Patient and Provider Perspectives About Referral, Self-reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health-System (Preprint)

Abstract

With an urgent need for innovative, scalable, and sustainable solutions to increase access to evidence-based behavioral health care services, digital mental health applications (DMHAs) represent an emerging, novel solution to address this care gap. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for six unique DMHAs into clinical care in 2019.

This research investigated patient and provider experiences with DMHA referral, DMHA utilization, and perceived importance of engagement, functionality, design, and information attributes in real-world practice.

Separate cross-sectional surveys were developed for patients and providers. Surveys were tested for face and content validity, administered to KPMAS patients and providers online through REDCap, and completed between 3/2022 and 6/2022. Samples included randomly selected patients who had previously been referred to at least one DMHA as well as behavioral health and primary care providers who had referred DMHAs between 4/2021 and 12/2021.

After random selection and telephone outreach, 119 patients were e-mailed a survey link, 58/119 (49%) completed the survey, and 44/119 (37%) confirmed receiving a DMHA referral. The mean sample age was 42.21 years (sd=14.08, n=29), 73% were female (n=32), 73% (n=32) had at least a 4-year college degree, 41% (n=18) were Black/African American, and 39% (n=17) were White. Twelve (27%) patient respondents screened positive for anxiety symptoms and ten (23%) for depression. Twenty-seven (61%) respondents reported DMHA use for ≤6 months since referral, with 16 (36%) reporting use within the past 30 days. Nineteen (43%) respondents reported DMHAs were very or extremely helpful for improving mental and emotional health. Most important patient-reported DMHA attributes by domain were fun and interesting to use (Engagement); ease in learning how to use (Functionality); visual appeal (Design); and having well-written, goal- and topic-relevant content (Information). Twelve out 60 (20%) randomly sampled providers completed the survey. Mean provider respondent age was 46 years (sd=7.75, n=11), and 92% (n=11) were female with a mean number of years since completing training of 14.3 years (sd=9.94, n=10). Seven providers (58%) were physicians with the remainder a licensed psychologist or clinical social worker. Most important provider-reported DMHA attributes by domain were personalized settings and content [Engagement]; ease in learning how to use [Functionality]; arrangement and size of screen content [Design]; and having well-written, goal- and topic-relevant content [Information]. Providers described “typical patients” commonly referred to DMHAs by perceived need, technical capability, and common medical conditions; and offered guidance for successful use.

To ensure DMHA engagement, this research reinforces the necessity to identify and tailor individual patient needs and preferences with the most appropriate DMHA. With the breadth of DMHA choices, it is essential for health systems to develop decision support systems to assist providers with selecting the appropriate DMHA, optimizing uptake, and sustaining use.