Smartphones and Mental Health Awareness and Utilization in Developing Countries: Focus Group Study (Preprint)

BackgroundMental health disorders pose a significant challenge in low- and middle-income countries (LMICs), contributing substantially to the global disease burden. Despite the high prevalence of these disorders, LMICs allocate less than 1% of health budgets to mental health, resulting in inadequate care and a severe shortage of professionals. Stigma and cultural misconceptions further hinder access to mental health services. These challenges are present in Bangladesh, with high prevalence rates of depression and anxiety, as well as a centralized and underresourced mental health care system. Digital tools, such as smartphone apps and online platforms, offer innovative solutions to these challenges by increasing accessibility, cost-effectiveness, and scalability of mental health interventions.ObjectiveThis study aims to characterize the views around digital tools for mental health among residents of Korail (a major slum in Dhaka, Bangladesh), including the use of smartphones, and investigate acceptable digital tools and barriers and facilitators for digital mental health tools.MethodsA total of 8 focus group discussions were conducted with 38 participants, including individuals with serious mental disorders and their caregivers. The focus group discussions were guided using a semistructured topic guide, which included broad questions on smartphone usage to contextualize digital access, primarily focusing on perceptions of using mobile technology for mental health care. Focus groups were held in Bangla, audio recorded, and transcribed and translated in English. Data were analyzed using thematic analysis in NVivo 14.ResultsParticipants (mean age 37 y, SD 13.7) were mostly female (30/38, 79%), and 45% (17/38) personally owned smartphones, although 92% (35/38) reported smartphone access within the household. The findings revealed a general lack of awareness and understanding of digital mental health tools among slum residents. However, there was a notable appetite for these tools; participants recognized their potential to provide timely and cost-effective support, reduce hospital visits, and make health care more accessible. Participants highlighted the convenience and communication benefits of smartphones but expressed concerns about misuse such as excessive use, particularly among adolescents. Barriers to the utilization of digital mental health tools included limited technological literacy and accessibility issues. Despite these challenges, participants acknowledged the potential of these tools to bridge the gap in mental health services, especially for those unable to travel. The importance of providing proper guidance and education to maximize the effectiveness of digital tools was emphasized.ConclusionsDigital mental health tools hold promise for improving mental health care in underserved slum communities. This study underscores the need for further research and investment in tailored digital mental health solutions to address the unique needs of slum populations in LMICs.

The need for a new generation of digital mental health tools to support more accessible, effective and equitable care.

Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance mental health care delivery and achieve the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools in clinical care settings. This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings using a sociotechnical approach. A scoping review methodology was used to identify the relevant factors from the literature. Five academic databases (MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO) were searched to identify pertinent articles using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by 2 reviewers, and data were extracted using a standardized data extraction form. Articles were included if the digital mental health tool had at least 1 patient-facing component and 1 clinician-facing component, and at least one of the objectives of the article was to examine user engagement with the tool. An established sociotechnical framework developed by Sittig and Singh was used to inform the mapping and analysis of the factors. The database search identified 136 articles for inclusion in the analysis. Of these 136 articles, 84 (61.8%) were published in the last 5 years, 47 (34.6%) were from the United States, and 23 (16.9%) were from the United Kingdom. With regard to examining user engagement, the majority of the articles (95/136, 69.9%) used a qualitative approach to understand engagement. From these articles, 26 factors were identified across 7 categories of the established sociotechnical framework. These ranged from technology-focused factors (eg, the modality of the tool) and the clinical environment (eg, alignment with clinical workflows) to system-level issues (eg, reimbursement for physician use of the digital tool with patients). On the basis of the factors identified in this review, we have uncovered how the tool, individuals, the clinical environment, and the health system may influence user engagement with digital mental health tools for clinical care. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care.

BackgroundAs mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools.ObjectiveThe specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools.MethodsThe web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document.ResultsBased on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers).ConclusionsThe use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways.

