In chapter 2 a research question with six sub questions was constructed. Answers to these are given per category from integrative research model (chapter 2).
5.1.1 Reasons for remaining anonym
In the first place the results give an answer to the first sub question: What are the reasons of participants for not choosing for the non-anonymous variant?
Through analyzing the questionnaire it has been shown that there are several reasons and motives for people wanting to stay anonymous. The analysis of the psychological and instrumental Barriers proved that the option to choose between the anonymous variant and the other treatment variants represents the main barrier for participants. The opportunity to choose between anonymous and non-anonymous seems to be an important reason why people do not participate non-anonymously.
Furthermore, participants’ stated having a problem with their employer and their social environment knowing about their alcohol abuse problem which can be related to their fear of stigmatization. The mean score result (4.00) of the stigma item “De meeste mensen denken negatief over mensen met een alcoholprobleem” showed that the fear of being stigmatized is a relevant Barrier for participants when thinking about signing up for the non-anonymous variant. Additionally, participants indicated that they did not want their general practitioners and health insurance to know about their abuse problem and that they are concerned about their privacy. People were also afraid that there could be wrong conclusions drawn on the basis of their alcohol problem regarding their future health problems and care. These fears contributed to the participants’ behavior of avoiding the non-anonymous treatment variant to avoid these fears.
Items regarding the fear or uncertainty of additional insurance costs resulted in low mean scores. Having to pay a contribution to health insurance did not appear to be no reason for participants to choose against the non-anonymous variant. This finding might also be related to the fact that most participants are well earning.
Concerning the Information Status, there seems to be a wide knowledge gap with approximately half of the participants not having read the information about the alternative treatment options. Also, 61% of the participants stated that they did not know that they could start immediately when choosing one of the alternative options. These results show that the insufficient knowledge status and advantages about the alternative options are given.
After providing the sufficient information about the procession of identification information and the advantage of no waiting time only 21% of the participants stated that they were intended to sign up for the non-anonymous variant. This number seems low but it means that two out of ten people can be persuaded to sign up for the non-anonymous variant providing being sufficiently informed. Therefore we can conclude that the waiting time did not play a role for participants when deciding about their treatment variant.
The second sub question in the study was: Is there a relationship between the Motivation to change and the Intention to sign up for the non-anonymous variant?
The correlation between general Motivation and Intention to sign up for the non-anonymous variant was positive but very small (.033). There was no significant relationship found between these variables. Most participants indicated that they do not intent signing up for the non-anonymous option after having read the additional information about the advantages and conditions of the non-anonymous option. This shows that even if most people are highly motivated to change their drinking behavior through participating in the anonymous treatment, they do not perceive the waiting time as a big barrier when it comes to choosing between anonymous and non-anonymous variant. That might be due to their unawareness of the actual waiting time duration and their perceived advantage to take part anonymously.
For most respondents the intention to sign up for the non-anonymous variant was low. Nevertheless, there was a small group who did indicate that they would sign up for the non-anonymous variant after being informed about the actual enrolment procedure and storage of personal details. This finding suggests that factors like Solution Suggestions and Information Status exert some influence on participants Intention to sign up for the non-anonymous variant. This assumption has been confirmed by linear regression analysis.
Furthermore the results gave answer to the third sub question: Which psychological constructs exert influence on the Intention to sign up for the non-anonymous variant?
Correlation analysis showed that the intention to sign up for the non-anonymous variant is namely dependent on Solution Suggestions and Information Status of the participant. There had been no significant correlation between any of the other constructs and Intention.
The Subjective Norm didn’t seem to play an important role in the outcome behavior of participants. This is implied by the fact that despite most of their family and friends wouldn’t want them to follow the treatment, respondents still signed up for the treatment. This finding was also grounded by the mean score of the Subjective Norm item. It was found to be 2.73, meaning that the positive perceptions of Subjective Norm about the online treatment is relatively low
If there should be an influence of Subjective Norm on the intention to sign up for the treatment it would be a negative correlation. But the participating people had already signed up for the online treatment and therefore it might not have played such a big role in decision making. This might be the reason though, why most people wish to remain anonymous. Being known as an alcoholic is not a socially desirable.
The resulting mean score of the Perceived Severity variable (4.41) shows that most participants perceived their alcohol abuse problem as a serious problem and that they were thinking about doing something about their alcohol consumption for some time. Although participants rate their Perceived Severity of alcohol abuse as high (=serious), this variable seems to have no influence on the Intention of people concerning the enrolment-attitude for the non-anonymous variant.
The construct Perceived Self-efficacy had a mean score of 3.74, which shows that participants generally see themselves as able to change their drinking behavior. There is also no significant correlation found between Perceived Self-efficacy and Intention.
The findings about the Outcome Beliefs of treatment have shown to be consistent with the findings of Subjective Norm. These findings state that attitude of family and friends had no impact on the Intention of participants which variant to follow. With the Outcome Beliefs the least important one was to improve the relationship with family and friends. People don’t aim to improve their relations with family and friends through the treatment. Participants added the goal to reduce their alcohol consumption, win back the control over alcohol consumption and being a role model for their children in the open part of the question.
5.1.4 Solution Suggestions
The fourth sub question: Which Solution Suggestions are perceived as stimulating for people to sign up for the non-anonymous treatment?
Respondents who rated the Solution Suggestions high were also more likely to indicate having the Intention of signing up for the non-anonymous variant.
