Decision-making about uptake and engagement with digital mental health services: a qualitative exploration of service user perspectives

ObjectiveDigital mental health services (DMHS) overcome many barriers to help-seeking. Yet, people's use and uptake of treatment with DMHSs varies considerably. This study explored service user perspectives on deciding to take up online assessment and treatment for anxiety and/or depression within a large national DMHS.MethodParticipants were 20 adults who had self-referred or were referred by a GP to an Australia-wide DMHS for psychological assessment (group 1), plus follow-up discussion of treatment/other service options with a therapist (group 2), plus enrolment into internet-delivered treatment with optional therapist guidance (group 3). Participants took part in one-to-one semi-structured interviews, with parallel question guides tailored to their group status. Interviews were transcribed verbatim and analysed thematically using framework methods.ResultsAnalyses yielded three interlinking themes. Theme 1 highlighted the "importance of the broader treatment context, and its interaction with DHMS"; Theme 2 drew attention to "how the internal service structure shapes decision-making"; Theme 3 focussed on "the scope and limitations of DMHS".ConclusionFindings provide in-depth insights into service user decision-making around engagement with DMHS and can inform the development of interventions to support users to take up DMHS offerings that are best suited to their needs, preferences, and current circumstances. What is already known about this topic: Digital mental health services (DMHSs) bypass many of the barriers to treatment-seeking DMHS users vary in how and the extent to which they engage with digital treatments. There is limited understanding of factors influencing user decisions to uptake and engage with DMHS.What this topic adds: Service user attitudes and experiences, the DMHS's internal structure and service delivery model, and the broader treatment landscape including external health professionals, all appear to shape user decision-making.Identified themes align with constructs from the Consolidated Framework for Implementation Framework, namely intervention characteristics; outer setting; inner setting;and characteristics of individuals.Consistent with models of shared decision-making, service users value the role of therapists in supporting active and informed decision-making around uptake and engagement with the DMHS.