Barriers and facilitators to engagement with a mental health EHR-linked digital tool: a mixed-methods study

Objectives Digital self-management applications linked to electronic health records (EHRs) offer scalable solutions for rising mental health needs. This study evaluates how experience changes perceptions of an EHR-linked digital self-management tool (Beth). Design An explanatory mixed-methods study comparing clinicians and service users who have or have no experience of Beth. Group differences were analysed using non-parametric tests. Qualitative data were analysed thematically. Setting UK NHS Mental Health trust. Participants 32 clinicians and 31 service users. Interventions After demonstrating the digital tool, participants completed outcome measures. Main outcome measures Technology use questionnaires, Mobile Application Rating Scale (MARS). Results MARS ratings reflected moderate quality. Experienced service users rated engagement lower than non-users (U=166.00, z=2.68, p=0.007). Clinicians rated Beth quality more positively than service users (U=236.00, z=−3.04, p=0.002). All non-users voiced concerns about confidentiality, whereas experienced service users thought this was less problematic and instead commented on potential care team disconnection if communication was only through the app. Despite differences, both experienced and non-users highlighted the need for improved accessibility by simplifying the format and log-in processes and suggested more advanced features to increase engagement. Both clinician groups recognised the potential to enhance self-monitoring and support for service users between appointments. Conclusions Experience of this EHR-linked digital tool appeared to increase acceptability and confidentiality views." Addressing privacy concerns, providing clinician training, and increasing co-design features is likely to increase successful implementation. Addressing potential users concerns through active promotion should encourage daily use of an EHR-linked digital tool.