Expert Consensus Survey on Digital Health Tools for Patients With Serious Mental Illness: Optimizing for User Characteristics and User Support

Abstract

Background: Digital technology is increasingly being used to enhance health care in various areas of medicine. In the area of serious mental illness, it is important to understand the special characteristics of target users that may influence motivation and competence to use digital health tools, as well as the resources and training necessary for these patients to facilitate the use of this technology.

Objective: The aim of this study was to conduct a quantitative expert consensus survey to identify key characteristics of target users (patients and health care professionals), barriers and facilitators for appropriate use, and resources needed to optimize the use of digital health tools in patients with serious mental illness.

Methods: A panel of 40 experts in digital behavioral health who met the participation criteria completed a 19-question survey, rating predefined responses on a 9-point Likert scale. Consensus was determined using a chi-square test of score distributions across three ranges (1-3, 4-6, 7-9). Categorical ratings of first, second, or third line were designated based on the lowest category into which the CI of the mean ratings fell, with a boundary >6.5 for first line. Here, we report experts' responses to nine questions (265 options) that focused on (1) user characteristics that would promote or hinder the use of digital health tools, (2) potential benefits or motivators and barriers or unintended consequences of digital health tool use, and (3) support and training for patients and health care professionals.

Results: Among patient characteristics most likely to promote use of digital health tools, experts endorsed interest in using state-of-the-art technology, availability of necessary resources, good occupational functioning, and perception of the tool as beneficial. Certain disease-associated signs and symptoms (eg, more severe symptoms, substance abuse problems, and a chaotic living situation) were considered likely to make it difficult for patients to use digital health tools. Enthusiasm among health care professionals for digital health tools and availability of staff and equipment to support their use were identified as variables to enable health care professionals to successfully incorporate digital health tools into their practices. The experts identified a number of potential benefits of and barriers to use of digital health tools by patients and health care professionals. Experts agreed that both health care professionals and patients would need to be trained in the use of these new technologies.

Conclusions: These results provide guidance to the mental health field on how to optimize the development and deployment of digital health tools for patients with serious mental illness.

Keywords: biomedical technology; patient engagement; severe mental disorders.

Figure 1

Survey structure. Results from highlighted sections and questions are reported in this paper. HCP: health care professional.

Figure 2

Patient characteristics that affect engagement with and use of a digital health tool. The CIs for each option are shown as horizontal bars; consensus is indicated by a shaded bar; the number of respondents, the mean rating, and SD are given in the column on the right. Note that some respondents did not rate some options; therefore, the number of respondents is 39 or 40 for the options in this survey question. The experts rated each item on a scale of 1 to 9, with 1=likely to make it very difficult for person to engage with and use, 5=not likely to influence the ability to engage with or use, and 9=extremely likely to promote engagement and ability to use. *Highest rating of 9 given by ≥50% of experts.

Figure 3

Disease-related characteristics that affect a patient’s ability to engage with and use a digital health tool. The CIs for each option are shown as horizontal bars; consensus is indicated by a shaded bar; the number of respondents, the mean rating, and SD are given in the column on the right. Note that some respondents did not rate some options; therefore, the number of respondents is 39 or 40 for the options in this survey question. The experts rated each item on a scale of 1 to 9, with 1=likely to make it very difficult for person to engage with and use, 5=not likely to influence the ability to engage with or use, and 9=extremely likely to promote engagement and ability to use.