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Barriers and Facilitators to Peer-Supported Implementation of Mental Health Mobile Applications with Veterans in Primary Care

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Abstract

Mental health disorders are highly prevalent among veterans in primary care, yet most of these patients do not receive adequate treatment due to provider time constraints, patient travel costs, and stigma associated with mental health care. Mobile health (mHealth) can overcome these impediments to care access; however, poor patient engagement with mHealth limits its routine implementation. Peer specialists may increase patient engagement with mHealth by offering supportive accountability and support through shared experiences. This study sought to identify barriers and facilitators of peer-supported mHealth implementation with veteran primary care patients. Qualitative interviews, guided by the Consolidated Framework of Implementation Research ([CFIR] Damschroder et al., 2009), were conducted with 28 key informants (17 peer specialists and 11 primary care providers) from 14 sites participating in a Department of Veterans Affairs national evaluation of peers in primary care. Thematic analysis was used to identify CFIR determinants to peer-supported mHealth implementation. CFIR barrier domains included Inner Setting (e.g., lack of implementation infrastructure, limited peer training on mHealth, and ineffective promotion of mHealth) and Characteristics of Individuals (e.g., lack of knowledge of the peer role and limited tech literacy). CFIR facilitator domains comprised Intervention Characteristics (e.g., strong support for peers in this role), Characteristics of Individuals (e.g., role alignment with a holistic care approach), and Outer Setting (e.g., emphasizing app benefits, the importance of app demonstrations, and follow-up encounters). The findings inform the development of a strategy for implementing peer-supported mental health mobile apps with veterans in primary care.

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Acknowledgements

The authors would like to acknowledge Dr. Christina Shook for her assistance in connecting the investigators with the Peers in PACT network and Dr. Carrie Gray for providing qualitative research training to each interviewer.

Funding

This work was supported by a VA Health Services Research & Development (HSR&D) grant awarded to Daniel M. Blonigen (PPO 18-223).

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Authors and Affiliations

  1. Clinical Psychology PhD Program, Palo Alto University, Palo Alto, CA, USA

    Alexandra L. Montena

  2. VA Center for Integrated Health, Syracuse VA Medical Center, Syracuse, NY, USA

    Kyle Possemato

  3. National Center for PTSD, Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Eric Kuhn & Eve B. Carlson

  4. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA

    Eric Kuhn, Eve B. Carlson, Mark McGovern & Daniel Blonigen

  5. Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA

    Jennifer Smith & Daniel Blonigen

  6. Department of Medicine, Stanford University School of Medicine, CA, Stanford, USA

    Mark McGovern

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Correspondence to Alexandra L. Montena.

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Ethical approval was granted by a Stanford University Human Subjects Committee (e-protocol #46490) on June 19, 2018. All participants recruited for this study provided verbal informed consent to participate.

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Montena, A.L., Possemato, K., Kuhn, E. et al. Barriers and Facilitators to Peer-Supported Implementation of Mental Health Mobile Applications with Veterans in Primary Care. J. technol. behav. sci. 7, 1–12 (2022). https://doi.org/10.1007/s41347-021-00198-3

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