The efficacy of digital mental health (DMH) services is well established. Digital mental health services are comprised of the technology, service protocol, and, ideally, implementation plan to support delivery. Like their traditional in-person treatment counterparts, DMH services have been developed and are being studied to target the behavioral, cognitive, and/or affective mechanisms that impact functioning (eg, decreasing avoidance via a digital anxiety intervention). However, when DMH services move from controlled research settings to deployment in real-world health care settings, engagement is an acute problem.1 Implementation attempts often show low rates of service use and retention among patients (ie, failure for individual-level engagement), and DMH services fail to be integrated successfully within their targeted systems of care (ie, failure for systems-level engagement among clinicians/organizations). For example, a large-scale attempt to implement commercially available and free-to-use digital depression services in primary care failed.2 Several factors impede successful implementation of evidence-based interventions into care, such as organizational, sociopolitical, and economic policies (eg, reimbursement challenges) and failed understanding of mechanisms by which implementation strategies improve outcomes. Another critical factor affecting low engagement is the failure to adequately incorporate end users (eg, patients, clinicians, and care systems) in the design of DMH services.
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Graham AK, Lattie EG, Mohr DC. Experimental Therapeutics for Digital Mental Health. JAMA Psychiatry. 2019;76(12):1223–1224. doi:10.1001/jamapsychiatry.2019.2075
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