Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

Abstract

Background The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.

Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study

“…Participants suggested that goal setting, quantified self-tracking, and pain journals could help adolescents in overcoming this barrier, by registering pain triggers, identifying pain thresholds, and assessing the value of behavior change. This resonated with the findings by Slater et al [ 69 ] about how adolescents were capable of setting personal recovery goals and the descriptions by Moon et al [ 72 ] and Lalloo et al [ 87 ] about quantified self-tracking's potential for enhancing adolescent-GP communication during clinical encounters, by allowing the adolescents to capture, explore, and articulate connections among management experiences, reflections, and outcomes [ 88 ]. However, our findings expanded upon this by illuminating the gap between ensuring that the self-tracked data are actionable to the adolescents and integrate into the GP’s decision-making process to facilitate mutual articulation.…”

“…These studies focused on using mHealth data for enhanced communication during consultations as a driver for behavior change but provided little insights into how core features should accommodate the nonlinear, context-sensitive nature of mHealth interventions [ 38 ] or how to include parents as informal carers between GP consultations [ 71 ]. Systematic reviews by Moon et al [ 72 ] and Slater et al [ 68 ] corroborated participants’ visions about how mHealth could improve communication between GP clinics and home environments to facilitate collaborative care. However, both reviews highlight how adjusting apps to be integrated into formal and informal tasks and workflows of GPs and patients is crucial to ensure meaningfulness and continual use of mHealth and other digital patient education concepts.…”

“…Several studies outlined mHealth’s potential for improving patient-clinician communication during consultations [ 35 - 37 , 68 , 72 ], but little knowledge exists on how mHealth apps could be used to build patient-GP relationships across time—a core theme in collaborative care [ 49 ]. Our analysis outlined how GPs took on the role as change agent during consultations, which entailed alternating between the expert and guide role to guide adolescents toward independence in management.…”

An mHealth Platform for Augmenting Behavioral Health in Primary Care: Longitudinal Feasibility Study

“…For example, our intervention allowed the BHCM to nudge patients to engage with psychoeducational materials. Higher engagement can potentially be achieved by personalizing technology to deliver the right content in the right amount and at the right time [ 11 , 30 , 31 ]. Future research should identify pathways for personalization and investigate its effects on engagement and clinical improvement.…”

“…Despite the theoretical benefits of app-augmented collaborative care, relatively little is still known about the feasibility of app usage in collaborative care. It is unknown whether patients in collaborative care settings are likely to use apps, what features of mobile apps are the most beneficial in this setting, and what patient population(s) may be the most likely to benefit from app-augmented collaborative care [ 11 ]. For example, in the broader literature on mHealth, there is concern that older individuals may be less familiar with technology and may therefore be less inclined to engage with it [ 21 ]; however, this has not been systematically examined, to our knowledge, in the collaborative care setting.…”