Digital Health Interventions in Depression Care—A Survey on Acceptance from the Perspective of Patients, Their Relatives and Health Professionals

Häfner, Jessica; Schönfeld, Simone; Tokgöz, Pinar; Choroschun, Katharina; Schlubach, Arndt; Dockweiler, Christoph

doi:10.3390/healthcare10102019

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…Also, self-reported competence and actual behaviour may differ in practical situations. Another interpretation of this finding could be that digital skills have a minor role for participants: Previous research on patients' mobile health adoption identified users' self-efficacy as an essential component for digital mental health interventions adoption ( 19 , 46 , 60 , 61 ). Taken together, this suggests that patients tend to perceive digital skills as a small hurdle if they are convinced they may benefit from DTx.…”

Section: Discussionmentioning

confidence: 98%

A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription

Posselt,

Baumann,

Dierks

2024

Front. Digit. Health

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BackgroundDepressive disorders are an emerging public health topic. Due to their increasing prevalence, patients with depressive disorders suffer from the lack of therapeutic treatment. Digital health interventions may offer an opportunity to bridge waiting times, supplement, or even substitute in-person treatment. Among others, the Unified Theory of Acceptance and Use of Technology (UTAUT) explains that actual technology use is affected by users' behavioural intention. However, patients' perspectives on digital interventions are rarely discussed within the specific context of primary care provided by general practitioners (GP) and need further exploration.MethodA qualitative study design with semi-structured interviews was used to explore DTx-acceptance of patients with mild or moderate depression (n = 17). The audio-recorded interviews were transcribed verbatim, coded, and thematically analysed by qualitative content analysis.ResultsPatients' performance expectancies reveal that DTx are not perceived as a substitute for face-to-face treatment. Effort expectancies include potential advantages and efforts concerning technical, motivational, and skill-based aspects. Moreover, we identified health status and experience with depressive disorders as other determinants and potential barriers to patients' DTx acceptance: Difficult stages of depression or long-time experience are perceived hurdles for DTx use. GPs' recommendations were just partly relevant for patients and varied according to patients' consultancy preferences. But still, GPs have a crucial role for access due to prescription. GPs' influence on patients' DTx acceptance varies between three situations: (1) pre-use for consultation, (2) pre-use for access and (3) during DTx-use. Further, GPs' guidance could be especially relevant for patients during DTx-use in routine care.DiscussionThe UTAUT-based exploration suggests that acceptance determinants should be considered independently and embedded in personal and situational aspects. DTx require a healthcare professional to prescribe or diagnose the disease, unlike other digital offerings. We identified prescription- and depression-related determinants, exceeding existing theoretical constructs. GPs' guidance can compensate for some barriers to DTx use e.g., by increasing commitment and motivational support to strengthen patients' acceptance.ConclusionWe argue for a multidimensional integration of acceptance determinants for further development of health technology acceptance research. Future research should specify how DTx can be integrated into routine care to strengthen user acceptance.

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Section: Discussionmentioning

confidence: 98%

A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription

Posselt,

Baumann,

Dierks

2024

Front. Digit. Health

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“…One study in particular did not allow for single attribution of information to the group of healthcare professionals. 16 And due to the different study designs, different medical conditions and subjective selection of questions in interviews and surveys may bias the results, especially as some studies focus on special DHAs that include special features and obstacles not transferable to all kinds of DHAs. Some studies incorporated service providers that already had experience with DHAs.…”

Section: Discussionmentioning

confidence: 99%

Rapid review on the incentives of digital health apps for physicians and psychotherapists: A German perspective

Kreuzenbeck,

Schneider,

Brenner

et al. 2024

DIGITAL HEALTH

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Objective The Digital Healthcare Act introduced the prescription of digital health applications under specific circumstances in 2019 in Germany. They are funded through the social security system. In market access of prescribed digital health applications, Germany is pioneering the market. There remains a gap in understanding the views of medical professionals on the incentives of using these applications. As prescription of digital health applications starts emerging in other European countries, we sought to generate an overview of incentives and barriers that affect the caregivers in their decision of promoting and prescribing them in Germany. Methods A Rapid Review of the Web of Science database for the years 2017–2023 was performed using sensitive search strings. Two reviewers conducted a three-phase selection via title, abstract and full-text independently from each other. The quality of studies was assessed systematically by both reviewers. Both quantitative and qualitative studies with primary data were included, and study quality was assessed using a standardised form. Results Out of 1643 initial results, 12 studies with information from 9302 physicians and psychotherapists were identified. Eight quantitative and four qualitative studies were included in the analysis. Key findings suggest that while between 40% and 60% of caregivers see relevant incentives mainly based on patients’ benefits, 20–40% see relevant barriers. For the physicians’ daily work, there were slightly more barriers than incentives identified in the quantitative synthesis. The qualitative studies revealed no relevant incentives that were not attributed to patients. Conclusion While digital health solutions offer promising avenues for enhancing patient care, their acceptance among healthcare professionals hinges on addressing prevailing concerns. Continuous research and dialogues with the medical community are pivotal to harness the full potential of digital health applications in healthcare.

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“…In our study, the main reason for refusal was financial. In a survey of patients with depression [ 20 ], the fact that all costs are covered is a factor that facilitates acceptance. Our results may differ from those in other countries, such as Germany or the United States, where Deprexis is reimbursed when prescribed by a health care professional.…”

Section: Discussionmentioning

confidence: 99%

Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study

Amiot,

Sauvaget,

Alamome

et al. 2024

JMIR Form Res

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Background Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression.

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Digital Health Interventions in Depression Care—A Survey on Acceptance from the Perspective of Patients, Their Relatives and Health Professionals

Cited by 8 publications

References 28 publications

A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription

A qualitative interview study of patients' attitudes towards and intention to use digital interventions for depressive disorders on prescription

Rapid review on the incentives of digital health apps for physicians and psychotherapists: A German perspective

Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study

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