The primary outcomes that will be measured include changes in symptoms of depression based on the following clinically validated symptomology questionnaires: Patient Health Questionnaire-9 (PHQ-9) and the Quick Inventory of Depressive Symptomatology Questionnaire [33,34]. An additional measurement of quality of life change will be made based on the Quality of Life and Enjoyment Questionnaire [35]. All questionnaires were shown to be reliable and highly valid. Questionnaires will be collected directly through OPTT before treatment (baseline), after session 6, after the final session (week 12), and after a 6-month follow-up. Participants will not be offered incentives to increase the completion of the questionnaires. OPTT will collect use statistics (ie, log-ins per day and amount of time spent logged in) to help better understand the relationship between engagement and treatment outcomes.

Through the focus groups, health care providers will be asked about the feasibility of providing the electronic-delivered psychotherapy program and how it compares with in-person psychotherapy delivery. They will be asked to make their judgments based on variables such as time commitment, connectedness to patients, and benefits and drawbacks. From the focus group interviews with the participants, personal, social, and cultural factors (eg, gender, sexuality, background, supportive resources, and structural or social barriers) will be extracted using an interpretive phenomenological analysis approach. In addition, any adverse events and adherence to the intervention will be reported.

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