JMIR Publications

ABSTRACT

Background:

Digital mental health interventions (DMHIs) have the potential to address long-standing barriers to accessing mental health services, including clinician shortages, time and transportation impediments, and attitudinal obstacles. Despite their promise, DMHIs have barriers of their own that directly impact enrollment, treatment adherence, and attrition rates in these programs. Unlike in traditional face-to-face therapy, there are no standardized and validated measures of barriers in DMHIs.

Objective:

The present study describes the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale–7 (DIBS-7).

Methods:

Following an iterative QUAN --> QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n =259) in a DMHI trial for anxiety and depression who identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 participants (Mage = 23.02; 78.4% female; 69.9% racial/ethnic minority) receiving the same DMHI. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs, such as treatment expectations and satisfaction, as well as behavioral indicators of treatment adherence, after statistically controlling for demographic variables commonly associated with DMHI treatment engagement, such as participant age, sex, and racial/ethnic minority status.

Results:

Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α = .82, ω = .89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr = -.25), number of modules with activity (pr = -.55), number of weekly check-ins (pr = -.28), and treatment satisfaction (pr = -.71).

Conclusions:

To our knowledge, this is the first validated short measure of barriers in DMHIs. Results provide preliminary support for the use of the DIBS-7 as a potentially useful scale for clinician and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs.