Digital health literacy and digital engagement for people with severe mental ill health across the course of the COVID-19 pandemic in England

Abstract

Background An unprecedented acceleration in digital mental health services happened during the COVID-19 pandemic. However, people with severe mental ill health (SMI) might be at risk of digital exclusion, partly because of a lack of digital skills, such as digital health literacy. The study seeks to examine how the use of the Internet has changed during the pandemic for people with SMI, and explore digital exclusion, symptomatic/health related barriers to internet engagement, and digital health literacy. Methods Over the period from July 2020 to February 2022, n = 177 people with an SMI diagnosis (psychosis-spectrum disorder or bipolar affective disorder) in England completed three surveys providing sociodemographic information and answering questions regarding their health, use of the Internet, and digital health literacy. Results 42.5% of participants reported experiences of digital exclusion. Cochrane-Q analysis showed that there was significantly more use of the Internet at the last two assessments (80.8%, and 82.2%) compared to that at the beginning of the pandemic (65.8%; ps < 0.001). Although 34.2% of participants reported that their digital skills had improved during the pandemic, 54.4% still rated their Internet knowledge as being fair or worse than fair. Concentration difficulties (62.6%) and depression (56.1%) were among the most frequently reported symptomatic barriers to use the Internet. The sample was found to have generally moderate levels of digital health literacy (M = 26.0, SD = 9.6). Multiple regression analysis showed that higher literacy was associated with having outstanding/good self-reported knowledge of the Internet (ES = 6.00; 95% CI: 3.18–8.82; p < .001), a diagnosis of bipolar disorder (compared to psychosis spectrum disorder – ES = 5.14; 95% CI: 2.47–7.81; p < .001), and being female (ES = 3.18; 95% CI: 0.59–5.76; p = .016). Conclusions These findings underline the need for training and support among people with SMI to increase digital skills, facilitate digital engagement, and reduce digital engagement, as well as offering non-digital engagement options to service users with SMI.

Use of digital devices and applications by people with severe mental illness in Switzerland

“…Overall, our results mean that there is actually no digital exclusion or digital division at the device level. However, we know from other studies that people with severe mental health problems often do not have the digital skills that are necessary in an increasingly digitalised society (Spanakis et al, 2023;Spanakis et al, 2024). Compared to non-service user populations and also to other patient populations, our service users apparently have fewer wearables (Dhingra et al, 2023;Shandhi et al, 2024).…”

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

“…Although people with SMI experience major health inequalities and have a life expectancy 10 to 25 years shorter than that of the general population [ 9 , 10 ], less research on digital interventions has been conducted in this patient group compared with other conditions [ 11 ]. Assumptions that people with SMI will not be able or willing to engage in technology-augmented assessment and treatment have combined with the known element of digital exclusion due to the intersection of SMI and socioeconomic inequities, resulting in a shortfall of development in this area [ 12 , 13 ].…”