Patient and Care Team Perspectives of Barriers to and Facilitators for the Implementation of a Digital Health Program for Depression in Primary Care: Qualitative Study

TL;DR

This study explores how a digital health program for depression in primary care is perceived by patients and care teams, identifying what helps or hinders its use.

Contribution

The study provides new insights into the implementation challenges and facilitators of a digital health program for depression from both patient and care team perspectives.

Findings

Patients wanted more educational resources in the app to support their depression treatment.

Care teams found the program useful for tracking patients and improving communication.

Tracking features had mixed effects, with some patients finding them confusing or unhelpful.

Abstract

Depression is pervasive, and rates are rising in the United States. Most people with depression receive care from primary care clinicians, but gaps in the quality of care exist. Team-based approaches to depression care have been shown to aid in treatment and management; yet, challenges exist in implementation. Digital health apps have been shown to be effective in improving depression symptoms and enhancing patient engagement in some populations. Many, however, do not share data with clinical care teams.

This study aimed to understand the barriers to and facilitators for implementation of a digital health program that supports coordinated use by clinical care teams and patients, via a mobile app and care team–facing web interface, for depression in primary care.

This study was part of a larger intervention study that included 4 primary care practices: 2 intervention and 2 control sites. The intervention sites used a patient-facing mobile app and a care team–facing web interface, and the control sites continued usual care. The study team conducted interviews from May to October 2021. Patient and care team participants were recruited toward the end of their study involvement. Separate semistructured interview guides were developed for patient and care team participants. Interviews were recorded and transcribed. Data were coded using Atlas.ti.9, and data analysis was completed using a grounded theory approach.

Interviews with patient (n=8) and care team (n=8) participants revealed 3 main topics for program implementation: app/interface usability, tracking, and program recommendations. For app/interface usability, overall, navigation for both patient and care team participants was simple and straightforward. Although app content was relevant, patient participants desired additional educational resources and information to aid in their depression treatment and management. In terms of tracking, care team participants indicated that data obtained via the interface enabled them to monitor patients in between visits; and in some circumstances, these data facilitated conversations with patients about treatment plans. Tracking medication adherence differed among patient participants due to established routines of taking medications consistently, lack of motivation to track, or lack of interest in tracking. Care team participants reported the ability to respond more quickly to side effects. Patients commented on tracking difficulties: confusing response options, insufficient goal attainment response options, not being able to provide details or write notes, and no ability to change goals. Some patient and care team participants perceived that tracking encouraged communication with one another; others perceived tracking as having no impact on shared decision-making.

Results suggest implementation of a digital health program for depression treatment and management in primary care practices could impact patient medication adherence, produce faster turnaround time for medication optimization, encourage goal setting, and foster communication between patients and care team members. Program enhancements could optimize patient and care team member engagement.