JMIR Publications

ABSTRACT

Background:

Mental health conditions are highly prevalent among US Veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act Model. The implementation of MBC may be further supported by remote measurement-based care (R-MBC), in which data are collected remotely using mobile applications (apps) or other technology platforms.

Objective:

To evaluate Veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support R-MBC for mental health care.

Methods:

Our mixed-methods sequential explanatory evaluation encompassed mailed surveys with Veterans who used MHC and follow-up semi-structured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics and compared responses between Veterans that indicated they used MHC for ≥3 months with Veterans who used the app for ˂3 months using chi-square tests. We analyzed interview data using thematic analysis.

Results:

We received 533 surveys (20% response rate) and completed 20 interviews. Approximately half of survey respondents (n=268) indicated actual use of MHC on the surveys and also reported duration of use; these respondents were included in analyses comparing Veteran experience of MHC by their duration of MHC use. A majority of these respondents overall, and a greater proportion who had used MHC for ≥3 months (vs. <3 months), agreed/strongly agreed that using MHC helped them be more engaged in their health and health care (65%), make decisions about their treatment (60%), and set goals related to their health and health care (60%). Interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (vs. <3 months), agreed/strongly agreed that using MHC enhanced their communication (68% vs. 52%, p = 0.009) and rapport (58% vs. 43%, p = 0.018) with their VHA providers. Interviewees described how MHC helped focus therapy time and facilitated trust. Commonly reported challenges in using MHC among respondents overall included difficulty understanding graphs of their assessment data (42%), not receiving enough training on the app (28%), and not being able to change responses to assessment questions (28%). Interviewees offered suggestions for improving the app (e.g., facilitating ease of login, offering additional reminder features) and for increasing adoption (e.g., marketing the app and its potential advantages for Veterans receiving mental health care).

Conclusions:

Although experiences with the MHC app varied, Veterans were positive overall about its use. Veterans described associations between use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting VHA’s Collect-Share-Act model of MBC.