Clinical Targets and Attitudes towards Implementing Digital Health Tools for Remote Measurement in Treatment for Depression: A Qualitative Study

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Abstract

Background
Remote measurement technologies (RMTs) such as smartphones and wearable devices could improve treatment outcomes for depression through enhanced illness characterisation and monitoring. However, little is known about which digital outcomes are clinically meaningful to patients and clinicians. Moreover, if these technologies are to be successfully implemented within treatment, stakeholders’ views on barriers to, and facilitators of, their implementation in treatment need to be considered.

Objective
This study aimed to (1) identify clinically meaningful targets for digital health research in depression, and (2) explore attitudes towards their implementation in psychological services.

Methods
A grounded theory approach was employed on qualitative data from three focus groups on patients with a current diagnosis of depression and clinicians with over 6 months’ experience delivering psychotherapy (n = 22).

Results
Emerging themes on clinical targets fell into two main categories: ‘promoters’ and ‘markers’ of change. The former are behaviours that participants engage in to promote mental health; the latter are behaviours that signal a change in mood. These themes were further subdivided into external (changes in behaviours), or internal (changes in thoughts or feelings) and mapped with potential digital sensors. Six implementation acceptability themes emerged: (1) technology-related factors, (2) information and data management, (3) emotional support, (4) cognitive support, (5) increased self-awareness, and (6) clinical utility.

Conclusions
The ‘promoters’ vs ‘markers’ of change differentiation has implications for a causal model of digital phenotyping in depression, which this paper presents. Internal vs external subdivisions are helpful in determining which factors are more susceptible to being measured with active vs passive methods. The implications for implementation within psychotherapy are discussed with regards to treatment effectiveness, service provision, and patient and clinician experience.
Original languageEnglish
JournalJMIR Mental Health
Publication statusAccepted/In press - 14 Jun 2022

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