Decision-making about uptake and engagement among digital mental health service users: a qualitative exploration of therapist perspectives

Objective: This study explored therapist perspectives on decision-making about uptake and engagement with online assessment and treatment for anxiety and depression among digital mental health service (DMHS) users. Methods: Semi-structured interviews with 20 therapists from two Australian DMHSs were conducted; interviews were audio-recorded, transcribed verbatim, and analysed thematically using Framework Methods. Results: Analyses yielded three interrelated themes: 1) Interplay between users, the DMHS and broader mental health system; 2) Decision-making process and dynamics; and 3) Information and decision-support needs. Theme 1 highlighted the diversity of DMHS users, and how users’ interactions with third-party health professionals influence access/use, showing that DMHSs are not a standalone entity. Theme 2 revealed therapists’ key role within DMHSs, including how they shape users’ decision-making through managing expectations and deliberating on options and “treatment fit”. Theme 3 demonstrated considerable variability in how informed and knowledgeable users were when engaging with DMHSs, and how some users have decisional uncertainty and delay, and would benefit from additional decisional support. Conclusions: Findings provide in-depth therapist insights into what influences service user decision-making about using DMHS for assessment and treatment. These insights can inform user-centred design of DMHSs and highlight the need to better integrate DMHS into mainstream mental healthcare.