The digital divide: factors impacting on uptake of remote therapy in a South London psychological therapy service for people with psychosis

Abstract

Background: Remote therapy promises a cost-effective way of increasing delivery of psychologicaltherapy in underserved populations. However, research shows a "digital divide", with some groups experiencing digital exclusion. Aims: To assess whether technology, accessibility, and demographic factors influence remote therapy uptake among individuals with psychosis, and whether demographic factors are associated with digital exclusion. Methods: Remote therapy uptake and demographics were assessed in people (n ¼ 51) within a psychology-led service for psychosis, using a survey of access to digital hardware, data and private space. Results: The majority of individuals had access to digital devices, but 29% did not meet minimum requirements for remote therapy. Nineteen (37%) individuals declined remote therapy. Those who accepted were significantly younger and more likely to have access to technology than those who declined. The mean age of those with access to smartphones and large screen devices was younger than those without access. Conclusions: A subgroup of people with psychosis face barriers to remote therapy and a significant minority are digitally excluded. Older age is a key factor influencing remote therapy uptake, potentially related to less access to digital devices. Services must minimize exclusion through provision of training, hardware and data, whilst promoting individual choice.

Telepsychiatry services during COVID‐19: A cross‐sectional survey on the experiences and perspectives of young adults with first‐episode psychosis

“…It is noteworthy that some participants did not feel that the platform was confidential. Concerns regarding confidentiality and privacy reported in this study are also echoed in recent literature regarding factors influencing uptake of remote therapy in patients with psychosis (Watson et al, 2021 ). These concerns may be due to reasonable fears about the security of the internet and the video conferencing technology, and/or due to the nature of psychosis symptoms.…”

“…While a review conducted by Santesteban‐Echarri et al (2020) found limited evidence to support the notion that delusional thinking interferes with patient acceptance of telepsychiatry, recent studies indicate otherwise. For example, one study found that voices and unusual experiences or beliefs accounted for 37% of the reasons that patients with psychosis declined remote therapy during the COVID‐19 pandemic (Watson et al, 2021 ). Similarly, clinicians working with patients that experience delusional thinking also expressed concerns about using telepsychiatry with this clinical population (Cruz et al, 2021 ).…”

“…Although access to WiFi is becoming increasingly available in the communities of Canada, for example, via schools, work settings, community organizations, libraries, and other public settings, several factors may limit the usefulness of this access, for example: quality (stability) of the internet connection; physical distancing guidelines during the COVID‐19 pandemic context; and, security of the internet connection. In other countries, such as the United Kingdom, financial limitations in being able to pay for internet access and lack of technology also play a role in explaining why some patients with psychosis do not participate in remote treatment (Watson et al, 2021 ).…”

Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis

“…We propose that mental health is a highly relevant area in researching technology exclusion and health care engagement, as people in contact with mental health services have been found to be disproportionately affected by the “digital divide.” This is particularly marked in psychosis, with Robotham et al [ 6 ] reporting that approximately one-fifth of their sample was digitally excluded compared with only 3% of those with depression, although this rate had reduced from 30% in an earlier study [ 7 ]. Of note, excluded participants (ie, those with reduced technology access, confidence, and use) were significantly older—a finding that was replicated in a study examining factors associated with uptake of remote therapy in psychosis [ 8 ]. In a previous study by Robotham et al [ 7 ], Black people also had higher rates of exclusion, although this finding was not replicated in the follow-up study.…”

Do cognitive impairments limit treatment gains in a standalone digital intervention for psychosis? A test of the digital divide

“…The varying rates are tied to socio-demographic factors, including age and economic status. Not surprisingly, older people with SMI report lower rates of smartphone ownership than younger ones ( Watson et al, 2021 ), and receipt of disability payments is a strong predictor of reduced likelihood of smartphone ownership ( Young et al, 2020 ). While there are affordable options for smartphones, the financial resources needed for purchasing data plans can be prohibitive for those living in poverty ( Vogels, n.d. ).…”