Abstract
Digital health technologies are predicted to increasingly dominate public health as a means of delivering care, collecting and sharing health-related data, and enabling individuals to manage their health. While new digital interventions to support healthcare delivery are constantly being developed, many struggle to move beyond piloting and trialing and reach real-life integration. The evaluation of digital technologies often focuses on quantifiable, technical aspects such as system performance, usability, and cost-benefits. However, to guide the user-centered design and effective implementation of digital health technologies it is important to consider how and why people adopt, adapt, and incorporate technologies into their daily practices. This requires more in-depth inquiries about how people react, respond, relate to, and make sense of technologies.
Focusing on the implementation of a newly developed digital tool to support person-centered care and self-monitoring of mental health, this study aimed to examine how clinicians and their clients adopted, adapted, and incorporated this tool into their therapeutic practices. We conducted a pilot study within a psychiatric hospital setting in which 10 clinicians and 20 clients tested and evaluated a prototype of a digital self-monitoring tool. The tool allowed clients to self-monitor their mental health in their daily lives via a smartphone app and subsequently review their data in collaboration with their clinician. 7 clinicians and 11 clients participated in interviews to examine their experience with using the tool. We undertook a thematic framework analysis focusing on 1) prior knowledge and expectations, 2) actual use in practice, and 3) potential future use of the tool.
Only one participant had prior experience with digital self-monitoring. However, several had experience with using digital technologies in health care and with analog self-monitoring techniques. Clinicians initially found the tool to be too complex. They did not feel they had adequate competencies to make full use of it and expressed a need for more support. With practice, most clinicians manage to make use of the tool, but familiarizing themselves with it was considered highly time-consuming. Clients found that the frequent self-assessments were somewhat burdensome. While filling in the assessments did not take long, clients often experienced difficulties in responding to the notifications, as they were busy doing other things. Still, the majority reported that they made an effort to comply with the notifications. Clinicians perceived the data visualization as somewhat difficult to interpret and would spend time examining their clients' data in preparation for therapy sessions. Meanwhile, most clients reported that they were able to make sense of the data with the help of their clinician. Despite challenges, participants generally found that the self-monitoring tool provided them with useful information that could guide clients’ therapy. Many expressed a wish to use self-monitoring tools again but stressed that it should be made more user-friendly and less burdensome for clients.
While these are promising findings, a major limitation of this study is potential sampling bias, as people with positive attitudes towards technology are likely over-represented. Future studies should aim to also involve more technology-skeptical people.