Jo Eunkyung, Kouaho Whitney-Jocelyn, Schueller Stephen M, Epstein Daniel A
Department of Informatics, University of California, Irvine, CA, United States.
Department of Psychological Science, University of California, Irvine, CA, United States.
JMIR Ment Health. 2023 Sep 22;10:e49684. doi: 10.2196/49684.
Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment in which development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care, as opposed to mental health apps, which primarily provide supplemental support, suggesting a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy.
In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions of whether and how ethical principles are followed and incorporated.
We identified 8 mobile apps that (1) provided teletherapy on 2 dominant mobile app stores (Google Play and Apple App Store) and (2) had received >5000 app reviews on both app stores. We wrote Python scripts (Python Software Foundation) to scrape user reviews from the 8 apps, collecting 3268 user reviews combined across 2 app stores. We used thematic analysis to qualitatively analyze user reviews, developing a codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers.
The qualitative analysis of user reviews revealed the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning that their therapists did not listen to them, were distracted during therapy sessions, and did not keep their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might affect their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints.
Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas regarding professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that, to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services.
远程治疗应用程序已成为传统面对面治疗的一种有前景的替代方式，尤其是在新冠疫情之后，因为它们有助于克服一系列获取治疗的地理和情感障碍。然而，远程治疗应用程序的迅速激增是在一个开发速度超过该领域各种监管和伦理考量的环境中发生的。因此，鉴于缺乏监管和监督，研究人员对远程治疗应用程序的伦理影响和潜在风险表示担忧。与主要提供补充支持的心理健康应用程序不同，远程治疗应用程序有更直接复制传统护理实践的独特目标，这表明需要从现有的治疗伦理准则角度审视远程治疗应用程序的伦理考量。
在本研究中，我们检查了商业远程治疗应用程序的用户评论，以了解用户对是否以及如何遵循和纳入伦理原则的看法。
我们确定了8款移动应用程序，这些应用程序（1）在2个主要移动应用商店（谷歌Play和苹果应用商店）上提供远程治疗，并且（2）在两个应用商店上都收到了超过5000条应用评论。我们编写了Python脚本（Python软件基金会）来从这8款应用程序中抓取用户评论，共收集了来自2个应用商店的3268条用户评论。我们使用主题分析对用户评论进行定性分析，根据心理学家、精神科医生和社会工作者的行为伦理准则制定了一个编码手册。
对用户评论的定性分析揭示了远程治疗应用程序用户的伦理担忧和机遇。用户经常感觉到他们的远程治疗师不专业，提到他们的治疗师不听他们说话、在治疗过程中分心以及不遵守预约。用户还指出远程治疗应用程序存在技术故障和治疗师无法提供服务的情况，这可能会影响他们提供连续护理的能力。用户对这些应用程序的可承受性有不同看法，一些人认为它们价格合理，而另一些人则不这么认为。用户进一步提出订阅模式导致定价不公平，并对缺乏成本透明度表示担忧。用户认为这些应用程序可以通过克服地理和社会限制来帮助促进获得护理。
我们的研究表明，用户认为商业远程治疗应用程序在许多与治疗相关的伦理原则方面是遵循的，但在专业性、护理连续性、成本公平性和成本透明度等关键领域存在不足。我们的研究结果表明，为了提供高质量的护理，远程治疗应用程序应该优先考虑对治疗师的公平补偿，开发更灵活和透明的支付模式，并投资于确保应用程序稳定性和治疗师可用性的措施。未来需要开展工作来制定远程治疗标准，并提高这些服务的质量和可及性。
