JMIR Publications

ABSTRACT

Background:

Digital transformation in healthcare is progressing at a fast pace. Digital health applications are one of the most visible faces of this transition, with mental health-focused apps as one of the main therapeutic areas. However, concerns regarding their scientific robustness drove regulators to establish evaluation procedures, with Germany’s DiGA program pioneering in app prescription with costs covered by statutory health insurance. Portugal gathers a set of conditions and requirements that position it as an excellent testbed for digital health applications. Its daunting mental health landscape reinforces the potential interest in new interventions. However, to understand if they would be acceptable, we need to understand the supply side’s attitudes and perceptions toward them – i.e., those of psychiatrists and psychologists.

Objective:

This study aims to understand the attitudes and expectations of psychiatrists and psychologists toward digital mental health applications in the Portuguese context, as well as perceived benefits, barriers, and actions to support their adoption.

Methods:

We conducted a two-stage sequential mixed methods study. Stage one consisted of a cross-sectional web survey adapted to the Portuguese context was delivered to physicians and psychologists. The second stage complemented the insights of the web survey’s results with a Key Opinion Leader analysis.

Results:

A total of 160 complete survey responses were recorded, most from psychologists. This is the most extensive study on mental health professionals’ attitudes and perceptions of digital mental health applications in Portugal. A total of 87.2% (136/156) of respondents supported the opportunity to prescribe digital mental health apps. Increased health literacy (87%), wider adherence to treatment (86%), and proper disease management (79%) were the most frequently agreed upon benefits of DMHA. However, only 43.6% (68/156) of respondents planned to prescribe or recommend digital mental health applications, with psychologists being more favorable than psychiatrists. Professionals still face substantial barriers, such as a lack of information on digital mental health applications (96%), the level of initial training effort (72%), and the need for adjustments of clinical processes and records (71%). Professionals unsure of prescribing digital mental health applications reported that having more information on the available apps and their suitability for health objectives (94%), more scientific evidence of the validity of the apps as a health intervention (92%) and established recommendations of apps by specific clinical guidelines or professional societies (91%) would be essential to foster adoption.

Conclusions:

More information about digital mental health applications regarding clinical validity and how they work is necessary so such an intervention can be adopted in Portugal. Recommendations from professional and scientific societies, as well as from governmental bodies, are strongly encouraged. Even though the benefits of and the barriers to using these apps are consensual, more evidence is needed, along with further promotion of mental health professionals’ digital literacy.