JMIR Publications

ABSTRACT

Background:

In 2019, reimbursable mHealth apps (Digitale Gesundheitsanwendungen, DiGA) have been inte-grated into routine care in Germany. Despite their possible potential, their uptake remains limited, particularly for treating mental disorders. There is sparse evidence on patient-reported real-world use, discontinuation and barriers.

Objective:

This study aimed to investigate usage patterns among DiGA users in outpatient mental health care and to compare experienced barriers among users with anticipated barriers among non-users.

Methods:

We conducted a cross-sectional mixed-mode survey (postal and web-based) among adults insured by Germanys biggest statutory health insurance fund (Techniker Krankenkasse, TK). A random sample of 2,000 individuals from each group (DiGA users and DiGA non-users) was drawn. Re-spondents were contacted in April 2024 (initial invitation) and May 2024 (reminder), with the survey remaining open until September 2024. Group comparisons were performed using chi-square tests for nominal variables and Mann-Whitney-U tests for ordinal variables, with effect sizes reported as Phi/Cramer’s V and correlation coefficients (r), respectively.

Results:

In total, 1,413 participants were included (769 users; 644 non-users; response rates 38.5% and 32.2%). Among users, 37% did not complete the DiGA program, whereas premature discontinua-tion was significantly more common among younger users (discontinuation rates: ≥60 years: 24.1% vs. 18–40 years: 55.6%). Non-users reported stronger anticipated barriers than users based on ac-tual experience, particularly regarding technical problems (median: users 1 vs non-users 5; p < 0.001; r = −0.79) and a perceived mismatch with one’s condition (median: users 2 vs non-users 5; p < 0.001; r= −0.64).

Conclusions:

Results indicate that while many users complete DiGA programs, discontinuation remains common and is more pronounced among younger users. The gap between expectation and experience sug-gests that anticipated barriers among non-users may exceed barriers encountered in practice. Ad-dressing perceived technical reliability and fit, alongside strategies supporting sustained engage-ment, may be relevant for optimizing DiGA implementation in outpatient mental health care.