Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences

Abstract

BackgroundMental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care.ObjectiveThe objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality.MethodsWe conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption.ResultsInterviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use.ConclusionsOpenness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology.

Technology use and preferences for mental health self‐management interventions among older veterans

“…Regarding mobile apps, the preference for apps was stronger for veterans living in an urban compared with rural regions and are in line with our predictions and previous research 24. Contrary to our predictions, presence of elevated mental health symptoms, present in 46% of participants, were not related to preference for any modalities.…”

“…Regarding mobile apps, the preference for apps was stronger for veterans living in an urban compared with rural regions and are in line with our predictions and previous research 24. Regarding mobile apps, the preference for apps was stronger for veterans living in an urban compared with rural regions and are in line with our predictions and previous research 24.…”

“…Rural status was characterized using zip codes aggregated using the Rural Urban Commuting Area (RUCA) codes 40 as employed in a previous study of veterans' technology attitudes. 24 Veterans' place of residence were grouped as urban (ie, metropolitan areas) or rural (small, isolated towns ranging to large rural towns) using categorization method C. 40…”

“…In one of the few studies that considered older veteran technology use, researchers conducted a series of semistructured interviews and found no qualitative differences for older veterans (50 to 70 years old) compared with younger veterans (18 to 49 years old). 24 However, older veterans had lower rates of smartphone ownership (32% vs 56%) and more difficulties using technology compared with younger veterans. Another study 25 found that 17.6% and 56% of older veterans had access to smartphones and home Internet, respectively.…”

“…[19][20][21] Research on veterans' attitudes toward mobile apps demonstrates that most have positive attitudes toward this intervention modality. [22][23][24] Yet, little attention has been given to older veterans' attitudes toward technology. In one of the few studies that considered older veteran technology use, researchers conducted a series of semistructured interviews and found no qualitative differences for older veterans (50 to 70 years old) compared with younger veterans (18 to 49 years old).…”