Healthcare Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study.

Silfee, Valerie; Williams, Kelly; Leber, Brett; Kogan, Jane; Nikolajski, Cara; Szigethy, Eva; Serio, Catherine

BACKGROUND Despite the growing evidence indicating the efficacy of digital interventions for behavioral health treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. OBJECTIVE To assess providers' views on the feasibility and acceptability of delivering a Cognitive Behavioral Therapy (CBT)-based mobile application (app) in multiple care settings. METHODS Participating providers included behavioral and physical health providers from a women's health center, an outpatient behavioral health clinic, and both rural/urban primary care settings. All participating providers co-created workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, providers referred adult patients experiencing anxiety or depression to a digital CBT app, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by providers through the electronic medical record. To better understand facilitators and challenges to integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. RESULTS Nineteen provider interviews were conducted to discover motivators and barriers for referring RxWell. Providers benefited from a focused discussion about how to incorporate the referral process into their workflow and knowing the app content was rooted in evidence. While providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress were needed. Providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone and/or preference for in-person therapy. Providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, the ability to have an extra treatment option that teaches behavioral health exercises and having a CBT treatment option that overcomes barriers (e.g., wait times, co-pays, travel) to traditional therapy modalities. CONCLUSIONS Digital intervention success in healthcare settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse their use within routine workflow. CLINICALTRIAL