Early Psychosis Service User Views on Digital Technology: Qualitative Analysis

Abstract

BackgroundDigital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs).ObjectiveThe objective of our study was to explore early psychosis service users’ subjective views on DHIs.MethodsFramework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings.ResultsThe following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care.ConclusionsIn the first study of its kind, early psychosis service users’ were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities.

Development and Long-Term Acceptability of ExPRESS, a Mobile Phone App to Monitor Basic Symptoms and Early Signs of Psychosis Relapse (Preprint)

“…Thus, as in previous studies with both patients and staff, participants in the current study suggested that self-monitoring apps should enhance rather than replace face-to-face appointments [30,57]. Nevertheless, as participants in a recent study hypothesized [42], some found an app more accessible than mental health staff, reporting that they are more open about their symptoms on an app, they can complete it at points when they are unwilling to speak to someone, it is more frequent than their usual contact with a clinician and it removes the feeling of inconveniencing someone to report symptom increases. Furthermore, several participants with low symptoms described the app in positive, anthropomorphic terms (e.g.…”

“…Other key barriers which could be addressed to increase app engagement included lack of smartphone experience, skepticism regarding the app, the study policy to not use the app whilst abroad and lack of literacy. Although the latter was also reported as a potential barrier by a third of participants in a recent qualitative study, they nevertheless found smartphones more accessible than paper-based alternatives [42].…”

“…Particularly for early psychosis patients, an app is more like their usual communication with others making it potentially de-stigmatizing compared with usual care [42]. Participants emphasized the potential value of the app for those in the acute phase of psychosis.…”

“…[24,[35][36][37]). Only a few studies include qualitative feedback from people with psychosis regarding actual [28,30,38] or hypothetical [39][40][41][42] acceptability of apps to monitor or ameliorate psychosis symptoms. Most had relatively young samples, likely to be more au fait with this technology ('digital natives') than is typical of those with chronic psychosis, and none examined psychosis patients' experiences of long-term native smartphone app use.…”

A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems

“…Participants believed that entering data on a DHI in the absence of any clinician involvement may be meaningless. Therefore, participants were willing to grant the care team access to their data, but had mixed views about whether this access should be automatic or user-initiated.Traditionally, symptom monitoring approaches tend to involve the automatic transfer of symptom information [48]; however, these findings suggest service users should have control over information transfer, which echoes views expressed by staff [49] and individuals with bipolar disorder [50] and first episode psychosis [51]. Concerns over third party access were also expressed and may be a barrier to DHI uptake by people with severe mental health problems.…”