Background: Technology-enabled services (TESs) have the potential to increase access to mental healthcare. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a pilot implementation of myStrength, a digital cognitive behavioral therapy platform, to explore its potential to reduce loneliness among isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Method: A single-site 6-month pilot implementation recruited English (n = 15) and Spanish-speaking (n = 15) isolated older adults who received a digital literacy course followed by 8 weeks of myStrength access and human support. We evaluated factors related to reach, effectiveness, adoption, and implementation using the perspectives of users and County staff. Descriptive statistics were used to examine reach, adoption, and implementation. Nonparametric tests, including Friedman and Wilcoxon signed-rank, were used to examine effectiveness.
Results: Reach: Compared to overall county demographics, platform users were majority female (93.1% vs. 50.5%), ethnoracialized (62.1% vs. 24.2%), and of lower socioeconomic status (Mdn = $35,000 vs. $131,008). Effectiveness: Users reported a significant (z = -2.62, p < .001) decrease in loneliness. Adoption: Users logged into myStrength an average of 10 times and completed 33 activities during the 8 weeks of myStrength use. Implementation: Each pilot staff (N = 20) spent an average of 19.8 hr (SD = 16.51) supporting users' use of myStrength during the pilot. Pilot staff reported several adaptations to meet the needs of users.
Conclusions: Successes included reaching the target population, reducing loneliness, and user adoption. However, pilot staff invested significant time to support those with lower digital literacy skills. As such, although TESs may address unmet needs, their use with underserved populations may require upfront and ongoing support provided by the settings where they are implemented.
Plain language summary title: Testing a New Digital Therapy Tool for Isolated Older Adults in County Mental Health Services.
Keywords: RE-AIM; county mental health; isolated older adults; pilot implementation; technology-enabled services.
This paper reports on the use of digital tools to support needs in publicly funded mental healthcare. In 2021, Marin County piloted a program involving the use of myStrength, a digital cognitive-behavioral therapy (dCBT) platform, with human support provided by a nurse intern or promotores. Although several studies have demonstrated that dCBT can be effective, few studies have evaluated this in real-world settings or considered issues related to its implementation. As such, although dCBT can provide benefit to people, less is known about how to deploy it, especially in diverse contexts and populations. This project specifically focused on reducing loneliness among isolated older adults, including both English and Spanish speakers. This paper adds valuable insights by demonstrating that the project successfully reached the target population, reduced loneliness, and achieved high user adoption rates. It also identified challenges, including low digital literacy skills among the target populations and the need for substantial upfront and ongoing support. The findings suggest that the combination of dCBT and human support holds promise in addressing unmet mental health needs, especially among vulnerable populations. At the same time, the implementation of these services in such contexts demands substantial resources and support, especially to bridge the digital literacy gap. These implications have practical significance for practitioners, researchers, and policymakers, emphasizing the importance of tailored support mechanisms when deploying digital tools in publicly funded service settings to ensure equitable access and effectiveness.
© The Author(s) 2024.