Mental health clinicians’ perceptions and perceived challenges about recommending mental health apps to patients in Ethiopia

Abstract

Introduction

Mobile health apps are becoming increasingly popular and are viewed as supplementary aids that simplify healthcare tasks, facilitate patient follow-up, monitor patient symptoms, and support self-care. Their utility may be essential in low-resource countries including Ethiopia. However, their accessibility, availability, trustworthiness, and credibility were identified as the main perceived challenges when recommending the app to patients.

Objective

To explore mental healthcare professionals’ perceptions and perceived challenges about mental health apps for patients with depression and anxiety.

Methods

Two focus group discussions were conducted with mental healthcare professionals (n = 14) from February 10–20, 2024, at Amanuel Mental Specialized Hospital in Ethiopia. The collected audio-recorded data were transcribed into text, coded, and then exported to NVivo version 14 for analysis.

Results

A total of 14 multi-disciplinary mental health professionals participated in focus group discussions. The first focus group consisted of 8 study participants, and the second focus group comprised 6 participants. Most of the interviewed health professionals (12) were male. Four main themes were identified: (1) perceived benefit (improvement of patients’ well-being and mental health accessibility), (2) perceived alleviation of healthcare work burden, (3) perceived challenges (usability, accessibility, trustworthiness, credibility and effectiveness), and (4) suggested app features (psychoeducational, self-assessment and self-monitoring, self-care, multimedia and reminders).

Conclusion

The involvement of mental health professionals is vital for the successful development of mobile mental health apps. App features such as psychoeducational, self-assessment, self-monitoring, self-care, multimedia, and reminders received positive feedback from healthcare professionals. However, participants expressed and perceived challenges about the app’s accessibility, availability, effectiveness, trustworthiness, and credibility.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44192-026-00443-2.

Introduction

A worldwide estimated 13% of the population suffers from mental disorders, and 82% of those live in low/middle-income countries [1]. Depression and anxiety account for over 50% of mental disorders [2]. In developing nations like Ethiopia, mental health conditions exhibit a higher prevalence and carry a significant impact. For example, in Ethiopia, individuals with mental illness often face stigma and discrimination [3, 4]. These challenges can make it difficult for them to access the support and care they need. In Ethiopia, people who suffer from mental health conditions often have very high unmet needs for modern treatment and support [5], due to mental health awareness, the limited availability of mental health services, and support systems [6–8]. Therefore, the emergence of digital mental health interventions offers opportunities to support conventional type mental health interventions to improve the outcomes of people with mental disorder [9, 10].

Mobile mental health applications (apps) are viewed as supplementary aids that simplify healthcare tasks such as counselling, tracking patients progress report, patient follow-up, and monitoring [11]. They have been shown to promote patient empowerment and improve treatment adherence [11, 12]. Mobile app-based self-management of mental health makes mental health care more accessible, flexible, and convenient for patients. To ensure successful implementation, mobile mental health app-based interventions should be introduced to frontline staff to enhance care and expand choices for patients [13].

Bauer and his colleagues reported about 66.3% of health professionals believed technology-based treatments could improve the quality of life of many patients [14]. In Poland, about 86% of health professionals believe mobile mental health apps could support patients [15]. For instance, mobile mental health apps could help individuals with mental disorders to better cope with their mental illnesses[15]. Other findings from mental health professionals in Portugal confirmed that mobile mental health apps could enhance mental health literacy, empower individuals to make informed decisions, improve access to healthcare, and boost treatment adherence [16]. The use of mobile mental health apps by patients has the potential to reduce the burden on health professionals by minimizing the amount of time they are required to spend with patients [13]. Another study conducted in Nigeria demonstrated that mobile-based interventions enhance patient-provider communication and save time for both parties [17]. For example, an app with information about mental health content improves patients’ knowledge and complements the role of physicians [18, 19]. Recently, the American Psychiatric Association investigated mindfulness, meditation, breathing exercises, appointments and medication reminders were the most recommended app features for patients [20]. Previous research has established that mobile mental health app features with psychoeducation content, sleep hygiene, and physical exercise were the most prevalent suggested app features [21, 22]. However, to explore whether these app features are suitable or not for their patients, clinicians must carefully weigh the risks and benefits of mobile app features [23].

Even though mental health professionals are willing to recommend an app for their patients, several factors influence their intentions to do so including lack of information, language preferences, the perceived usefulness of the app, users’ cultural context, and perceived suitability [16, 24, 25]. Recently, the American Psychiatric Association reported that approximately 90% of individuals who download a mental health app discontinue its use within 30 days for various reasons such as uncertainty about the app for their needs, doubts about its validity, and difficulties in operating them [26]. Research conducted in Australia on mental health app prescriptions for patients indicates that only one-third (32.5%) of Australian general practitioners recommended mindfulness apps for their patients. Another study conducted in the USA confirmed that out of 13 psychiatrists, only 4 (31%) recommended apps to patients [27]. The main barriers to recommending an app were the lack of knowledge on the effectiveness of apps, and the lack of trustworthy sources to access them [28]. Furthermore, app privacy, safety, and trustworthiness are the major perceived challenges raised by doctors for not recommending mental health apps for their patients [29].

