Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis
BackgroundDigital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. ObjectiveThis prospectively registered syst...
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| Format: | Article |
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JMIR Publications
2025-01-01
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| Series: | JMIR Mental Health |
| Online Access: | https://mental.jmir.org/2025/1/e65246 |
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| author | Emily Eisner Sophie Faulkner Stephanie Allan Hannah Ball Daniela Di Basilio Jennifer Nicholas Aansha Priyam Paul Wilson Xiaolong Zhang Sandra Bucci |
| author_facet | Emily Eisner Sophie Faulkner Stephanie Allan Hannah Ball Daniela Di Basilio Jennifer Nicholas Aansha Priyam Paul Wilson Xiaolong Zhang Sandra Bucci |
| author_sort | Emily Eisner |
| collection | DOAJ |
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BackgroundDigital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low.
ObjectiveThis prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings.
MethodsA systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach.
ResultsThe review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs’ relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery.
ConclusionsIdentified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed.
Trial RegistrationPROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871 |
| format | Article |
| id | doaj-art-55bd791b1c1048ebbdeff7be2270e14c |
| institution | Kabale University |
| issn | 2368-7959 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Mental Health |
| spelling | doaj-art-55bd791b1c1048ebbdeff7be2270e14c2025-01-20T20:01:00ZengJMIR PublicationsJMIR Mental Health2368-79592025-01-0112e6524610.2196/65246Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework SynthesisEmily Eisnerhttps://orcid.org/0000-0001-5164-2407Sophie Faulknerhttps://orcid.org/0000-0003-1549-0922Stephanie Allanhttps://orcid.org/0000-0002-1016-0708Hannah Ballhttps://orcid.org/0000-0002-1178-5080Daniela Di Basiliohttps://orcid.org/0000-0003-3786-442XJennifer Nicholashttps://orcid.org/0000-0003-1889-1107Aansha Priyamhttps://orcid.org/0009-0005-6162-5914Paul Wilsonhttps://orcid.org/0000-0002-2657-5780Xiaolong Zhanghttps://orcid.org/0000-0003-2964-0485Sandra Buccihttps://orcid.org/0000-0002-6197-5333 BackgroundDigital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. ObjectiveThis prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings. MethodsA systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach. ResultsThe review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs’ relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery. ConclusionsIdentified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed. Trial RegistrationPROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871https://mental.jmir.org/2025/1/e65246 |
| spellingShingle | Emily Eisner Sophie Faulkner Stephanie Allan Hannah Ball Daniela Di Basilio Jennifer Nicholas Aansha Priyam Paul Wilson Xiaolong Zhang Sandra Bucci Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis JMIR Mental Health |
| title | Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis |
| title_full | Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis |
| title_fullStr | Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis |
| title_full_unstemmed | Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis |
| title_short | Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis |
| title_sort | barriers and facilitators of user engagement with digital mental health interventions for people with psychosis or bipolar disorder systematic review and best fit framework synthesis |
| url | https://mental.jmir.org/2025/1/e65246 |
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