eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes

Abstract

BackgroundAnxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited.ObjectiveThe objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied.MethodsWe conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness (“fitness for purpose”), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration (“spread” or “reach” of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as “positive results” and unfavorable ratings on measurement scales as “negative results.” Those studies that reported both positive and negative findings were coded as having “mixed results.”ResultsA total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes.ConclusionsAcceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality ...

Implementation of e‐mental health for depression and anxiety: A critical scoping review

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“…Moreover, several systematic reviews have evaluated how implementation outcomes have been measured for a subset of programs aimed at specific populations or a subset of implementation outcomes, such as adoption and fidelity. [4,[26][27][28] This paper provides a discussion of the full range of implementation outcomes with respect to a full range of BIT addressing a host of behavioral health concerns. The goal of this paper is to advance the evaluation of BIT implementation with the hope of improving future implementation efforts.…”

“…A recent 2018 systematic review of implementation measurement for technology-based mental health interventions found that acceptability was the outcome most frequently measured, commonly via project-specific, non-validated measures. [28] The most well-known model of health information technology acceptability the Technology Acceptance Model (TAM) in which the perceived usefulness and ease of use of the technology is assessed, along with a number of associated constructs such as prior experience, output quality, and social influence. [35] The concept of technology usability clearly overlaps with acceptability and is included as a major construct in the TAM and similar models.…”

“…In spite of the potential benefits of BITs and the well documented efficacy of many BITs, their successful implementation has faced considerable challenges. [22,28] To help advance the study of BIT implementation, we have characterized implementation outcome measurement for BITs and argue that the implementation outcomes put forward in Proctor and colleagues' seminal work should be recharacterized to address aspects unique to BITs. [23] To this end, we have selected several characteristics of BIT implementation on which future research should be based.…”