Barriers, Facilitators, Attitudes, and Preferences Toward Digital Mental Health Interventions Among Patients with Severe Mental Illness and Their Caregivers: A Qualitative Exploration from a Low- and Middle-income Setting

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Abstract
Background: Digital mental health interventions (DMHIs) offer a potential solution to bridge the considerable treatment gap in mental health service delivery. Our objectives were to qualitatively examine barriers, facilitators, attitudes, and preferences toward DMHIs among patients with severe mental illness (SMI) and their caregivers. Methods: In-depth interviews were conducted with remitted patients with schizophrenia or bipolar disorder and their caregivers. A semi-structured interview guide with open-ended questions and prompts was used. Interview sessions were audio-recorded and transcribed verbatim. Descriptive open coding was done. Generated inductive codes were arranged first into categories and then into themes. Results: Twelve patients with SMI and 12 caregivers were interviewed. Key barriers to the use of DMHIs were perceived ineffectiveness of technology-assisted consults (compared to in-person visits), perceived adverse effects, inadequate digital literacy, cognitive barriers such as forgetting details during teleconsultations, and concerns about confidentiality. Key facilitators included convenience, wide reach and availability, willingness to adapt, shared access to devices in households, and the potential of DHMIs to increase awareness about mental illness. Attitudes toward DMHIs were ambivalent, with concerns about technology-mediated clinical interactions but openness to personalized service delivery through technology, such as medication and appointment reminders, and toll-free contact numbers for emergencies. They also emphasized the importance of raising awareness about mental illness through DMHIs. Conclusions: Patients with SMI and their caregivers identified significant structural and individual barriers to the use of DMHIs. We suggest that DMHIs for this group should be co-designed to address their needs and concerns, thereby enhancing uptake.

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