Aim: Informal caregivers have an important role in bridging the gap between the assistance care recipients need and what can be provided by the health care systems across Europe. The burden of the caregiving role places a significant threat to caregiver health, and the vast majority of caregiver's report stress and emotional strain, depression, and increased rates of chronic diseases. In line with this, strengthening the caregiver's mental health is one of the main goals for optimal caregiving. Caregivers already struggle with the demand of their role while coping with health problems, social, family, and work obligations. The solution for the caregiver's mental health needs to be accessible, low cost, and time-effective. This scoping review investigates digital mental health tools available as a mean of supporting the mental health of caregivers.Method: Databases searched include Summon search box, the Cochrane Library, and PubMed. Three groups of keywords were combined: relating to digital mental health interventions for caregivers, digital mental health interventions and stress in elderly care, and digital mental health interventions and burden in elderly care.Results: Caregivers reported that digital mental health tools have an overall positive role in their health. Coping skills, emotion regulation, skill building, and education are found to be important aspects of digital mental health tools. There was a noted lack of digital mental health apps available specifically for the caregiver of older adults. Furthermore, the digital mental health tools, divided into three categories in this review, focused either on building skills or educating caregivers and assisting with the duties rather than the mental health of the caregiver itself. As repeatedly suggested in the reviewed studies, digital mental health interventions overall contribute to reducing the caregiver burden with a limitation of addressing one aspect of caregiver needs –i.e., specific coping skills or education regarding illnesses such as Alzheimer's disease and Dementia. The lack of all-encompassing, data and theory-driven digital mental health tools for addressing and supporting the caregiver's mental health is evident.

IntroductionImproving effective user engagement with digital mental health tools has become a priority in enabling the value of digital health. With increased interest from the mental health community in embedding digital health tools as part of care delivery, there is a need to examine and identify the essential factors in influencing user engagement with digital mental health tools in clinical care. The current study will use a Delphi approach to gain consensus from individuals with relevant experience and expertise (e.g. patients, clinicians and healthcare administrators) on factors that influence user engagement (i.e. an essential factor).MethodsParticipants will be invited to complete up to four rounds of online surveys. The first round of the Delphi study comprises of reviewing existing factors identified in literature and commenting on whether any factors they believe are important are missing from the list. Subsequent rounds will involve asking participants to rate the perceived impact of each factor in influencing user engagement with digital mental health tools in clinical care contexts. This work is expected to consolidate the perspectives from relevant stakeholders and the academic literature to identify a core set of factors considered essential in influencing user engagement with digital mental health tools in clinical care contexts.

The objective was to explore New Zealand mental health clinicians’ and trainees’ knowledge, utilization, and attitudes towards digital mental health tools through semi-structured interviews. Participants were recruited from an online survey about digital mental health tools. At the survey’s conclusion, participants could express interest and provide contact details via a link. One-on-one in-depth Zoom interviews were conducted, lasting an average of 45 min each. Data collection occurred between August 2021 and February 2022. Anonymized transcripts were analyzed using reflexive thematic analysis. Seventeen clinicians took part, and four primary themes emerged: (1) receptiveness to digital innovation, most had used digital mental health tools with clients, observing beneficial outcomes and positive responses; (2) digital technology remains a double-edged sword, offering significant supportive opportunities while also highlighting the digital divide; (3) impediments to clinical implementation, stemming from concerns about maintaining clinical safety and the need to adapt beyond established comfort zones; (4) aspirations for digital technology in clinical practice, encompassing innovative ideas, desire for tools responsive to New Zealand’s diverse communities, and ideas to maximize their potential. This qualitative study gives voice to New Zealand mental health practitioners and their interest in digital innovations to improve client care. However, integrating digital mental health tools into clinical practice effectively depends on overcoming challenges like the digital divide, data privacy, safety concerns, and the lack of tools that reflect New Zealand culture or offer personalization to meet individual needs. It highlights the need for collaboration in developing and deploying digital interventions that are both aligned with clinician requirements and adapted to the specific contexts of their client communities. This research provides a historical (albeit 3-year-old) account of clinician attitudes and knowledge. Given the rapid pace of technological innovation—particularly the rise of generative AI since late 2023—taking snapshots of changing attitudes becomes ever more important as the technological landscape continues to evolve.

