Eisner Emily, Faulkner Sophie, Allan Stephanie, Ball Hannah, Di Basilio Daniela, Nicholas Jennifer, Priyam Aansha, Wilson Paul, Zhang Xiaolong, Bucci Sandra
Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom.
Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
JMIR Ment Health. 2025 Jan 20;12:e65246. doi: 10.2196/65246.
Digital 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.
This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings.
A 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.
The 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.
Identified 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.
PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871.
用于监测和改善精神分裂症或双相情感障碍患者健康状况的数字心理健康干预措施（DMHIs）显示出了前景；然而，用户参与度参差不齐，临床综合使用率较低。
这项前瞻性注册的系统评价研究了临床医生和患者参与DMHIs的障碍与促进因素，以为在现实环境中的实施提供参考。
对7个数据库进行系统检索，确定了报告有关影响工作人员或患者参与DMHIs的因素的定性或定量数据的实证研究，这些DMHIs旨在监测或改善精神分裂症或双相情感障碍患者的心理或身体健康状况。采用实施研究的综合框架，遵循最佳拟合框架综合方法来综合有关障碍和促进因素的数据。
该评价纳入了175篇论文（150项研究；11446名参与者），描述了随机对照试验、调查、定性访谈以及可用性研究、队列研究和案例研究。样本包括精神分裂症谱系精神病患者（98/150，占研究的65.3%）、双相情感障碍患者（62/150，占研究的41.3%）和临床医生（26/150，占研究的17.3%）。关键促进因素包括对DMHIs相对优势的强烈认可、干预重点与特定患者需求之间的明确联系、简单、省力的数字界面、有人支持的服务提供方式以及在需要时提供设备。尽管工作人员认为患者会丢失、损坏或出售设备，但纳入评价的研究发现设备丢失率仅为11%。障碍包括干预的复杂性、感知到的风险、用户动机、对自我反思的不适、数字贫困、精神病症状、与现有临床工作流程的兼容性差、工作人员和患者担心DMHIs会取代传统的面对面护理、基础设施限制以及提供服务的资金支持有限。
确定的障碍和促进因素突出了DMHI开发和实施的关键考虑因素。至于更广泛的影响，需要可持续的商业模式来确保循证DMHIs得以维持和推广。
PROSPERO CRD42021282871；https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871 。
