A quantitative observational cross-sectional study was performed. We translated the knowledge assessment test from Donovan et al [25]. For attitude assessment, we used the translated version the questionnaire applied in the study of Becker and Jensen-Doss [28] after obtaining approval from the authors. The translation process followed the guidelines detailed in Sousa and Rojjanasrirat [29].

This study targeted health care workers who could potentially deliver cCBT such as psychiatrists, psychologists, and social workers, among others, and was carried out between February and March of 2018 on a clustered sample spanning tertiary hospitals in Riyadh, Saudi Arabia. Due to poor responses and limited resources, an expanded data collection to span electronically collected data from mental health professionals in the Kingdom of Saudi Arabia was needed; therefore, we altered the sampling technique to convenience sampling. Similar to the Australian study results [25], the target sample size was calculated using the following equation by setting Z_α to 1.282, S to 1.48, and d to 0.2, to obtain 90% confidence: n=Z_α² S²/d²=(1.282(²) 1.48(²/(0.2)²=90, where Z_α is the normal deviate, reflecting the type I error (calculated for 80% error); S is the standard deviation; and d is the accuracy of the estimate.

Considering a nonresponse rate of 30%, the total target sample size was 117 participants (90+27). With relaxation of the sampling technique, a total sample size of 121 participants was reached. A pilot study was performed with 10 mental health care professionals at King Khalid University Hospital in Riyadh (who were not included in the sample) to estimate the time needed to fill out the survey, assess the questionnaire’s comprehensibility, and determine any additional logistical requirements.

All participants were informed of the purpose of the study and their right to withdraw at any time without any obligation toward the study team via a consent form. No incentives or rewards were provided for participation. The study design and purpose of the study were approved by the King Saud University Institutional Review Board before data collection commenced.

Data were analyzed using Statistical Package for Social Sciences version 22 (IBM Corp). Continuous variables such as age are expressed as mean (SD), whereas categorical variables are expressed as frequency and percentages. The t test and one-way analysis of variance were used to compare continuous variables. A P value <.05 was considered statistically significant.

Our study assessed mental health care professionals’ knowledge and attitudes toward cCBT. Most of the participants were uncertain and lacked knowledge. However, the majority of participants agreed and believed in cCBT, and were confident about using it. One of the main reasons for this lack of knowledge is the lack of availability of cCBT programs in Arabic. Moreover, it appears that lack of knowledge about cCBT is not limited to Saudi Arabia, as this issue has also been demonstrated in other regions [7,24]. Nevertheless, this lack of knowledge does not greatly influence the attitude toward using computers, which is somewhat similar to the findings in Australia [25]. This suggests that lack of knowledge about cCBT is easy to overcome and does not affect the attitude toward cCBT. However, the authors of the Australian study concluded that it is possible to change the knowledge of mental health workers about cCBT, at least to some extent, by providing them with accurate information and demonstrations as needed [25]. In another study, the attitude toward computer usage showed a positive trend, which may provide more opportunities to benefit from cCBT [26]. These results indicate a promising future for more involvement with this approach [18,20,21].

In another study, Computer-Based Training Attitudes Scale scores were higher among therapists who reported having previously used computer-based training. Negative responses toward computer-based training largely originated from those facing greater practical barriers to the use of computer-based training [26]. In our study, there was no difference in cCBT knowledge between professionals with different backgrounds (eg, psychologists, psychiatrists, social workers, and others), which is similar to the results of the Australian study [25]. The reason could be that there is no difference in teaching and training among different specialties regarding cCBT. Most of our participants were unsure of their answers when asked about cCBT, which is similar to the results reported by Donovan et al [25] in Australia, as most of their participants had little to no knowledge of cCBT.

Clinically, cCBT can be beneficial. Reviewed advantages include flexibility in time and location, cost-effectiveness, reduction of personal stigma, time of the mental health care professional, time of waiting for treatment, the behavior of asking for help and guidance, and being satisfied by the provided treatment [30]. Despite the benefits mentioned, to accept cCBT as an alternative to the usual approach, more research should focus on how it works as an intervention [30]. There are some noted disadvantages of cCBT. Some primary concerns raised are the possible inadequacy of the therapeutic relationship and omission of the professional’s contact. Another concern is that the program is not customized to each user [21]. Moreover, some professionals doubt the competence of care provided through computers [30], and the majority still consider that the usual intervention is more effective and preferable [18,20,21].

Future research should aim to recruit greater numbers of participants with various levels of training, skills, and different backgrounds so that effective comparisons can be made [25]. Future research should also provide clinicians with a chance to use cCBT with their clients to investigate if they would choose it. This could help generate a behavioral measure rather than assessing “intention” only [25]. The knowledge assessment in our study was very narrow, with only six questions. Future research should include a larger number of questions assessing knowledge to ensure that any information the participants may have is reflected in their knowledge scores [25]. In addition to the suggestions for future research, replicating the study several times over the next 10 years would be interesting as changes in the country are occurring rapidly [25]. In addition, assessing patients’ attitudes in Saudi Arabia toward cCBT would be very helpful.

We used an electronic questionnaire to reach the participants in Riyadh through data collectors. We did not receive a sufficient number of responses because of the limited mental health care professionals in Riyadh, and therefore we reached out to different cities in Saudi Arabia by sending an invitation through WhatsApp groups and emails. Future research should expand this approach by including a larger participant population. Future research should also provide participants with a broader range and more items in the knowledge test.

The results of this study suggest that mental health care professionals in Saudi Arabia are in need of more education and training regarding cCBT; however, their attitudes toward its use, and their comfort in using computers in general, show great promise.

Lack of knowledge did not affect the participants’ attitude toward cCBT, as they demonstrated a positive attitude overall. In addition, we recognize that mental health care professionals need more involvement in various up-to-date therapeutic approaches and need more resources for cCBT in Arabic. Further research should be performed to assess patients’ acceptance of cCBT in Saudi Arabia along with clinical trials measuring its effectiveness in the Saudi population.