Increasing Behavioral Health Access with Self-Screening mHealth Apps, Smart Devices & Telehealth

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The critical roles of digital health apps, digital devices, and telehealth or teletherapy services in healthcare access are steadily being examined and reported in the recent scientific literature. In the three recently-published studies reviewed below, the role of digital health tools such as mobile health applications (mhealth apps), digital smartphone devices, and the ensuing use of telehealth and teletherapy are examined as ways to increase mental health access. These studies point the way for telebehavioral health service professionals in all settings to consider how to best position themselves to anticipate the inevitable growing market for their telehealth services.

Self-Administered mHealth Apps Screening Trial

Behavioral providers can expect increased referrals from primary care offices that encourage patients to self-screen using mHealth apps and provide the needed digital devices. According to a study reported in 2022 by David P. Miller and colleagues in the Journal of the American Medical Association Network (JAMA Network), patients have successfully shared sensitive information about themselves using a self-administered mobile health application. Questions given to patients through the self-screening app were the same as those asked verbally by healthcare professionals during in-person meetings at the same healthcare clinics. Participants accessed sensitive personal questions via a digital tablet made available through their primary physician’s offices. 
Titled Universal Screening in Primary Care Practices by Self-administered Tablet vs. Nursing Staff, the study was carried out by a research team from North Carolina’s Wake Forest University Health Sciences. It used mPATH, a self-screening mobile health application developed by the research team. The study included 23,026 adult participants from June 2019 to February 2020. Patient answers were documented in their electronic health records. Physician offices’ mobile health application utilization rate was between 10% and 60% across six clinics.
Despite wide variation in providing digital health access tools across clinics, self-administered mhealth apps screening identified more than twice the number of patients who required immediate clinical attention compared to the in-person oral administration of questions. The study provides an overview of how health apps can allow patients to self-rate symptoms by digital devices to help overcome barriers such as time pressure and social discomfort in a primary care setting when revealing sensitive information. The primary finding in this study was a doubling in the proportion of positive screenings for patients identified with depression, fall risk, or intimate partner violence. 
Researchers concluded that the notable success of the self-screening mobile health application over verbal questioning is likely to be attributable to the alleviation of social anxiety due to the technology’s ability to provide increased privacy during self-report. They believe that such digital health access tools allow patients and clients to answer sensitive questions with less inhibition than typically experienced when asked the same potentially embarrassing questions in-person by a healthcare professional. Whether identifying at-risk symptoms involves digital self-reports or in-person interviews with professionals. An increase in the accuracy of health screening can lead to increased treatment and resulting outcomes.

Increasing Health Care Access through Digital Health Tools

In another study of healthcare access, a 2021 report in the Journal of Medical Internet Research also found smartphones, tablets, mobile health applications, and similar digital technologies play a crucial role in patient engagement and healthcare access. It was entitled, Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE. The study was designed to oversample historically underserved communities from April 2017 to December 2017. It included 2149 patients who self-reported their Internet access, their access to needed medical care, and related outcomes. Of those participants, 61.38% were women, 30.48% were non-Hispanic White, and 30.99% were non-Hispanic Black.
Across these subgroups, smartphone ownership was associated with obtaining needed medical care, suggesting that access to smartphone technology can increase health care access. Additionally, illnesses such as cancer have the potential to amplify health engagement. Again, access to digital devices allows patients to obtain needed information to make decisions about healthcare and associated providers.

Telemedicine & Telebehavioral Health for Mental Health Access

In yet a third recently-published article, the role of telemedicine, telebehavioral health, and teletherapy was examined for patients who struggle with healthcare access. The January 2022 volume of the Journal of Psychiatric Research published a study conducted by Nyssa Z.Bulkes and colleagues. It compared the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment before the COVID-19 pandemic (N = 1,192) to the outcomes of a comparably sized group of patients who received telehealth treatment during the pandemic (N = 1,192). 
Entitled, Comparing Efficacy of Telehealth to In-Person Mental Health Care in Intensive-Treatment-Seeking Adults, the study provides a well-delineated overview of telebehavioral health efficacy. It supports the position that digital health tools access allows patients and clients to enjoy clinical support from the privacy of their homes, maintain the confidentiality of their sensitive information, and avoid the anxiety of potential social stigma. 

Conclusion

Self-screening mobile health applications and smartphone digital devices can play an important role in educating patients and clients about their need for behavioral and psychiatric care. Once the need is identified, telehealth and teletherapy are favored options for providing mental health care to people who struggle with health access. Making mental health service options available more digitally is a reasonable path for behavioral clinicians to develop their telehealth and teletherapy practices. When properly administered by trained clinicians, telebehavioral care can be as effective as in-person consultation for some populations.

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