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The burden of mental health disorders is among the top 10 causes of disease burden worldwide, and evidence shows no signs of reduction since 1990. To reduce their impact on the global population, more effective prevention and treatment programs should be implemented, with access to care remaining one of the core pillars of successful interventions. In parallel, digital health apps have become one of the most visible faces of the ongoing digital transformation in health care, and digital mental health apps (DMHAs) are among the most downloaded condition-specific apps. Although a match between mental health needs and emerging technological solutions could serve as a path to success, it is not clear to what extent these tools are acceptable to mental health professionals.
In Portugal, characterized by a high mental disease burden, an aging population, and health care provision constraints, the relevance of DMHAs is still undetermined. The aim of the study is to explore the attitudes and expectations of psychiatrists and psychologists toward digital mental health apps in the Portuguese context, as well as their perceived benefits, barriers, and potential actions to support adoption. This is intended to better inform public policy and public and private efforts regarding the development of products and services in this area.
The authors collected primary data from a survey questionnaire distributed online, leading to 160 completed surveys. Responders were asked to express their level of agreement using a Likert scale regarding several topics related to the potential benefits of DMHAs, the perceived barriers to adoption, and how to support DMHA adoption. They also provided data on their demographic characteristics and workplace setting. These data were complemented by a key opinion leader (KOL) analysis of six digital mental health experts on the Portuguese landscape regarding the obtained results and their opinions on the survey’s questions.
Regarding potential perceived benefits, most respondents expressed agreement with all listed outcomes. For patients, these ranged from increased health literacy (87%), wider adherence to treatment (86%), proper disease management (79%), and improved access to health care (75%), as well as an improved ability to make informed choices (65%). On the other hand, practitioners mostly agreed on the benefits regarding time savings due to efficiency gains (70%), availability of additional treatment options (66%), and better quality of patient care (58%). However, only 39% agreed DMHAs would lead to greater treatment success.
Concerning the barriers to DMHA adoption, almost all respondents agreed that information on digital health apps was lacking (96%), with most also considering the learning and usability curve (72%) as well as the need for adjustments in the clinical practice (71%) as relevant factors. At least one-third of respondents showed uncertainty or neutrality regarding the absence of a definition for co-payment mechanisms and a lack of product/service support from manufacturers.
At the same time, some measures to support DMHAs were recognized. Most identified proposals gathered overwhelming agreement answers, chief among them were having more information on apps and their suitability (94%), more evidence of DMHAs as health interventions (92%), and recommendations or guidelines issued by scientific and professional societies (91%). More disagreement and uncertainty were revealed regarding the role of DMHA integration into health insurance packages.
Some key aspects to keep in mind concern the characteristics of the online survey respondents. First, participation was free and unrewarded, so answers may reflect the opinions and behaviors of the practitioners most passionate about this topic. However, the KOL analysis showed that the survey results were consistent with the perceived reality regarding the broader group of professionals. Second, most answers came from female practitioners (84%) and from people 55 years or younger (94%), which do not seem to match the characteristics of the target population. Third, most responders served populations with more than 20,000 residents (85%), representing a primarily urban setting. Moreover, many practitioners worked in more than one type of practice, most commonly at clinics (36%) and hospitals (35%), with only 11% working at the primary care level.
Respondents who reported more positive attitudes toward DMHAs and those who worked in a clinic reported higher intention of prescription. Male respondents also reported a higher likelihood of assuming more positive attitudes toward DMHAs.
A statistically significant association was found between the digital affinity score and prescription intentions but not for the association between digital affinity and the physicians’ attitudes. Overall, our results lead us to believe that Portuguese professionals expect to prescribe DMHAs shortly (the next 12 months); still, they are currently not very optimistic about these tools. This may suggest that they are open to changing their views. Here, identified measures to lead the adoption of these apps will be key leverage points.
The research team concluded in their JMIR Publications Research Output that there is significant potential for DMHAs to help Portugal tackle the increasingly unmanageable burden of mental illness, namely, anxiety and depression. However, physicians’ concerns must be considered, and their buy-in must be ensured if apps are to gain traction. It is time for Portugal’s health system to address this issue, as it bears many commonalities with other digital health tools, such as the need for digital literacy in health professionals.
Most professionals declared support for the opportunity to prescribe DMHAs. However, more information on their clinical validity and way of working in clinical practice is needed before they can be trusted by care providers in Portugal. Recommendations from professional and scientific societies, as well as governmental bodies, are strongly encouraged. There is high consensus regarding the benefits of and barriers to using DMHAs and the need to promote professionals’ digital literacy.
Moreover, as Portugal has a mostly centralized health data system, with a common single health number for all patients and a relatively small population, it could serve as a fit candidate for developing new DMHA tools and assessing their impact. In addition, the country can serve as an example for other European countries to follow these innovative approaches.
Based on the findings, our recommendations will help market- and public-based agents identify the key issues for mental health professionals and how to best overcome them, thus improving their product or service market fit and, consequently, access to digital mental health care.
Nogueira-Leite D, Diniz JM, Cruz-Correia R. Mental Health Professionals’ Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study. JMIR Hum Factors. 2023.