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DepressionNCT06584422

Empower@Home: Hybrid Effectiveness-Implementation Randomized Controlled Trial (RCT)

A study testing Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depression and Telephone friendly visits in people with Depression, run by University of Michigan at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study is a randomized Type I hybrid effectiveness-implementation trial aimed at evaluating the effectiveness of Empower@Home, an internet-delivered cognitive-behavioral therapy (CBT) program supported by aging service providers, in comparison to enhanced usual care for homebound older adults with depressive… Read more about this study

Who is it for?
Ages 50 years and older
Conditions the study is for
Depression
What is being tested?
Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depression and Telephone friendly visits
Could I receive a placebo?
No, everyone receives an active treatment
How many people
256 participants
Where
1 siteUnited States
Study dates
1 Oct 2024to Jul 2029
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 50 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • (1) be receiving or eligible to receive services at the recruitment sites
  • (2) read and speak English
  • (3) be at least 50 years old
  • (4) have at least moderate depressive symptoms at screening (≥ 8 on the Patient Health Questionnaire-9 [PHQ-9]).
  • (5) Participants who are NOT currently receiving outside therapy must agree NOT to start outside therapy during study participation. Participants who are currently receiving outside therapy must agree NOT to increase their outside therapy frequency during study participation.

Who cannot join

  • (1) probable dementia based on the Blessed Orientation and Memory Scale.
  • (2) moderate or high risk of suicide based on the 6-item Columbia-Suicide Severity Rating Scale
  • (3) a terminal illness with less than six months to live or unstable physical health conditions based on self-report
  • (4) a diagnosis of a psychotic disorder like schizophrenia or bipolar disorder based on self-report and medical chart review
  • (5) severe vision impairment based on self-report (i.e., legally blind)
  • (6) current substance use disorders or receiving substance use treatment.
  • (7) currently receiving outside therapy more frequently than once a month or have started a new therapy treatment less than 3 months ago

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Xiaoling Xiang, PhD contact

734-763-6581

xiangxi@umich.edu

United States1 site, 1 recruiting
  • University of Michigan

    Ann Arbor, Michigan, 48109

    Xiaoling Xiang, PhD, xiangxi@umich.edu

    Xiaoling Xiang, PhD

    Recruiting

Other trials in United States

About this study

Official title: Community-Embedded, Layperson-Supported Digital Mental Health Intervention for Homebound Older Adults With Depression: A Type 1 Hybrid Effectiveness- Implementation RCT

This study is a randomized Type I hybrid effectiveness-implementation trial aimed at evaluating the effectiveness of Empower@Home, an internet-delivered cognitive-behavioral therapy (CBT) program supported by aging service providers, in comparison to enhanced usual care for homebound older adults with depressive symptoms. A total of 256 participants will be randomly assigned to either the treatment group (Empower@Home) or the control group (enhanced usual care) in a 1:1 allocation ratio, with randomization stratified by participating agencies.

The primary aim of this study is to determine the clinical effectiveness of the Empower@Home program. It is hypothesized that participants receiving Empower@Home will show greater improvements in depressive symptoms at 12, 24, and 36 weeks after entering the study compared to those receiving enhanced usual care. Additionally, treatment moderators will be explored and a cost-effectiveness analysis will be conducted to assess the economic viability of the intervention.

Read more

The second aim is to investigate the mechanisms of change facilitated by the intervention using a mixed-methods approach. Causal mediation analysis will examine whether the acquisition of CBT skills, reduction in cognitive distortions, and increased behavioral activation, as well as participant engagement and the therapeutic alliance with the coach, mediate the treatment effects. Qualitative interviews with participants will be conducted to provide deeper insights into these mechanisms and enhance the interpretation of the mediation analysis.

The third aim focuses on evaluating the implementation process using the updated Consolidated Framework for Implementation Research (CFIR). This will involve a qualitative process evaluation to identify barriers and facilitators to the implementation of Empower@Home, drawing on perspectives from multiple stakeholders.

Read the detailed description

This study is a randomized Type I hybrid effectiveness-implementation trial designed to evaluate the clinical effectiveness and implementation process of Empower@Home, an internet-delivered cognitive-behavioral therapy (CBT) program tailored for homebound older adults with depressive symptoms. The trial compares Empower@Home, supported by aging service providers, to an enhanced usual care condition. The study involves 256 participants who will be randomly assigned to either the treatment or control group, with randomization stratified by agency.

