Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings

Emerson, Margaret R.; Caspari, Jennifer Harsh; Notice, Maxine; Watanabe‐Galloway, Shinobu; Dinkel, Danae; Kabayundo, Josiane

doi:10.1016/j.genhosppsych.2021.01.008

Cited by 10 publications

(6 citation statements)

References 50 publications

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“…As healthcare and public health professionals continue to leverage and increase the use of mobile apps to aid in educating patients and promoting self-care management, we need to ensure communication provided in mobile apps is suitable to the target patient populations (74). The development of a brief tool which can be easily and effectively used to evaluate content being delivered via mHealth which screens for acceptability for low health literacy populations is warranted.…”

Section: Discussionmentioning

confidence: 99%

Addressing and evaluating health literacy in mHealth: a scoping review

Emerson¹,

Buckland²,

Lawlor³

et al. 2022

mHealth

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Background: Recent surveys have revealed many adults have basic or below basic health literacy, which is linked to medical errors, increased illness, and compromised public health. Health literacy as a concept is multi-faceted extending beyond the individual to include social structures and the context in which health information is being accessed. Delivering health information via mobile devices (mHealth) expands the amount of information available while presenting challenges to ensuring these materials are suitable for a variety of literacy needs. The aims of this study are to discover how health literacy is addressed and evaluated in mHealth app development.Methods: A scoping review of 5 peer-reviewed databases was conducted. Eligible articles were written in English, addressed general literacy or mHealth/digital/eHealth literacy, and collected literacy information in order to incorporate literacy into the design and/or modification of an app or collected literacy information to describe the population being studied. The "Health Literacy Online" (HLO) United States (U.S.) government guide was used as a framework.Results: Thirty-two articles were reviewed. Articles included health literacy recommendations for all HLO categories and some recommendations not aligned with these categories. Most articles addressed health literacy using specific HLO categories though none incorporated every HLO category. The most common categories addressed engagement and testing of mHealth content. Though several studies addressed health literacy through a formal assessment tool, most did not. Evaluation of health literacy in mHealth was enduser focused and did not extensively evaluate content for fit to a variety of individuals with limited health literacy. Conclusions:The recommendations seen consistently in our results in conjunction with formal HLO categories can act as beginning steps towards development of a health literacy evaluation tool for mHealth apps themselves. It is clear efforts are being made to reduce barriers to using mHealth for those with literacy deficits, however, it was also clear that this space has room to be more pragmatic in evaluation of mHealth tools for literacy. End user engagement in design and testing is necessary in future mHealth literacy tool development.

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Section: Discussionmentioning

confidence: 99%

Addressing and evaluating health literacy in mHealth: a scoping review

Emerson¹,

Buckland²,

Lawlor³

et al. 2022

mHealth

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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%

“…The number and variety of digital health services for mental disorders is constantly increasing over the last decade ( 18 ). Digital health services for mental health include health promotion, prevention, or treatment of some disorders, e.g., by providing behavioural information to encourage patients’ self-management ( 19 , 20 ). Digital interventions for mental health can be applied with professional guidance to assist and follow up the use, completely self-guided by patients or as blended approaches as an additional part of face-to-face treatments ( 13 , 16 ).…”

Section: Introductionmentioning

confidence: 99%

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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“…COVID-19 has further highlighted these inequities (Wang et al., 2020). Anecdotal evidence suggests that MHMAs that facilitate self-support and peer-support have the potential to offer equitable mental health support to the underserved population (Aziz et al., 2022; Emerson et al., 2021). Our study examines this potential using longitudinal user-level data on socio-demographic characteristics and app activity data collected from a MHMA.…”

Section: Discussionmentioning

confidence: 99%

Towards Achieving Mental Health Equity for the Underserved Population: Evaluating the Potential of Mobile Apps

Tang,

Sinha,

Moen

et al. 2024

Production and Operations Management

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The underserved population—i.e., individuals who identify themselves as non-female, non-heterosexual, or non-White—have long faced inequities when accessing traditional clinic-based mental health services. Individuals from the underserved population tend to use and benefit from these services less than their better-served counterparts (i.e., those who identify themselves as female, heterosexual, and White). This study investigates whether similar inequities exist within the context of mobile apps specifically designed to provide self-support and peer-support. To this end, we conduct an empirical analysis using longitudinal user-level data collected from a mental health mobile app (MHMA). Our results indicate that: (i) in contrast to the traditional clinic-based mental health services, in a MHMA setting, users from the underserved population engage with the app services and derive similar benefits as much as their better-served counterparts; and (ii) there is a positive relationship between app usage frequency and the mental condition of app users. Our post-hoc analysis uncovers that the MHMA promotes equitable usage and benefit for users: (i) from the underserved population via self-management functions that enable self-support; and (ii) from the better-served population via online community functions that facilitate peer-support. These findings suggest that MHMAs have the potential to achieve equity through both user engagement and the benefits derived from such engagement. We conclude by discussing the implications for mobile app firms, policymakers, and organizations in their efforts to achieve mental health equity for the underserved population.

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Mental health mobile app use: Considerations for serving underserved patients in integrated primary care settings

Cited by 10 publications

References 50 publications

Addressing and evaluating health literacy in mHealth: a scoping review

Addressing and evaluating health literacy in mHealth: a scoping review

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

Towards Achieving Mental Health Equity for the Underserved Population: Evaluating the Potential of Mobile Apps

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