Mapping the literature on the implementation of e-mental health programming

Mental illness is global health issue that, according to the World Health Organisation, will affect one in four people in their lives. To meet this growing challenge, both well-established and novel approaches will no doubt be necessary. Among the alternative models of treatment and prevention are e-mental health services, which comprise all technology-enabled therapies, such as telehealth, informational websites, internet-based programs, and mobile phone applications.

However, a full understanding of what works and what doesn’t is needed for e-mental health services to live up to their promise. This includes knowing how programs have been rolled out, what leads to their effective implementation, and the outcomes from the implantation methods.

To help map the state of knowledge in this area, PCHSS and Australian Institute of Health Innovation investigators undertook a critical scoping review of research on the implementation of e-mental health programming and recently published their findings in the Journal of Community Psychology.

Of an initial batch of over four thousand articles related to e-mental health, the reviewers whittled the list down to 33 matching their selection criteria: English-language, peer-reviewed articles on the implementation of a technology-specific e-mental health program seeking to address anxiety or depression. These 33 articles evaluated a total of 29 programs.

Slightly over half of the studies were from the United States, while the remaining articles were from Australia, Canada, New Zealand, and various European countries. Of the 29 programs studied, about 41% targeted depression, 34% targeted an anxiety disorder, and 25% targeted both.

Moreover, most of the 33 studies reported on the “acceptability,” “appropriateness” and “feasibility” of program implementation, while fewer reported on the “fidelity,” “adoption,”  “penetration,” sustainability, and costs.

Across the articles, the authors noted a general lack of methodological rigor and strong theoretical underpinnings to the implementation research. However, they pointed to the hopeful fact that this is an expanding area of study: while their search spanned nearly two decades, about 85% of the included articles were from the last five years. As such, the authors stressed the need for future studies to “make use of an appropriate framework, theory or model [and] to develop valid, reliable and practical measures for assessing the implementation of e‐mental health programs.”