# Engaging underrepresented patient groups in specialised treatment – qualitative results from the PROVIDE-C randomised trial on integrated mental health video consultations for depression and anxiety

## TL;DR

This study shows that video consultations for mental health can be accepted by underrepresented groups like elderly and rural patients, improving access to care.

## Contribution

The study provides novel insights into how underrepresented patient groups experience and accept mental health video consultations in primary care.

## Key findings

- Underrepresented patients found mental health video consultations useful for symptom relief and therapeutic alliance.
- Technical support in primary care helped patients with low technology literacy engage with video consultations.
- Embedding video consultations in primary care improves access for patients hesitant about mental health treatment.

## Abstract

Mental health specialist video consultations (MHSVC) offer a promising way to address the growing burden of depression and anxiety. However, their acceptance among groups with lower mental health care uptake and limited technology literacy remains underexamined.

This study explores how underrepresented patients—elderly, rural, and male individuals with depression or anxiety—experience and accept MHSVC after participating in PROVIDE-C, a randomized trial evaluating a five-session MHSVC intervention in primary care.

A qualitative interview study in rural Germany used inductive content analysis and the Technology Acceptance Model (TAM). TAM suggests that perceived usefulness and ease of use influence technology adoption.

Among 21 PROVIDE-C participants, attitudes toward MHSVC were largely positive. Patients found the intervention useful for therapeutic alliance, symptom relief, and treatment measures, with many preferring continued sessions. Prior mental health care experience and strong primary care relationships increased acceptance. Some patients, already familiar with videoconferencing due to COVID-19, adapted easily, while those with lower technology literacy relied on technical support in primary care to engage with MHSVC for the first time.

Embedding MHSVC in primary care enhances access for patients hesitant about mental health treatment or unfamiliar with digital tools. The PROVIDE model effectively reaches underserved populations, namely elderly, rural patients, improving access to specialized care and reducing depression and anxiety symptoms, as evidenced by its demonstrated effectiveness.

ClinicalTrials.gov, United States National Institutes of Health NCT04316572. Prospectively, registered on 20 March 2020.

The online version contains supplementary material available at 10.1186/s12889-025-25235-1.