(PS10-B28) Non-treatment Seeking Adults’ Preferences for Human Support in the Context of an Automated Text Message-based Intervention

Introduction

In the United States, nearly one in two adults experiences a mental health condition during their lifetime; however, a significant number of these adults do not receive care for their mental health condition. This constitutes a substantial treatment gap, which may be partially explained by structural barriers (e.g., financial costs), and attitudinal barriers (e.g., preference for anonymity) to accessing traditional in-person mental health care.

        Digital Mental Health Interventions (DMHIs) have the potential to increase access to care for individuals who do not want to, or cannot, use traditional services. Specifically, DMHIs can be delivered at a low cost and accessed on users’ own schedules and in their own environments. Adding human support to DMHIs may increase users’ adherence to, and engagement with, digital interventions. Furthermore, despite disinterest in formal treatment modalities, non-treatment seeking adults show interest in human supported DMHIs. However, it is unclear how adults who are not interested in face-to-face services want to engage with human-support in the context of a DMHI.

Methods

We conducted a field trial of an automated text message-based DMHI for depression and anxiety to elicit users’ needs and preferences for digital human-supported coaching. We recruited 20 participants aged 18-58 (Mage  = 31, SDage = 13.21) through the Mental Health America Website and a research recruitment registry. Participants received interactive text messages consisting of 11 psychological strategies (e.g., cognitive restructuring, behavioral activation) for 8 weeks, and completed semi-structured interviews after 4 and 8 weeks of use. During interviews, participants provided their perspectives on adding a coach to the intervention. Transcripts of these interviews were subjected to a modified thematic analysis.

Results

         Most participants viewed adding a human coach to the texting intervention favorably and identified human connection and increased accountability as the primary motivations behind their interest in coaching. Participants stated overall preferences for engaging with a coach once per week by text message; more frequent contact with a coach was perceived as burdensome, and other modes of communication (e.g., phone call) were viewed less-favorably compared to texting. It was particularly important to users that a coach has experience using the digital tool on which they are coaching, and is educated in mental health topics; however, a coach did not need to hold an advanced degree. As such, participants were accepting of a trained paraprofessional serving as a coach. Of participants who rejected the addition of a human coach, 80% cited the intervention’s ease-of-use as the primary reason behind their disinterest, while 20% cited privacy concerns (i.e., coach perceived as an invasion of privacy).

Conclusion

         These findings are consistent with models of human-supported coached interventions such as the Supportive Accountability Model and the Efficiency Model of Support in that human coaching can provide individuals with accountability structures and non-therapeutic human connection, but may not be as important if key barriers (e.g., usability concerns) are absent.