Rationale: Depression is a significant public health concern among homebound older adults, with approximately 50% experiencing clinically significant depressive symptoms and 14% facing major depression-rates significantly higher than those of non-homebound counterparts. Homebound older adults often encounter barriers to accessing traditional mental health services, including physical disabilities, socioeconomic disadvantages, and racial or ethnic minority status. Empower@Home addresses these challenges by leveraging the existing workforce of aging service providers to support digital mental health interventions (DMHIs).

Intervention: Empower@Home is a nine-session, computerized CBT program enhanced with entertainment elements to increase engagement. The program is specifically designed for homebound older adults, incorporating age-relevant examples and a simplified user interface. It includes features such as a character-driven storyline, short videos, and interactive exercises to facilitate learning and engagement. The program is supported by lay coaches-aging service providers trained to offer weekly support calls, enhancing program adherence and personalization.

Study Aims:

Effectiveness: The primary aim is to determine the clinical effectiveness of Empower@Home compared to enhanced usual care. The hypothesis is that participants in the Empower@Home group will show greater improvements in depressive symptoms at 12, 24, and 36 weeks post-enrollment. Secondary clinical outcomes include improvements in anxiety, loneliness, social support, quality of life, disability burden, and pain severity.

Mechanisms of Change: The study will also explore the mechanisms through which the intervention produces change. Using a mixed-methods approach, the study will investigate whether CBT-related factors (e.g., skill acquisition, behavioral activation), engagement-related factors (e.g., narrative engagement), and coach-related factors (e.g., therapeutic alliance) mediate treatment effects. Qualitative interviews will complement these findings by providing participant perspectives on how the program facilitated behavioral change.

Implementation: The study will assess the implementation process using the updated Consolidated Framework for Implementation Research (CFIR). This qualitative process evaluation will identify barriers and facilitators to implementation from the perspectives of multiple stakeholders, including older adults, coaches, and agency staff. Data will be collected through interviews, meeting minutes, field observations, and other relevant sources, and analyzed using both traditional qualitative methods and natural language processing techniques.

Study Design: Participants will be recruited from 3 to 4 aging service agencies that serve as implementation sites. These agencies represent diverse service delivery models, enhancing the study's external validity. Participants will undergo remote assessments via phone at baseline, post-intervention, and follow-up intervals at 12, 24, and 36 weeks. The study will also employ a cost-effectiveness analysis, evaluating the economic viability of the Empower@Home program from a public healthcare payer perspective.

Expected Outcomes: The study is expected to demonstrate that Empower@Home, when supported by aging service providers, is more effective and cost-effective than enhanced usual care in reducing depressive symptoms and improving other psychosocial outcomes. Additionally, the findings will provide valuable insights into the barriers and facilitators to implementing DMHIs in community settings, offering guidance for future scalability and sustainability of such interventions.

Innovation: Empower@Home integrates user-centered design principles, community participatory research, and innovative engagement strategies, such as character-driven storytelling, to enhance user experience and therapeutic outcomes. The use of aging service providers as lay coaches not only addresses the shortage of mental health professionals but also aligns with the existing infrastructure of aging services, making the program highly scalable and sustainable.

This trial will contribute significantly to the growing body of evidence on the effectiveness of DMHIs in real-world settings and inform strategies for broader implementation within community-based aging services.

Conditions
Depression
Being tested
Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depression, Telephone friendly visits
Keywords
Cognitive behavioral therapy, Older Adults, Internet-based intervention, Depression, Social isolation
Medical subject headings
Depression, Social Isolation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depressionBehavioural

    Empower@Home is an online self-help intervention based on cognitive behavioral therapy principles designed to treat depressive symptoms in older adults. The intervention has three components: 9 interactive self-paced online sessions, printed workbook that goes along the online sessions for exercises and homework, and telephone coaching by a trained staff from a social service agency serving older adults. The online sessions contain entertainment elements in the form of a character-driven story of a homebound older adults, video-based psycho-educational content, voice-over instructions, interactive exercises, and weekly home practice assignments.

  • Telephone friendly visitsOther

    Participants in the waitlist control group will receive attention control through biweekly telephone-friendly visitors. Trained project staff will call participants to provide companionship, emotional support, and a friendly conversation. In addition, the callers will conduct a biweekly assessment of depressive symptoms using the patient health questionnaire (PHQ-9), to mirror the biweekly in-app PHQ-9 assessments with the experimental group.

