JMIR Publications

ABSTRACT

Background:

Digital health tools such as mobile apps and patient portals continue to be embedded in clinical care pathways to enhance the delivery of mental health care and achieve the quintuple aim of health care. However, a key issue that has greatly hindered the value of these tools is the suboptimal user engagement by patients and families. With only a small fraction of users staying engaged over time, there is a great need to better understand the factors that influence user engagement with digital mental health tools that are being used as part of clinical care delivery.

Objective:

This review aims to identify the factors relevant to user engagement with digital mental health tools in clinical care settings.

Methods:

A scoping review methodology was used to identify the factors from the academic literature. A total of five academic databases were used to identify relevant articles from the literature using key terms related to user engagement, mental health, and digital health tools. The abstracts were screened independently by two reviewers and data was extracted using a standardized data extraction form. The sociotechnical framework by Sittig and Singh was used to inform the mapping and analysis of the factors.

Results:

From a review of five academic databases, a total of 136 articles were identified and included in the analysis. Over 60% of the articles (84/136) were published in the last 5 years and many of the articles were from the United States (47/136) and United Kingdom (23/136). With regards to examining user engagement, the majority of articles (95/136) used a qualitative approach to understand engagement. From these articles, a total of 26 factors were identified across the seven categories of the Sittig and Singh Sociotechnical Framework. These factors ranged from technology-focused factors (e.g., the modality of the tool) to the clinical environment (e.g., alignment with clinical workflows) to system-level issues (e.g., reimbursement for physician use of the digital tool with patients).

Conclusions:

Collectively, these findings have led to the development of a framework on user engagement that encompasses factors across the micro-, meso- and macro-levels. Based on the findings from this work, it has uncovered numerous gaps and key considerations with regards to user engagement. Foremost, there is a need to better understand how the clinical environment and health system (e.g., reimbursement) can be conducive to supporting engagement with digital tools in clinical care settings. Moreover, exploring strategies for improving user engagement through these factors would be useful for health care leaders and clinicians interested in using digital health tools in care delivery. Future work should focus on validating and identifying a core set of essential factors for user engagement with digital mental health tools in clinical care environments. Clinical Trial: Not Applicable