Decision-making about uptake and engagement among digital mental health service users: a qualitative exploration of therapist perspectives

ABSTRACT

Objective

This study explored therapist perspectives on decision-making about uptake and engagement with online assessment and treatment for anxiety and depression among digital mental health service (DMHS) users.

Methods

Semi-structured interviews with 20 therapists from two Australian DMHSs were conducted; interviews were audio-recorded, transcribed verbatim, and analysed thematically using Framework Methods.

Results

Analyses yielded three interrelated themes: 1) Interplay between users, the DMHS and broader mental health system; 2) Decision-making process and dynamics; and 3) Information and decision-support needs. Theme 1 highlighted the diversity of DMHS users, and how users’ interactions with third-party health professionals influence access/use, showing that DMHSs are not a standalone entity. Theme 2 revealed therapists’ key role within DMHSs, including how they shape users’ decision-making through managing expectations and deliberating on options and “treatment fit”. Theme 3 demonstrated considerable variability in how informed and knowledgeable users were when engaging with DMHSs, and how some users have decisional uncertainty and delay, and would benefit from additional decisional support.

Conclusions

Findings provide in-depth therapist insights into what influences service user decision-making about using DMHS for assessment and treatment. These insights can inform user-centred design of DMHSs and highlight the need to better integrate DMHS into mainstream mental healthcare.

Key points

What is already known about this topic:

(1) Digital mental health services (DMHS) provide effective psychological treatment to people who may not otherwise access it.

(2) There is considerable variability in rates of people’s uptake and engagement with digital psychological treatments.

(3) Most research to date on uptake and engagement with digital psychological treatments has been quantitative in nature.

What this topic adds:

(1) Therapists play a critical role in facilitating informed decision-making to take up treatment amongst DMHS users.

(2) There is considerable variability in DMHS users in terms of their clinical profiles, preferences, needs, and how informed and knowledgeable they are regarding digital treatment.

(3) DMHS may support service user decision-making about uptake and engagement by providing treatment information preconsultation in text and multimedia formats, allowing extra time and scheduling followups to decide on treatment uptake.

KEYWORDS:

• Digital mental health service
• decision-making
• depression
• anxiety
• qualitative study
• iCBT

Acknowledgments

The authors wish to thank the therapists for generously volunteering their time and sharing their expertise for this research. The first author, Dr Alana Fisher, is supported by a Macquarie University Research Fellowship which partially funded this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

Additional information

Funding

The work was supported by the Macquarie University.