JMIR Publications

ABSTRACT

Background:

Access to mental healthcare is critical for the effective management of serious mental illness (SMI), but consumers with low-socioeconomic status have lower rates of service utilization and worse retention in care. Digital technologies are often lauded as a way to bridge access gaps; however, little is known about how technology-mediated care may influence care access among low SES consumers and how consumers use technology in care access.

Objective:

We examine the applicability of Levesque et al.’s access framework to technology-mediated care for SMI and analyze how low-SES consumers use technology to facilitate care access.

Methods:

Ethnographic observations at a mental health treatment court and interviews with low SES CMH consumers with SMI using CMH (n=14) and key informant interviews with health and service providers (HSPs) working with this population (n=14).

Results:

Levesque et al.’s framework required several extensions to accommodate care related to SMI for low-SES consumers: (1) a cyclical rather than linear trajectory; (2) simultaneous care acquisition from multiple HSPs; (3) staying in care long-term; and (4) identification of both one-time and ongoing health needs; and (5) an emergency pathway for entering care. Consumers often faced challenges related to the varied digital requirements of each provider and a dearth of integrative, patient-facing tools like portals. Within this context, some consumers use mobile apps, communication, and telehealth technologies across various care access stages. Consumers used technology by figuring out how to navigate technology-mediated care, especially by leaning on others, such as case managers, for support. These others provided consumers with temporary technologies, showed them how to use technologies, and accompanied them through the process of using technology for accessing care.

Conclusions:

A theoretical contribution of this work is its extensions of Levesque et al.’s care access framework to better reflect technology-mediated care for SMI among low-SES consumers. This work also underscores ongoing challenges for accessing technology-mediated care and the importance of human support in addressing access difficulties. Clinical implications include incorporating digital readiness assessments and providing comprehensive guidance on how consumers can effectively use technologies for care. Future work should investigate how technology-mediated care can make care access easier rather than harder.