Service user experiences and views regarding telemental health during the COVID-19 pandemic: A co-produced framework analysis
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Abstract
The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable.
Methods
We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants’ experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers.
Findings
The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants’ preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties’ access to technology and their individual preferences.
While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools.
Discussion
Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.
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SciScore for 10.1101/2021.02.18.21251978: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approval was obtained from the UCL Research Ethics Committee on 19/12/2019 (ref: 15249/001) and an amended topic guide covering experiences of COVID-19, including telemental health, was approved on 14/08/2020.
Consent: Potential participants were sent an information sheet and given the chance to ask questions, then formal consent was taken and recorded before the interview.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share …
SciScore for 10.1101/2021.02.18.21251978: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: Ethical approval was obtained from the UCL Research Ethics Committee on 19/12/2019 (ref: 15249/001) and an amended topic guide covering experiences of COVID-19, including telemental health, was approved on 14/08/2020.
Consent: Potential participants were sent an information sheet and given the chance to ask questions, then formal consent was taken and recorded before the interview.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Participants highlighted limitations of remote care that went beyond lack of access. Service users commented on different contexts in which remote care seemed more or less appropriate. Previous literature has varied in reports about how far video-calls can offer an authentic substitute for the connection made between service user and professional face-to-face. Regarding relational appointments, research involving female older adults [23] and veterans [22] has reported that service users tend to find video more impersonal than face-to-face due to reduced physical cues, and feel more comfortable talking to therapists in person, where possible. Conversely, a systematic review found that in terms of therapeutic alliance, only a minority of studies reported video-based interventions as inferior to face-to-face treatment [39]. Our study suggested people vary in the extent to which they feel rapport and therapeutic alliance can be of equivalent quality to face-to-face, but most seemed to feel it was to some extent inferior: it may be that the volunteer research participants in previous studies have been particularly open to seeing digital contacts as equivalent, or that better planning and preparation has improved experiences in these previous research studies. As with the present study, the evidence is mixed and potential negative impacts on rapport and therapeutic relationships, leading to more superficial therapeutic contacts, have been noted, including during the pandemic [2]. M...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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