2023 HSR&D/QUERI National Conference

1175 — The Feasibility of an Innovative Mobile Mental Health Intervention Using Passive Mobile Monitoring and Self-Tracking for Veterans with Serious Mental

Lead/Presenter: Melissa Medich,  COIN - Los Angeles
All Authors: Medich M (Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles), Cannedy SL (Mental Illness Research Education and Clinical Center, Los Angeles) Hoffman LC (Mental Illness Research Education and Clinical Center, Los Angeles) Pila JM (Mental Illness Research Education and Clinical Center, Los Angeles) Chinchilla MY (Mental Illness Research Education and Clinical Center, Los Angeles) Chassman SA (Mental Illness Research Education and Clinical Center, Los Angeles) Young AS (Mental Illness Research Education and Clinical Center, Los Angeles)

Early intervention in mental health crises can prevent devastating outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect worsening of SMI. This technology may benefit Veterans with SMI, but little is known about health IT acceptability among this population or their mental health providers. This study assesses the feasibility of passive mobile sending, an innovative approach to illness tracking, among Veterans with SMI and their mental health providers.

Data collection took place between December 2020 and June 2021 in one VA healthcare system. Semi-structured interviews with mental health providers (n = 16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with Veterans with SMI (n = 3 groups) and individual usability tests (n = 8) elucidated patient attitudes about engaging in health IT and their perceptions of the usefulness of mobile sensing as a tool for self-tracking and improving mental health assessments. The Health Information Technology Acceptance Model guided a rapid qualitative analysis of data.

Mental health providers discussed the utility of web-based data dashboards to monitor SMI patient health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care (e.g., medication management, tailoring treatment), capturing behaviors that patients don’t self-report, and watching trends and receiving alerts. MHPs’ concerns included increased workloads tied to dashboard data review (e.g., accessing the dashboard, validity and interpretation of data, intersection of burdens from electronic systems and limited appointment times), lack of experience using health IT in clinical care, and how SMI patients’ associated paranoia and financial instability would impact SMI patient uptake. Despite concerns, all mental health providers stated that they would recommend it to patients. Almost all Veterans with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health providers. They found the application easy to navigate, easy to understand dashboard data graphics, and stated that it was like having “your own health assistant.” Patient concerns centered on privacy and “government tracking,” and how the app would affect their phone’s battery life. Despite concerns, most reported that they would use the app.

Self-tracking is a potentially efficacious innovation for supporting self-management by Veterans with SMI and for improving clinical care, but more research is needed to further develop and study the feasibility and effectiveness of smartphone monitoring and data dashboards, in usual care. Limitations include sample size, and that preliminary feedback is based on discussions of proposed tools rather than user experiences.

Passive self-tracking has the potential to be a major innovation in the delivery of VA services for patients with SMI and other mental illnesses, and for Veterans at risk of mental illness.