Our goal with this construct was to find the most influential Solution Suggestions for participants. These important Solution Suggestions would then be manifested through research and will form the basis for further adjustments and changes of all important aspects of the program. The results indicated that clients would like to have more control about the handling of their data. The suggestion to automatically delete the identification information of every participant after finishing therapy was rated very high. This finding confirms our assumptions about participants’ resistance of giving up their identification information and is also consistent with the predictions of the “Pathway Disclosure Model.” This model states that people are going to be more willing to participate in a treatment if they do not to publish any identification information. In this way people remain in control of their identification information and do not have to worry about losing their anonymity. These findings show that perceived control about identification information plays an important role for people when deciding about signing up for a treatment option.
The fifth sub question: Do participants hold some important suggestions about how to stimulate people to participate via the non-anonymous pathway? was given by qualitative results.
Some participants mentioned the idea of replacing the non-anonymous variant with a larger anonymous one through letting all the insurance companies and the government pay for it. In that way the anonymous option would have more places of patient intake. Other suggestions hold the idea of indicating the advantage of the shorter waiting time more clearly, taking out the necessity of a referral letter from general practitioner and automatically deleting all the personal details after finishing the treatment. These additional Solution Suggestions given from participants contain the tendency of a larger anonymous variant instead of improving the acceptance of the non-anonymous one. Only one participant stated that she would sign-up for the non-anonymous variant when having known about the waiting time of five month. This finding is consistent with earlier findings about the weak impact of waiting time on Intention to sign up for the non-anonymous variant.
Finally the results gave answer to the sixth sub question: To what degree do Demographics influence the intention to sign up for the non-anonymous variant?
The distribution of gender was as expected, twice as many women than men participated in the survey and the education level is also higher than average with most participants in higher applied education (HBO). About 75% of the participants work in a full- or part time job or are self employed. No significant relationship could be observed between Demographics and Intention through the statistical analysis.
The comparison of the anonymous and non-anonymous group to detect the significant differences of participants resulted in interesting outcomes. Women are highly represented in the anonymous variant. Here, there is a clearly difference between the distribution of man and women. In the non-anonymous variant, the gender differences are not that wide. For the remaining variants, there could not been detected a significant difference between the groups. Although it can be seen (in the frequency table 4.2) that there are about three times as many participants in the age group from 25-35 years undergoing the non-anonymous treatment in comparison to the anonymous one. The differences in education and occupation are minimal. There can no conclusions be drawn from this analysis because it is not based on recent literature in the field and requires further investigation.
These conclusions allow giving an answer to the main research question: How can future participants be stimulated to sign-up for the non-anonymous treatment option (insurance paid)?
The research was an exploration into the factor influencing the Intention of participants to sign up for the online treatment. The executed research resulted in several conclusions which are summarized in the following recommendations. The following general recommendations address any deficiencies in the participants score in the examined factors to enhance participation in the non-anonymous treatment option.
Participants indicated that the possibility to choose between the anonymous and the non-anonymous options represents the largest barrier regarding the enrolment Intention for the non-anonymous option. As long as there is an anonymous option, people will rather go for that one than facing all the perceived fears of participating non-anonymous. Therefore, it is recommended to either leave the anonymous option out, to rename the options or to enlarge the number of clients for whom will be paid for under the anonymous treatment. If it should be possible for everyone to participate in treatment even Dutchman living abroad or people without a health insurance covering the treatment there could still be arranged the “emergency-option” where people have to explain their reasons of not being able to take part through one of the other options.
The information and advantages about the alternative options should be presented more eye-catching because about 50% of the respondents stated that they didn’t read the information of the alternative options. Instead of placing the four alternative option-buttons on one page next to each other there could be a new division of the options. Also, the fact that there is a waiting list for the anonymous variant and that participants may start immediately when choosing the non-anonymous variant should be stated more clearly on the website.
Only one person out of sixty-two stated that the long waiting time would be a reason for her to sign up for the non-anonymous variant if she would have to decide again. Beforehand most people either don’t know about the differences in waiting time among the variants or have no idea how long it will take to get a place in the treatment. Therefore, the aspect of waiting time should be stated more clearly and people should be able to get an idea about how long the waiting time would be before signing up and be given the possibility to start immediately through the non-anonymous option.
Participants’ fears regarding their loss of privacy have to be taken serious. There has to be found a way to give them a feeling of control about their identification information. Many respondents rated the Solution Suggestion “deleting the personal details after finishing the treatment” very high. This possibility should be taken into account and it could be tried to find an agreement between the participants and the health insurance needs to promote participation in the non-anonymous treatment.
Eventually, further research needs to be conducted to further clarify the “impact of waiting time.” In this study it was found that about 60% of the participants were not aware about the fact that there is no waiting time for the non-anonymous variant. It has been shown that even when people are aware of this advantage, most of them didn’t intend to sign up for the non-anonymous variant. This shows that the disadvantage of having to wait for treatment doesn’t seem to be an important barrier for participants influencing their Intention. Thereby, the question arises whether the participants feel and think like that (feelings and thoughts are caused/supported) due to their insufficient knowledge about the duration of waiting time or because they perceived advantage of anonymity outweighs the perceived disadvantage of having to wait for treatment. Furthermore it would be interesting to examine the threshold of tolerated waiting time.
The following central points should be considered by Tactus:
Take out the anonymous option to intensify the participants attention on the non-anonymous one