JMIR Publications

ABSTRACT

Background:

Improving mental health treatment within the Collaborative Care Model (CoCM) may be achieved by using e-mental health (e-MH) tools. Since e-MH tools have barriers to uptake, we want to understand patient e-MH preferences and practices while exploring the potential role of the care manager to facilitate incorporation of health technology into the CoCM existing workflows.

Objective:

Firstly, this pilot study sought to understand how patients select, engage, and utilize three self-help e-MH tools for depression. Secondly, the study explored satisfaction with the tools as well as facilitators and barriers to engagement, with particular emphasis on care manager interactions.

Methods:

This was a single-center, non-randomized, preferred assignment study of two cognitive behavioral therapy-based tools (Moodkit and moodgym) and an educational website (the Depression Center Toolkit). The tools were recommended for use in 15-minute sessions 3 times a week, for 6 weeks, coupled with low-intensity care manager coaching. Utilization of e-MH was also captured during an additional 4 weeks without coaching. Self-report outcome measures were gathered at baseline, weekly for 6 weeks, at week 10 and through activities suggested by the tool.

Results:

The 32 participants enrolled were predominantly female (84%, n=27), Non-Hispanic Caucasian (91%, n=29) with a mean age of 41.8 (range 20 to 78 years). Most participants (81%, n=26) presented with moderate to moderately severe depression (PHQ-9=11-19) and marked level of impairment in different areas of functioning. About 56% of the participants (n=17) initially selected Moodkit, 25% (n=8) moodgym and 19% (n=6) the Depression Center Toolkit. Four participants (12.5%, 4/32) switched tools within the first week. Seven participants (22%, 7/32) dropped out. The remaining 25 active individuals employed tools on average 3.2 times per week (SD 2.4). Most participants (68%) engaged with tools for 11 to 20 minutes or more at a time. Of the 18 participants surveyed at week 10, about 67% (12/18) were using their tools with no coaching. Satisfaction increased with progressive use of the tool. The care manager’s low intensity coaching lasted on average 7.9 minutes (SD=3.9) and promoted better understanding and greater usage of the tools. Other facilitators to adherence consisted of organization, convenience, ease, accessibility, and privacy policies of the tools while barriers included time constraints, depressive symptoms, and uncertainty about the efficacy of the tool.

Conclusions:

Uptake of e-MH tools for depression is feasible and associated with significant user satisfaction in CoCM. Low-intensity care manager coaching is consistent both with the collaborative care model and associated with good uptake and on-going use of e-MH tools. To our knowledge, this is the first study to leverage the care manager’s proactive outreach to and routine follow-ups with patients towards engagement into self-help digital tools. Clinical Trial: NCT04689568