Evaluation and optimisation of the Tinnitus E-Programme, an internet-based intervention for tinnitus self-management

Internet-based self-management interventions have the potential to reduce the current disparity in access to psychological support for people with tinnitus. One example is the Tinnitus E-Programme, which was developed in the United Kingdom to support self-management in people with tinnitus. Although freely available online, there was little understanding of how the intervention is used, its active ingredients, how it works, the circumstances in which it works best, and whom it works best for. This PhD aimed to address these issues by evaluating and optimising the Tinnitus E-Programme. A systematic review of self-help interventions for tinnitus was conducted, which concluded that there was a need for further evaluations of unguided self-help interventions in UK populations. A mixed methods study explored past, current, and new users’ (n=40) views and usage of the Tinnitus E-Programme (1.0), demonstrating that it was acceptable to people with tinnitus. However, its implementation was limited by instances of poor usability, user engagement, and adherence to behavioural goals. Consistent with a person-based approach, the findings from this mixed methods study were used alongside evidence-based (i.e. systematic and literature reviews) and theory-based (i.e. behavioural analysis and logic modelling) approaches to develop the Tinnitus E-Programme 2.0. Think aloud interviews with 19 people with tinnitus evaluated this new version of the intervention and findings revealed that the Tinnitus E-Programme 2.0 was acceptable to its target users. The two primary research studies highlighted how users’ pre-existing beliefs regarding tinnitus and self-management, their perceptions of relevance, and the nature of tinnitus can influence users’ engagement with the Tinnitus E-Programme 1.0 and 2.0. Several cognitive factors (e.g. illness beliefs), behavioural factors (e.g. practicing relaxation), and behavioural determinants (e.g. motivation to practice relaxation) were identified by us