User experience reevaluation and diffusion of technology in the context of compulsory usage illustrated by the example of telepsychotherapy—a literature review

Abstract

Objective Models explaining technology acceptance fail to recognize the influence temporary, compulsory usage, meaning forced usage due to external factors, may have on user evaluation and continued diffusion. However, in context of the Covid-19 pandemic, a highly infectious respiratory disease, the significance of this factor is evident. Triggered by legal contact restrictions and extended reimbursement capacities, usage of telepsychotherapy increased drastically, thereby influencing therapists' attitude and increasing the technology's maturity. In this comprehensive literature review, we aim to outline the current state of research toward telepsychotherapy adoption and identify potential influences of the compulsory usage on the reevaluation of technology as well as barriers inhibiting and factors promoting future use. Methods The review was conducted on the five databases ScienceDirect, Web of Science, PubMed, PubPsych, and IEEE up to April 2022. Results Out of 685 identified references, a final selection was made of 22 papers, discussing experiences with telepsychotherapy in the context of the Covid-19 pandemic. Satisfaction and intention to use are universally high, further increasing with time and use experience, while perceived challenges decrease. Barriers include mostly contextual factors, such as technical issues, reimbursement issues, strict regulations, insufficient infrastructure, and lack of organizational support, but also concerns regarding efficacy. Promoting factors are training, guidelines, and organizational support. Conclusions Telepsychohtherapy has become an integral part of psychotherapeutic care. A hybrid system in close coordination between provider and patient may prevail, addressing individual needs of both parties to achieve optimal care and provider well-being. This requires transparent regulations, guidelines, and standards.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…An important uptake factor of digital therapeutics was the presence of a legal framework to (1) distinguish digital therapeutics from commercial lifestyle and well-being apps, accrediting the former as a reimbursable form of health care, and (2) protect patients’ privacy, confidentiality, and (health) data security [ 1 , 4 , 5 , 13 , 15 , 47 , 52 , 54 - 56 , 59 , 66 , 77 , 80 , 87 , 96 , 99 , 108 , 109 , 112 , 116 , 120 , 123 , 133 , 139 , 148 , 149 , 157 , 161 , 166 , 167 , 169 , 186 , 190 , 208 , 209 , 212 , 231 ]. A clear example of such a legal framework is the mHealthBelgium validation pyramid in Belgium, which consists of 3 levels: the first level determines the basic requirements, such as the need for Conformité Européene marking, which indicates that a product adheres to the European Union health, safety, and environmental protection standards; the second level is designed to ensure interoperability and connectivity with the broader health informatics system; and the third level regulates the funding of digital health apps by the National Institute of Health and Disability Insurance, which is acquired after a digital health app has passed the clinical review process [ 224 ].…”

“…It was emphasized that there were benefits to allowing the procurement of digital therapeutics as locally as possible, as health purchasers (eg, Integrated Care Boards in the United Kingdom, insurance companies in the Netherlands, and employer groups in the United States) are best placed to assess the needs and preferences of their covered population, although this could translate into longer adoption times and higher uptake costs, as each individual insurer needs to invest in the digital infrastructure. There was a stated need to adjust or redesign the existing protocols and professional guidelines, commonly created for the provision of face-to-face health care, to create opportunities for digital therapeutics and address the liability and risk-sharing concerns with using digital therapeutics [ 19 , 51 , 52 , 57 , 63 - 66 , 81 , 87 , 106 , 110 , 112 , 114 , 118 , 121 , 126 , 139 , 149 , 158 , 192 , 205 , 207 , 225 , 233 ]. The presence or development of a high-quality digital infrastructure that can be accessed by all population groups [ 1 , 5 , 13 , 40 , 45 , 47 , 63 , 66 , 74 , 87 , 100 , 106 , 119 , 122 , 124 , 134 , 135 , 137 , 140 , 153 , 162 , 199 , 201 , 209 , 218 , 238 , 270 , 273 ], the availability of testing environments so that health professionals can gain experience with digital therapeutics [ …”

“…There was a stated need to adjust or redesign the existing protocols and professional guidelines, commonly created for the provision of face-to-face health care, to create opportunities for digital therapeutics and address the liability and risk-sharing concerns with using digital therapeutics [ 19 , 51 , 52 , 57 , 63 - 66 , 81 , 87 , 106 , 110 , 112 , 114 , 118 , 121 , 126 , 139 , 149 , 158 , 192 , 205 , 207 , 225 , 233 ]. The presence or development of a high-quality digital infrastructure that can be accessed by all population groups [ 1 , 5 , 13 , 40 , 45 , 47 , 63 , 66 , 74 , 87 , 100 , 106 , 119 , 122 , 124 , 134 , 135 , 137 , 140 , 153 , 162 , 199 , 201 , 209 , 218 , 238 , 270 , 273 ], the availability of testing environments so that health professionals can gain experience with digital therapeutics [ 129 , 201 ], and the inclusion of digital therapeutic modules in medical curricula were identified as facilitators of the uptake of digital therapeutics [ 52 , 58 , 61 , 62 , 70 ...…”

“…Demographic characteristics are associated with patients’ uptake of digital therapeutics. Younger age [ 5 , 19 , 40 , 43 , 49 , 52 - 54 , 63 , 83 , 100 , 101 , 126 , 135 , 139 , 175 , 177 , 181 , 182 , 196 , 203 , 206 , 235 , 236 , 256 , 259 ], sex (male or female depending on the circumstances) [ 17 , 53 , 62 , 63 , 101 , 181 , 182 , 235 , 256 ], higher language skills [ 19 , 53 , 126 ], higher education level [ 5 , 17 , 43 , 49 , 54 , 62 , 63 , 83 , 100 , 101 , 107 , 135 , 175 , 177 , 181 , 182 ], higher health literacy [ 40 , 47 ], being employed [ 5 , 17 , 62 , 100 , 101 ], higher income level [ 17 , 40 , 52 , ...…”

“…Furthermore, cultural and social environments [ 49 , 62 , 71 , 82 , 86 , 115 , 135 , 142 , 159 , 193 , 195 , 235 ]; ethnic background [ 40 , 101 , 102 , 107 , 142 , 175 , 193 , 195 , 235 ]; being unhealthy or living with a disability [ 11 , 17 , 40 , 52 , 62 , 80 , 100 - 103 , 107 , 181 , 190 , 206 , 236 , 259 , 270 ]; patient-specific needs, attitudes, and habits [ 1 , 80 , 102 , 109 , 110 , 193 , 195 ]; distance to health services [ 152 , 171 , 185 , 236 ], risk of contracting a disease [ 165 ]; insurance status [ 175 , 270 ]; time since diagnosis [ 177 ]; and past health care experiences [ 217 ] can influence the uptake of digital therapeutics. The extent to which the target group can access the internet is an additional determinant of the uptake of digital therapeutics [ 17 , 19 , 52 , 53 , 62 , 63 , 76 , 77 <...…”