Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study

Abstract

Background Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective This study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods Participating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow.

Nurse-led virtual prostate cancer clinic for survivorship care: Qualitative study of healthcare professional experiences and needs

“…HCPs describe ve facilitators for sustainable use of digital health technologies: (1) ease of use, (2) patient expectation-setting and coaching, (3) proper training and provision of support toHCPs involved in providing services through the technology (4) adequate sta ng, resourcing, and patient support, and (5) building trust in the platform for sustainable application of a digital health platform. These results have been echoed in studies examining HCP perspectives and involvement in the digital delivery of mental health therapies 45,46 , advocacy for patient use of digital health tools 25,47 , nurse-led telehealth prostate cancer supportive care 48 , digitally-mediated therapeutic adherence efforts 49,50 , and improving patient access and adherence to digital therapeutics 51,52 .…”

Strengthening the Impact of Digital Cognitive Behavioral Interventions Through a Dual Intervention: Proficient Motivational Interviewing–Based Health Coaching Plus In-Application Techniques

“…Individuals choose which program to enroll in, and access to a DHC is dependent upon the client’s health care benefits package or relationship with the health care organization. The coach-enhanced dCBI has been evaluated in diverse care settings including primary care, adolescent care, women’s health, and patient-centered specialty medical homes [ 26 , 27 ].…”

Health Providers’ Perceptions and Experiences of Using mHealth for Chronic Noncommunicable Diseases: Qualitative Systematic Review and Meta-Synthesis

“…The characteristics of the 24 studies included in this review are described in Table 1. mHealth technologies were applied to assist the management of the following CNCDs: mental diseases (depression, anxiety, epilepsy, or multiple sclerosis; n=9, 38%) [22][23][24][25][26][27][28][29][30], cancer (n=2, 8%) [31,32], heart failure (n=4, 17%) [33][34][35][36], asthma (n=1, 4%) [37], diabetes (n=2, 8%) [38,39], chronic pain (n=1, 4%) [40], chronic obstructive pulmonary disease (n=1, 4%) [41], and other chronic diseases (n=4, 17%) [42][43][44][45]. The participant sample sizes ranged from 8 to 43.…”

“…States [26,32,35,37,39,40], France [27,42], the Netherlands [43], Sri Lanka [44], Spain [30], and China [45]. The studies were conducted in public or private hospitals, primary care institutions, and home care facilities in urban or rural settings.…”

“…The studies were conducted in public or private hospitals, primary care institutions, and home care facilities in urban or rural settings. Data were collected in these studies through semistructured interviews (18/24, 75%) [23][24][25][26]28,29,[31][32][33][34][35][36]38,[41][42][43][44][45], focus group discussions (8/24, 33%) [22,24,27,28,30,37,40,42], or in-depth interviews (2/24, 8%) [37,39]. The analytic approaches followed in these qualitative studies included thematic analysis (11/24, 46%) [22][23][24]28,29,31,32,34,35,38,43], content analysis (7/24, 29%) [26,27,33,36,40,41,45], constant comparative method (4/24, 17%) [37,…”