Mental health problems are common and pose a tremendous societal burden in terms of cost, morbidity, quality of life, and mortality. The great majority of people experience barriers that prevent access to treatment, aggravated by a lack of mental health specialists. Digital mental health is potentially useful in meeting the treatment needs of large numbers of people. A growing number of efficacy trials have shown strong outcomes for digital mental health treatments. Yet despite their positive findings, there are very few examples of successful implementations and many failures. Although the research-to-practice gap is not unique to digital mental health, the inclusion of technology poses unique challenges. We outline some of the reasons for this gap and propose a collection of methods that can result in sustainable digital mental health interventions. These methods draw from human-computer interaction and implementation science and are integrated into an Accelerated Creation-to-Sustainment (ACTS) model. The ACTS model uses an iterative process that includes 2 basic functions (design and evaluate) across 3 general phases (Create, Trial, and Sustain). The ultimate goal in using the ACTS model is to produce a functioning technology-enabled service (TES) that is sustainable in a real-world treatment setting. We emphasize the importance of the service component because evidence from both research and practice has suggested that human touch is a critical ingredient in the most efficacious and used digital mental health treatments. The Create phase results in at least a minimally viable TES and an implementation blueprint. The Trial phase requires evaluation of both effectiveness and implementation while allowing optimization and continuous quality improvement of the TES and implementation plan. Finally, the Sustainment phase involves the withdrawal of research or donor support, while leaving a functioning, continuously improving TES in place. The ACTS model is a step toward bringing implementation and sustainment into the design and evaluation of TESs, public health into clinical research, research into clinics, and treatment into the lives of our patients.

An increasingly large body of randomized controlled trials has demonstrated the efficacy of mental health technologies, such as Web-based and mobile interventions, to prevent and treat mental disorders and increase psychological well-being. However, there is little evidence that these tools can be successfully implemented in clinical settings. The authors highlight three widely held misconceptions that they believe are holding back the field, and they reconceptualize the issues to strengthen the path toward implementation and accelerate innovation.

BackgroundThe prenatal care visit structure has changed little over the past century despite the rapid evolution of technology including Internet and mobile phones. Little is known about how pregnant women engage with technologies and the interface between these tools and medical care, especially for women of lower socioeconomic status.ObjectiveWe sought to understand how women use technology during pregnancy through a qualitative study with women enrolled in the Women, Infants, and Children (WIC) program.MethodsWe recruited pregnant women ages 18 and older who owned a smartphone, at a WIC clinic in central Pennsylvania. The focus group guide included questions about women’s current pregnancy, their sources of information, and whether they used technology for pregnancy-related information. Sessions were audiotaped and transcribed. Three members of the research team independently analyzed each transcript, using a thematic analysis approach. Themes related to the topics discussed were identified, for which there was full agreement.ResultsFour focus groups were conducted with a total of 17 women. Three major themes emerged as follows. First, the prenatal visit structure is not patient-centered, with the first visit perceived as occurring too late and with too few visits early in pregnancy when women have the most questions for their prenatal care providers. Unfortunately, the educational materials women received during prenatal care were viewed as unhelpful. Second, women turn to technology (eg, Google, smartphone applications) to fill their knowledge gaps. Turning to technology was viewed to be a generational approach. Finally, women reported that technology, although frequently used, has limitations.ConclusionsThe results of this qualitative research suggest that the current prenatal care visit structure is not patient-centered in that it does not allow women to seek advice when they want it most. A generational shift seems to have occurred, resulting in pregnant women in our study turning to the Internet and smartphones to fill this gap, which requires significant skills to navigate for useful information. Future steps may include developing interventions to help health care providers assist patients early in pregnancy to seek the information they want and to become better consumers of Internet-based pregnancy resources.

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CSCW has long been concerned with the distribution of activities in time and in space, but the problems of distributed work have often taken analytic and technical precedence. In this paper, we are interested in the issue of temporality in collaborative work. In particular, we want to examine how the temporal organization of action is experienced by those who are involved in it. To investigate this phenomenon, we conducted a field study of medical workers in a surgical intensive care unit. Through this study, we highlight the temporal organization of the work. In particular, we introduce and describe three temporal features -temporal trajectories, temporal rhythms, and temporal horizons -that emerge from and influence the work of healthcare providers as they attempt to seek, provide, and manage information during the course of their daily work.

Objective Integrating patient-reported outcomes (PROs) into electronic health records (EHRs) can improve patient-provider communication and delivery of care. However, new system implementation in health-care institutions is often accompanied by a change in clinical workflow and organizational culture. This study examines how well an EHR-integrated PRO system fits clinical workflows and individual needs of different provider groups within 2 clinics. Materials and Methods Northwestern Medicine developed and implemented an EHR-integrated PRO system within the orthopedics and oncology departments. We conducted interviews with 11 providers who had interacted with the system. Through thematic analysis, we synthesized themes regarding provider perspectives on clinical workflow, individual needs, and system features. Results Our findings show that EHR-integrated PROs facilitate targeted conversation with patients and automated triage for psychosocial care. However, physicians, psychosocial providers, and medical assistants faced different challenges in their use of the PRO system. Barriers mainly stemmed from a lack of actionable data, workflow disruption, technical issues, and a lack of incentives. Discussion This study sheds light on the ecosystem around EHR-integrated PRO systems (such as user needs and organizational factors). We present recommendations to address challenges facing PRO implementation, such as optimizing data collection and auto-referral processes, improving data visualizations, designing effective educational materials, and prioritizing the primary user group. Conclusion PRO integration into routine care can be beneficial but also require effective technology design and workflow configuration to reach full potential use. This study provides insights into how patient-generated health data can be better integrated into clinical practice and care delivery processes.

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