Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 17, 2022
Date Accepted: Oct 1, 2022
Date Submitted to PubMed: Oct 3, 2022
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Determinants of e-mental health use during COVID-19: findings from a cross-sectional Canadian study
ABSTRACT
Background:
Access to mental health treatment across Canada remains a challenge, with many reporting unmet care needs. National and provincial e-mental health programs have been developed over the past decade across Canada, with many more emerging during COVID-19 in an attempt to reduce barriers related to geography, isolation, transportation, physical disability and availability.
Objective:
This study aims to identify factors associated with the utilization of e-mental health services across Canada during the COVID-19 pandemic using Andersen and Newman’s framework of health service utilization.
Methods:
This study uses data gathered from the 2021 Canadian Digital Health Survey - a cross-sectional, web-based survey of 12,052 Canadians aged 16 years and older with Internet access. Bivariate associations between the use of e-mental health services and health service utilization factors (predisposing, enabling, illness level) of survey respondents were assessed using χ2 tests for categorical variables and t-test for the continuous variable. Logistic regression was used to predict the probability of using e-mental health services given the respondents’ predisposing, enabling, and illness level factors while controlling for respondents’ age and gender.
Results:
The proportion of e-mental health service users among survey respondents was small (883 out of 12,052). Results from the logistic regression suggest that users of e-mental health services were likely to be those with regular family physician access (OR=1.57, P=.02), living in non-rural communities (OR =1.08, P=.0005), having undergraduate (OR1.40, P=.0013) or post-graduate (OR=1.48, P=.0033) education, eHealth literate (OR= 1.05, P<0.0001). Those with lower e-mental health usage were less likely to speak English at home (OR=.056, P <.0001).
Conclusions:
Our study provides empirical evidence on the impact of individual health utilization factors on the use of e-mental health among Canadians during the COVID-19 pandemic. Given the opportunities and promise of e-mental health services in increasing access to care, future digital interventions should both tailor themselves towards users of these services and consider awareness campaigns to reach non-users. Future research should also focus on understanding the reasons behind the use and non-use of e-mental health services.
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