Promoting reach, dissemination, and engagement of technologies for addressing mental health care disparities among underserved populations.

Abstract

| INTRODUCTIONRalston, Andrews, and Hope (2019) provide a detailed review of promising technologies that aim to reduce mental health care disparities among underserved populations. Telemental health (e.g., videoconferencing), technology-mediated self-help (e.g., mobile applications, Internet-based), and technology adjuncts to care (e.g., symptom tracking, in-session treatment aids) are addressed. The authors proposed the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework as a guide to examine the potential for technology-based tools to address mental health care disparities. The authors were correct to note that research to date has focused primarily in the areas of effectiveness and adoption, whereas considerably less work has been done in the realms of reach, implementation, and maintenance of these tools among underserved populations. This review is a timely call to action given the tremendous opportunities technology can bring to addressing care disparities. A major priority moving forward is the need to better understand how to deliver evidence-based interventions to underserved populations in a manner that will be easily accessible and promote engagement and sustained use. We offer some comments, building on Ralston et al. (2019) review, that highlight opportunities to promote reach, dissemination, and engagement in evidence-based technology-enhanced interventions among underserved populations. | PROMOTING REACH AND DISSEMINATIONAmong technology-based resources, those delivered via mobile devices (e.g., cellphones, smartphones, tablets) might hold the most promise with regard to increasing reach. Roughly, 95% of US adults use a cellphone and 77% own a smartphone (Pew Research Center, 2018). Latinx (77%) and African-American (75%) adults are just as likely to own a smartphone as White adults (77%) and are more likely to seek health information online. Rates of cellphone and smartphone ownership are 92% and 67% for low-income level (less than $30,000 per year) families, and 91% and 65% for rural populations, respectively. Whereas smartphone ownership continues to rise, cellphone ownership continues to be dominant among underserved groups. This suggests that cellphone based alternatives to enhancing interventions may be a valuable way to improve reach and continuity of care among underserved populations. Mobile apps have been found to successfully decrease symptoms of anxiety, depression, and substance use, but reach and sustained use of these interventions has been poor. More research is needed to learn how to best adapt these interventions to optimize their utility.Whereas there is clear opportunity to improve reach with technology-based resources, strategies for effective dissemination are less clear. To date, there are over 20,000 mobile mental health applications available through both Apple's App Store for iOS devices and Google Play for Android devices. Moreover, data indicate that approximately 58% of

Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA)

“…The strengths of using a videoconferencing platform for peer-participant connection helped minimize structural barriers by increasing accessibility of services [ 30 , 37 ] and indirectly decreasing the effect of stigma on service access [ 31 ]. By reducing the structural barriers of travel and stigma, technology-enabled interventions hold promise in reducing health disparities associated with access to services [ 14 ].…”

“…Black and Hispanic HIV+ AYA are prolific users of technology; nearly all have a smartphone, among whom half report going online more than a few times a day [ 36 ]. Mobile platforms such as videoconferencing applications show promise in overcoming structural barriers by increasing accessibility of services [ 30 , 37 ] and indirectly decreasing the effect of stigma on service access [ 31 ].…”

“…Trained peer health coaches have competently delivered behavioral interventions to HIV+ adults [25][26][27] and adolescents [28], with improved adherence outcomes [25] and sustained viral suppression [29]. To address public health disparities among underserved populations, peer health coaches have also delivered educational or behavioral interventions using mobile health technology in a culturally sensitive manner [5,30,31]. Recommendations for designing and implementing peer-led interventions include a clear conceptual definition and rationale for the peer role [32], as these methodological constructs are important prerequisites to examining and explaining intervention effect [33].…”

Two-way messaging for rural users: A cohort comparison study.

“…Data from the Rural Health Research and Policy Center in 2016 indicate that per one hundred thousand residents, there are twice as many psychologists, social workers, and psychiatrists in metropolitan areas as compared to nonmetro areas (Larson et al, 2016). To address these disparities, many professionals have suggested the utilization of telemental health (TMH) services (Comer & Myers, 2016; Davidson et al, 2019; Garney et al, 2016; Schopp et al, 2006; Yellowlees et al, 2008). TMH services are interactive technologies designed to connect mental health providers with clients who are seeking help from their home or other remote locations.…”

Digital Mental Health Intervention Uptake Among Distressed New Zealand High School Students in a Comprehensive Survey: Implications for Digital Help Provision

“…On the other hand, the size of these effects could suggest that they were somewhat suitable for the masses, rather than being tailored to suit the needs or preferences of a target population, for example, adolescents who experience probable mental distress (Davidson et al, 2019;Muñoz et al, 2019). The current thesis explores one specific pathway to access DMHI, but to harness the potential of these resources as an equitable help option, future research needs keep the target audience, their needs and preferences at the fore while developing strong pathways to access DMHI.…”