JMIR Publications

ABSTRACT

Background:

Early intervention in mental health crises can prevent devastating outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect worsening of SMI. This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians.

Objective:

We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians.

Methods:

Data collection took place between December 2020 and June 2021 in one VA healthcare system. Semi-structured interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and their perceptions of the usefulness of mobile sensing as a tool for self-tracking and improving mental health assessments. The Health Information Technology Acceptance Model guided our rapid qualitative analysis of data.

Results:

Mental health clinicians discussed the utility of web-based data dashboards to monitor SMI patient health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care (e.g., medication management, tailoring treatment), capturing behaviors that patients don’t self-report, and watching trends and receiving alerts. Clinicians’ concerns included increased workloads tied to dashboard data review (e.g., accessing the dashboard, validity and interpretation of data, intersection of burdens from electronic systems and limited appointment times), lack of experience using health IT in clinical care, and how SMI patients’ associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it to their SMI patients. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile application easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and “government tracking,” and how the app would affect their phone’s battery life and data plans. Despite concerns, most reported that they would use the app.

Conclusions:

Many people with SMI would like to have mobile, informatics tools that can support their illness and recovery, however, this population presents some challenges to adoption and implementation. Healthcare organizations will need to provide resources to address these and support successful illness management among these populations. Clinicians are also supportive of technological approaches, with adapting to using informatics data into their workflow as the primary challenge. It will be necessary to ensure clinicians operate at the top of their skill set and that they are not overwhelmed by administrative tasks, data summarization or reviewing data that does not indicate a need for their intervention. Limitations include sample size, and that preliminary feedback is based on discussions of proposed tools rather than user experiences. Passive self-tracking has the potential to be a major innovation in the delivery of services for patients with SMI and other mental illnesses, and for patients at risk of mental illness. Clinical Trial: ClinicalTrials.gov NCT05023252; https://clinicaltrails.gov/ct2/show/NCT05023252