BackgroundNew Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement.ObjectiveWe aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers.MethodsInteractive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach.ResultsParticipants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face.ConclusionsDefining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

© 2019 Journal of Medical Internet Research. All rights reserved. Background: New Zealand youth, especially those of Maori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents' current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 whanau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health-need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

© 2019 Journal of Medical Internet Research. All rights reserved. Background: New Zealand youth, especially those of Maori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents' current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 whanau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health-need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

© 2019 Journal of Medical Internet Research. All rights reserved. Background: New Zealand youth, especially those of Maori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents' current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 whanau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health-need groups. This study demonstrates the importance of scoping possible user needs to inform design processes.

BACKGROUND The rapid growth of digital mental health tools offers accessible support for a growing global population with mental health needs. However, concerns exist regarding their safety, efficacy, and overall quality, particularly for tools used outside of healthcare settings. The lack of regulation exacerbates these issues, and existing quality assurance frameworks are limited in scope and not specific to mental health, failing to address crucial aspects such as user experience and evidence-based practices. OBJECTIVE This study aims to develop a novel, comprehensive, and pragmatic quality assurance framework specifically tailored to digital mental health tools – the Mental health Technology Assessment of Quality (MTAQ). METHODS A convergent mixed-methods design was employed to develop the framework. Participants included mental health service users, academic and health professionals, and digital health provision experts. Quantitative survey data (N=309) were collected and then analysed descriptively to evaluate stakeholder priorities across three domains: user experience, data, and evidence. The survey gathered broad insights into the relative value of various quality factors, supplemented by qualitative data from focus groups and interviews (N=101), which provided richer perspectives in relation to the initial, literature-derived domains. The qualitative data were analysed thematically using a deductive approach. RESULTS The study found that intuitive, accessible, user-centred design; robust data privacy and security measures; and rigorous evidence were important to consider when assessing the quality of digital mental health tools. These insights led to the development of MTAQ, covering key quality domains and a structured assessment process. CONCLUSIONS The MTAQ framework provides the first comprehensive quality assurance framework and criteria specifically for digital mental health tools. By aligning research evidence, stakeholder input, and clinical perspectives, this framework offers a pragmatic, user-informed standard that has broad application to improving the design, assessment, quality, and trustworthiness of tools in this rapidly evolving field.

BackgroundThe overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers.ObjectiveThis study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group.MethodsWe performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach.ResultsThe period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase.ConclusionsMore than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees’ well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic.

Digital mental health tools: A narrative review on overcoming barriers in the age of displacement and disparities.

ABSTRACTAn individual's mental health influences their capacity to think effectively, feel emotionally stable, and perform daily activities. As mental health concerns become more prevalent worldwide, new awareness and diagnostic and treatment tactics are needed. Digital tools and technology are helping solve these problems by providing scalable, tailored solutions for large populations. This detailed review examines mental health‐promoting internet tools. Smartphone applications, web‐based therapy systems, wearable tech, artificial intelligence‐powered resources, and virtual reality (VR) technologies were evaluated for efficacy and side effects. PubMed, PsycINFO, Scopus, IEEE Xplore, and Google Scholar were carefully searched. Search terms included “digital mental health tools,” “online therapy,” and “AI in mental health.” Randomized controlled trials, cohort studies, cross‐sectional studies, systematic reviews, and meta‐analyses of digital technology and mental health were included from among the literature published after 2010. Cognitive behavioral therapy methods, mood monitoring, and mindfulness exercises are among the numerous features of smartphone applications that have been demonstrated to mitigate symptoms of anxiety, depression, and tension. Online therapy platforms let marginalized individuals obtain therapy remotely. Wearable technology may detect heart rate, blood pressure, and sleep length, which may reveal mental health difficulties. Chatbots employ machine learning algorithms and natural language processing to deliver customized support and show promise for quick intervention. Exposure therapy for anxiety and trauma is increasingly using virtual reality environments. Although digital mental health therapies face challenges in relation to data privacy, limited long‐term efficacy, and technological inequality, digital technologies are modernizing mental healthcare. By offering inexpensive and effective alternatives to traditional therapies, digital technologies may help healthcare systems meet the growing demand for mental health services and overall well‐being.