The Potential of Digital Interventions to Transform Mental Healthcare Delivery
Digital mental health interventions (DMHIs) have the potential to serve a significantly wider portion of the population in need of mental health services. The coronavirus disease 2019 (COVID-19) pandemic has especially highlighted the exacerbation of mental health disparities among minoritized populations. Innovations and research on DMHIs continue to expand, reinforcing the need for a more systemic process of DMHI implementation.
In practice, DMHI implementation often skips the fundamental steps of conducting acceptability and feasibility studies. We propose a DMHI implementation framework that identifies an acceptability and feasibility study as an essential first step, simultaneously centering equitable processes that address populations disproportionately affected by mental illness.
Defining Acceptability and Feasibility
Acceptability refers to a patient’s or user’s willingness to use the DMHI. Researchers aim to understand the factors that increase use and engagement, as well as the barriers to using the DMHI. These factors can be assessed via focus groups, interviews, structured questionnaires, and backend data.
Feasibility is the degree to which the technology or product can be successfully integrated within the flow of usual care. This is an iterative process often measured by the frequency of DMHI use. Researchers must identify the patient, provider, user, and operational barriers to DMHI use.
In our framework, acceptability determines whether the community needs mental health services and whether the DMHI can meet these needs. Feasibility determines whether the users, administrators, and developers of the DMHI are satisfied.
Overlooking these factors can lead to unnecessary budgetary costs and inaccurate assessments of the effectiveness of the DMHI in clinical settings and use cases of general wellness support, thereby impacting the long-term sustainability and impact.
Conducting Acceptability and Feasibility Studies
Pilot studies that assess the acceptability and feasibility of a DMHI provide valuable information to refine the intervention prior to an efficacy trial. At the pilot stage, we determine whether the intervention is needed and possible (acceptability) and whether all parties involved are satisfied with the intervention’s integration within the flow of the user’s usual care or routine (feasibility).
The proposed implementation framework emphasizes conducting a needs assessment with organizations to strengthen the acceptability and feasibility of the intervention. Understanding the specific and unique needs of an organization or implementation setting allows researchers or organization leaders to gather comprehensive data on user perspectives on the DMHI and suggest data-driven improvements to the developers.
We utilize a mixed-methods approach by collecting both quantitative and qualitative data, which enables a more comprehensive evaluation of the DMHI according to the unique needs of the population. Qualitative feedback is communicated with the developers of the DMHI so appropriate adjustments can be made.
If our measures indicate high acceptability and feasibility rates, we can then consider moving toward an efficacy study.
Common Pitfalls and Mistakes
One of the most common mistakes in DMHI implementation is the failure to adequately determine the acceptability and feasibility of the intervention prior to conducting efficacy trials. Researchers will often overlook whether the DMHI is possible and attempt to answer whether the intervention “works,” leading to inaccurate assessments of the safety and usability of the DMHI.
Another common pitfall is failing to consider digital equity. Prior to the COVID-19 pandemic, we saw disparities among people who were of minoritized racial/ethnic backgrounds, low socioeconomic status, older, living in rural settings, identifying as LGBTQ+, and/or having a disability. Acceptability and feasibility studies are opportunities to explore systemic reasons for the lack of engagement with the DMHI, elevate their existing connections and understandings of technology, and provide sustainable educational opportunities to increase digital health literacy.
Implementing Acceptability and Feasibility in Practice
We have worked collaboratively with a wide variety of community partners to deploy virtual reality and other digital mental health technologies. In a case study of implementing a DMHI in a residential substance use disorder (SUD) program, we learned several key lessons:
- Obtaining buy-in from facility leadership was critical for problem-solving feasibility barriers related to deployment and initial implementation.
- Adequate employee orientation and training, along with a point of contact for ongoing technical support, significantly increased both technology use and staff and patient’s perceptions of the technology’s usefulness.
- Understanding patients’ general attitudes towards technology use prior to implementation helped inform decisions around training and user-friendly engagement.
- Focusing on equity in the implementation setting allowed persons in underserved settings to access high-quality, evidence-informed mental health interventions.
Recommendations for Successful DMHI Implementation
Based on our diverse experiences, we have developed several recommendations for achieving feasible and acceptable implementation:
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Select the DMHI That Fits the Organizations’ and Users’ Needs: Carefully understand the pain points and existing structures of the organization and individuals who will use the DMHI.
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Vet the DMHI Before Deployment: Ensure the selected DMHI has been clinically validated and offers high-quality, evidence-informed interventions.
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Consider Customization When Possible: Personalized engagement is often higher when the DMHI content can be tailored to the user’s specific needs.
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Choose DMHIs That Are Convenient, Easy to Use, and Anonymous: Users are more likely to engage with DMHIs that are accessible, user-friendly, and maintain data privacy.
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Provide Thorough Orientation and Framing of the DMHI: Positive framing and clear articulation of the DMHI’s benefits increase user willingness to engage.
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Facilitate Training and Implementation: Customized training approaches and availability of technical support are essential for sustainable DMHI use.
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Evaluate Implementation Over Time: Ongoing assessment of feasibility, acceptability, and effectiveness allows for problem-solving and iterative improvements.
The Significance of Digital Mental Health Transformation
Digital mental health interventions represent an ideal, and arguably essential, solution to address our current mental health crisis. When high-quality, evidence-informed content is paired with user-friendly, accessible, and transparent technology, DMHIs can make a significant impact.
The implementation that directly addresses and overcomes feasibility and acceptability barriers is crucial for effective, sustainable, and scalable deployment. Organizational efforts aimed toward deployment in a way that facilitates individual use, willingness to engage, and perception of effectiveness will ultimately allow for equitable and effective mental healthcare delivery.
