Decision-making about uptake and engagement with digital mental health services: a qualitative exploration of service user perspectives

Objective: Digital mental health services (DMHS) overcome many barriers to help-seeking. Yet, people’s use and uptake of treatment with DMHSs varies considerably. This study explored service user perspectives on deciding to take up online assessment and treatment for anxiety and/or depression within a large national DMHS. Method: Participants were 20 adults who had self-referred or were referred by a GP to an Australia-wide DMHS for psychological assessment (group 1), plus follow-up discussion of treatment/other service options with a therapist (group 2), plus enrolment into internet-delivered treatment with optional therapist guidance (group 3). Participants took part in one-to-one semi-structured interviews, with parallel question guides tailored to their group status. Interviews were transcribed verbatim and analysed thematically using framework methods. Results: Analyses yielded three interlinking themes. Theme 1 highlighted the “importance of the broader treatment context, and its interaction with DHMS”; Theme 2 drew attention to “how the internal service structure shapes decision-making”; Theme 3 focussed on “the scope and limitations of DMHS”. Conclusion: Findings provide in-depth insights into service user decision-making around engagement with DMHS and can inform the development of interventions to support users to take up DMHS offerings that are best suited to their needs, preferences, and current circumstances.