Accepted for/Published in: JMIR Formative Research
Date Submitted: Jul 30, 2023
Date Accepted: Oct 12, 2023
Warning: This is an author submission that is not peer-reviewed or edited.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.
Exploring the Implementation Feasibility of Digital Mental Health Innovations into Hospitals for Young People Who Present During a Suicide Crisis: A Qualitative Analysis
ABSTRACT
Background:
Hospitals are insufficiently resourced to appropriately support young people who present with suicidal crisis. Digital mental health innovations have potential to provide cost-effective models of care to address this service gap and improve care experiences for young people. Currently, however, little is known about whether digital innovations are feasible to integrate into complex hospital settings, nor how they should be introduced for sustainability.
Objective:
This qualitative study explored the potential benefits, barriers, and collective action required for integrating digital therapeutics for management of suicidal distress in youth into routine hospital practice. Addressing these knowledge gaps is a critical first step in designing digital innovations and implementation strategies that enable uptake and integration.
Methods:
We conducted a series of semi-structured interviews young people who had presented to an Australian hospital for a suicide crisis in the past 12 months and hospital staff who interact with these young people. Participants were recruited from the community, nationally, via online social media advertisements. Interviews were conducted individually, and participants were reimbursed for their time. The interview guide was based on Normalisation Process Theory (NPT) framework, which was developed to clarify the processes and conditions that influence whether and how an innovation becomes part of routine practice in complex health systems.
Results:
Analysis of 29 interviews (17 young people, 12 hospital staff) yielded four themes which mapped onto three NPT constructs related to coherence building, cognitive participation, and collective action. Overall, digital innovations were seen as a beneficial complement to, but not a substitute for, in-person clinical services. Timing of delivery was important, with agreement that digital therapeutics could be provided to patients while they were waiting to be assessed and/or shortly prior to discharge. Staff training to increase digital literacy was considered key to implementation, but there were mixed views over the level of staff assistance to support young people to engage with digital innovations. Improving access to technological devices and internet connectivity, increasing staff motivation to facilitate use of the digital therapeutic, and allowing patients autonomy over the use of the digital therapeutic were identified as other factors critical to integration.
Conclusions:
This qualitative study is the first to explore the suitability of using digital therapeutics to meet the needs of young people experiencing acute suicidal crisis with hospital settings. Findings highlight the importance of scoping intervention appropriateness with key stakeholders before implementation as the best opportunity to identify and address barriers to integration. Clinical Trial: Not applicable.
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