Identifying research priorities for digital technology in mental health care: results of the James Lind Alliance Priority Setting Partnership

Abstract

Digital technology, including the internet, smartphones, and wearables, provides the possibility to bridge the mental health treatment gap by offering flexible and tailored approaches to mental health care that are more accessible and potentially less stigmatising than those currently available. However, the evidence base for digital mental health interventions, including demonstration of clinical effectiveness and cost-effectiveness in real-world settings, remains inadequate. The James Lind Alliance Priority Setting Partnership for digital technology in mental health care was established to identify research priorities that reflect the perspectives and unmet needs of people with lived experience of mental health problems and use of mental health services, their carers, and health-care practitioners. 644 participants contributed 1369 separate questions, which were reduced by qualitative thematic analysis into six overarching themes. Following removal of out-of-scope questions and a comprehensive search of existing evidence, 134 questions were verified as uncertainties suitable for research. These questions were then ranked online and in workshops by 628 participants to produce a shortlist of 26. The top ten research priorities, which were identified by consensus at a stakeholder workshop, should inform research policy and funding in this field. Identified priorities primarily relate to the safety and efficacy of digital technology interventions in comparison with face-to-face interventions, evidence of population reach, mechanisms of therapeutic change, and the ways in which the effectiveness of digital interventions in combination with human support might be optimised.

A Virtual Agent to Support Individuals Living With Physical and Mental Comorbidities: Co-Design and Acceptability Testing

“…Indeed, a James Lind Alliance Priority Setting Partnership on digital technology and mental health, tasked with identifying the top 10 research questions posed by patients and clinicians, asks “Can common elements of therapy that come from person-to-person interactions be maintained with digital technology?” (priority 8) [36]. Our work speaks to this research question, in providing some evidence that a virtual agent could replicate certain aspects of traditional peer support incorporating behavior change techniques.…”

Perceived acceptability of wearable devices for the treatment of mental health problems

“…The high proportion of respondents who had experienced mental health conditions and accessed clinical treatments was a strength of this study. Furthermore, we were able to provide some support for the notion that e‐mental health may help to improve access to treatment—and perhaps also retention—which has been identified as a priority area for research (Hollis et al, 2018). Given our findings, one direction for future study is to evaluate the factors that influence the perceived effectiveness of wearable devices.…”

“…Research indicates that consumers' perceived benefits and limitations of e‐mental health treatments differ from traditional face‐to‐face treatment (Musiat, Goldstone, & Tarrier, 2014), and also that individual interest in these treatments varies (Nicholas et al, 2017). Since there is a demand from clients to receive more personalized treatments (Hollis et al, 2018), and accommodating client preferences results in more positive outcomes and fewer dropouts (Swift, Callahan, Cooper, & Parkin, 2018), there is a clear need to understand which factors shape the acceptability of wearable devices to identify client groups for which they might be efficacious.…”

Agents of change: Understanding the therapeutic processes associated with the helpfulness of therapy for mental health problems with relational agent MYLO

“…In particular, relational agent interventions rely on dynamic change to deliver flexible, acceptable interventions to users. 20,21 Identifying mechanisms of action, including the therapeutic alliance as an agent of change, particularly in relational agents, is a top 10 research priority in digital interventions in the UK. 21 Investigating therapeutic processes requires a detailed analysis of what happens in therapy, how it is experienced by clients, and why they find it helpful or hindering.…”

“…20,21 Identifying mechanisms of action, including the therapeutic alliance as an agent of change, particularly in relational agents, is a top 10 research priority in digital interventions in the UK. 21 Investigating therapeutic processes requires a detailed analysis of what happens in therapy, how it is experienced by clients, and why they find it helpful or hindering. [22][23][24][25] Greater transparency regarding precisely how and why digital interventions achieve psychological change is likely to increase user trust, streamline interventions to their key components, and, consequently, increase reach.…”