through the full process, and for pragmatic reasons, I am leaning towards reducing the total number of participants rather than having a disproportionate number of them opt out. At the same time, we have to get better at identifying every patient’s individual drive to participate and adjust the therapy accordingly,’ Sven Alfonsson says.

The development of U-CARE continues, and in keeping with the notion of action research*, the organisation has hired a family member of a previous patient, whose experiences represent valuable data to the ambition to regularly overhaul the programme according to the keywords: Accessible design, Relevant functions, More efficient uses of the time of therapists. In parallel, a programme for continued establishment of the U-CARE portal as a national resource for research on psychological support and treatment is being drawn up.

‘In the relatively near future, we will be able to offer a completed product. Therefore, we must find collaborative partners for innovation and implementation in short order, among other things. Thus, in accordance with the recommendations of the Swedish Research Council, we have formulated a plan for our development and how to anchor U-CARE’s treatments in traditional healthcare – because even though we build for research, our focus remains firmly on the patient,’ says Helena Grönqvist.

Facts: U-CARE and internet-based self-help

• U-CARE is an interdisciplinary research programme at Uppsala University with the overarching goal to prevent and ameliorate psychosocial conditions in patients and family members resulting from physical illnesses.
• The U-CARE portal is an internet-based platform also developed to support research. The self-help programmes provide information, interactive support and cognitive behavioural therapy.
• U-CARE is one of 43 state-funded strategic research areas in Sweden.

* research with active participation by those affected by a planned change

Visit the U-CARE website

See also the interview with Louise von Essen

Magnus Alsne