JMIR Publications

ABSTRACT

Background:

Emerging adults (EAs; aged 18-29 years) experience a high burden of mental health (MH) concerns during a developmental period marked by increasing autonomy and vulnerability to symptom onset. Many EAs face challenges in accessing and sustaining engagement with developmentally appropriate care. Digital measurement-based care (dMBC), which involves the routine use of patient-reported outcome measures (PROMs), has been introduced as an approach to support EA engagement and improve responsiveness of care through ongoing monitoring and informed clinical decision-making. However, its integration into routine care remains variable, and there is limited understanding of how EAs experience and engage with dMBC in practice.

Objective:

This study aimed to examine how EAs experience and engage with dMBC in routine MH care and to identify the key processes that shape its use in clinical settings.

Methods:

A descriptive qualitative design was used to generate formative evidence on EAs’ experiences with dMBC. Semi-structured interviews were conducted with 23 purposively sampled EAs who were either actively receiving care or had recently been discharged from one of two outpatient MH clinics in Southern Alberta, Canada. Within these settings, dMBC was implemented via a web-based platform to collect and review PROMs within a clinically staged-informed stratified care model. Under this model, clinical staging categorizes individuals based on the progression and complexity of their presentation to guide treatment intensity and service pathways. All participants completed baseline PROMs, with subsequent completion varying based on clinician discretion, participant use, and scheduled clinical time points at 6 months, 12 months, and discharge. Interview data were analyzed using thematic analysis.

Results:

Findings identified four interconnected processes shaping engagement with dMBC: Technology, Tracking, Translation, and Therapeutic Guidance. These processes were synthesized into a user-centered integration model (the “4Ts”). Engagement was influenced by the platform's usability and accessibility, the role of tracking in supporting reflection and awareness, the use of PROM data to facilitate communication, and the extent of clinician involvement in interpreting and applying results. Across the themes, the integration of PROM data into therapeutic interactions emerged as central to sustaining engagement, while variability in use reflected differences in individual capacity, perceived relevance, and clinical integration.

Conclusions:

dMBC functions most effectively when embedded within relational and clinical processes, rather than as a standalone digital tool. The 4Ts model offers a preliminary framework for understanding the conditions that support meaningful engagement in EA MH care. Ongoing co-design work is underway to mobilize these insights into practice-oriented strategies to support implementation.