Study groups in NCT06584422
Study groupRoleWhat they receive
Empower@Home supported by aging service providersExperimentalParticipants will be provided with access to a 9-session online program called Empower@Home, a self-help intervention based on cognitive behavioral therapy principles. The intervention has three components: 9 interactive self-paced online sessions, printed workbook that goes along the online sessions for exercises and homework, and telephone coaching by a trained staff from a social service agency serving older adults. Participants will have up to 12 weeks to try to complete the program with the support of a trained coach.
Receives: Behavioral: Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depression
Attention call with friendly visitorsOtherParticipants will receive enhanced care as usual, including care as usual from their social service provider and a psycho-educational handout. In addition, they will receive telephone friendly calls from a research staff every other week to mimic the human interactions provided by coaches in the experimental group.
Receives: Other: Telephone friendly visits

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Patient Health Questionnaire-9 (PHQ-9)

    Change in 9 item standardized measures of depressive symptom severity. PHQ-9 score ranges from 0 to 27, with a higher score indicating more severe symptoms.

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

Secondary outcomes (6)
  1. Change in Duke Social Support Index (DSSI)-10

    Change in 10 item standardized measure for social interaction and satisfaction with social support. Total score ranges from 10 to 30, higher score means higher social support.

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

  2. Change in EuroQol 5-Dimension 5-level (EQ-5D-5L)

    Change in 5 item standardized quality of life measure. EuroQol 5-Dimension 5-level is a commonly used tool to measure health-related quality of life. The final index score for the EQ-5D-5L is calculated by converting the health states described by a respondent into a single summary index value using a scoring algorithm. The EQ-5D-5L index score typically ranges from less than 0 (worse than death) to 1 (perfect health).

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

  3. Change in Hamilton Depression Rating Scale (HAM-D)

    Change in 7-item clinician-administered assessment of depression. HAM-D is a clinician-administered interview commonly used to assess depressive symptoms and will be administered by a Master of Social Work-prepared research staff who will complete the HAMD training offered by the Center for Telepsychology. Total scores range from 0 to 26, with a higher score indicating more severe symptoms.

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

  4. Change in WHO Disability Assessment Schedule 2.0 (WHODAS 2.0)

    Change in 12 item standardized measure for health and disability. The WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) is a standardized tool developed by the World Health Organization for measuring health and disability across different cultures and settings. It captures the impact of a health condition on daily life across six domains: cognition, mobility, self-care, getting along with people, life activities, and participation in society. Total scores range from 0 to 60, higher scores means greater level of disability or loss of function.

    Measured: Change from Baseline at 12, 24, and 36 weeks

  5. Change in Pain intensity assessed by the Pain, Enjoyment, and General Activity (PEG) Scale

    Change in 3-item measure of chronic pain. The PEG Scale (Pain, Enjoyment, General Activity) is a brief, self-reported measure assessing three dimensions of chronic pain: pain intensity, the degree to which pain interferes with enjoyment of life, and the extent of its interference with general activity. Total scores range from 0 to 10, higher score means worse pain and more severe interference with life and activities.

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

  6. Change in Generalized Anxiety Disorder Assessment-7 (GAD-7)

    Change in 7-item standardized measure for severity of anxiety symptoms. GAD-7 score ranges from 0 to 21, higher score means more severe symptoms.

    Measured: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted4 Sep 2024
  2. Study start1 Oct 2024
  3. Primary completionJul 2029 (estimated)
  4. Study completionJul 2029 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
256 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06584422
Sponsor's protocol ID
HUM00254688
Other IDs
R01MH137064
Status last verified
Nov 2025
First submitted
30 Aug 2024
Last updated
21 Nov 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Individual participant data (IPD) will be shared through the National Institute of Mental Health\'s (NIMH) Data Archive (NDA), in compliance with NIMH funding requirements. The data will be available to qualified researchers following appropriate data use agreements. All quantitatively collected, non-identifying IPD, along with data dictionaries will be deposited to the NDA.

Publications

  • Xiang X, Narbut E, Zhang X, Ash S, Turner S, An R, Jester JM, Park S, Habash S, Himle JA. Leveraging Aging Service Providers to Support Internet-Based Cognitive Behavioral Therapy for Depression in Homebound Older Adults: Protocol for a Type 1 Hybrid Effectiveness-Implementation Randomized Controlled Trial. JMIR Res Protoc. 2025 Sep 5;14:e72953. doi: 10.2196/72953.

    PubMed 40910699

Questions about this trial

What is this clinical trial studying?

A study testing Empower@Home: An online cognitive-behavioral therapy self-care program for geriatric depression and Telephone friendly visits in people with Depression, run by University of Michigan at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 21 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Xiaoling Xiang, PhD (734-763-6581, xiangxi@umich.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Patient Health Questionnaire-9 (PHQ-9) (time frame: Change from Baseline to follow-up assessments at 12, 24, and 36 weeks). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06584422, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 21 Nov 2025.

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