Mobile health technology designed for developed countries often fails to transfer to African regions due to cultural context and socioeconomic factors [30]. For instance, a study in Rural South Africa revealed that while 50% of individuals with mental disorders had encountered mental health apps, none had used them. The obstacles preventing usage included restrictive religious beliefs, limited privacy, no native language options, low digital literacy, and a complicated user interface [31]. Depression and anxiety apps may be particularly useful in low-resource contexts where needs are high and access to mental health services is particularly limited in Ethiopia [32]. For instance, in Ethiopia, fewer than 10% of individuals with mental disorders are receiving modern treatment due to insufficient service delivery [33, 34]. Although one study has demonstrated psychological self-testing, and treatment recommendation for mental health app [35], There is currently no evidence‑based mobile mental health self‑care app in Ethiopia that has been designed and developed using mental health clinicians’ insights and concerns about recommending digital tools to patients.

To address this, we previously conducted a study to determine the intention and app feature preferences among individuals with mental disorders in Ethiopia [32]. However, to date, no empirical studies have examined the perceptions, perceived challenges, or suggestions on mobile mental health app use by patients among mental health professionals.

Insights from mental health professionals offer valuable guidance for app developers and policymakers in the field of mental health, particularly in low-income countries such as Ethiopia. By addressing the identified perceived challenges and incorporating their suggestions, this paper could inform the development of user-friendly mental health apps for individuals with depression and anxiety. It is anticipated that policymakers can use these findings to develop strategies that promote the use of mobile mental health apps and improve mental health service access.

Methods

Design and settings

The focus group interviews were conducted with mental healthcare professionals (n = 14) from February 10–20, 2024, at Amanuel Mental Specialized Hospital in Ethiopia. The focus group method was chosen for its reliability in capturing nuanced perceptions and challenges that influence mental health professionals’ willingness to recommend mobile mental health applications to their patients.

Study participants and requirements

Mental health care professionals working at Amanuel Mental Specialized Hospital and present during the data collection period were invited to participate in the study. To maintain the representativeness of the sample, study participants were purposively selected [36] from psychiatrists, psychiatric nurses, and clinical psychologists who were involved in patient treatment.

Focus group discussion procedure

To approach study participants, consent was obtained from the Amanuel Mental Specialized Hospital Review Board, as referenced in document AM/146/416. Advertisements were conducted through Amanuel Mental Specialized Hospital’s social media groups, particularly on Telegram, which was the most commonly used platform among hospital staff. Additionally, poster advertisements were displayed on the hospital’s public boards. Participant information sheets and consent forms were provided to those who expressed interest in the study. Informed consent was then obtained from all eligible participants. The first FGD consisted of eight participants, and the second FGD consisted of six participants, with at least one individual representing a psychiatrist, a psychiatric nurse, and a clinical psychologist. The FGDs were allocated a duration of 60–90 min. To address privacy challenges, group dynamics, and the importance of participants’ perspectives, the researcher established group expectations and ground rules. Participants were informed that data collected during the FGD was stored securely and would only be used for the research. No identifying data was disclosed to any third party.

The focus groups were facilitated by a team with expertise in digital health, mental health, and qualitative research (authors). The team engaged in brief reflexive discussions before and after each session. We emphasized that the purpose of the study was to understand participants’ perspectives rather than evaluate their practice. Facilitators adopted a neutral, non‑directive approach and encouraged equal participation to support openness and credibility of the data. Data saturation was achieved in the second round of FGDs. The subsequent FGDs reaffirmed the insights from the first and showed no emergence of new ideas, the research team concluded that data saturation had been reached.

Interview topic guide

The semi-structured interview guides were utilised for data collection in accordance with a framework designed by Hanna Kallio et al. [37]. The first author facilitated the FGD, which included a diverse group of participants, including psychiatry nurses, psychiatrists, and clinical psychologists. These participants were selected to represent professions and educational levels to ensure a wide range of perspectives. The interview guide covered topics such as (1) the perceived importance of mental health apps for patients, (2) the impact of mobile mental health app self-care by patients on mental health professionals, (3) content or features to be included in the app, and (4) perceived challenges about patients using a mobile mental health app for self-care. Furthermore, a semi-structured interview discussion guide can be seen in Supplementary file 1. Four experienced mental health care professionals who were proficient in both languages translated the focus group probe question from English to Amharic, then back to English to ensure consistency. An audio recorder was utilized to ensure the accuracy of the information provided. Furthermore, to enhance quality reporting, we used COREQ (COnsolidated criteria for REporting Qualitative research) Checklist [38].

Data analysis

Braun and Clarke’s six-step framework was chosen to guide the thematic analysis of these FGD results [39]. This framework was used to produce a well-structured report highlighting the key findings from the transcription [40]. We chose this method because it offers easily interpretable and concise descriptions of insights emerging from the qualitative data [41], and this framework is theoretically flexible in guiding the thematic analysis of qualitative data [39]. Braun and Clarke’s six-phase framework includes familiarization, coding, generating initial themes, reviewing themes, defining and naming themes, and writing up [40]. The first author meticulously listened to the audio recording and transcribed it into word transcript. After familiarization, the transcript was imported into NVivo version 14, and coding was conducted. Then, the first and second authors generated initial themes from the coding [42] and reviewed these themes [43, 44]. Several codes were grouped to form subthemes, which were then combined to form the main themes. Themes with similar meanings were merged to generate final themes. All authors defined and named themes [40] (Fig. 1).

Fig. 1.

Braun and Clarke’s six-step framework for doing thematic analysis [40]

Results

Two FGDs were conducted: the first with eight participants and the second with six. The second group largely reiterated the insights raised in the first, indicating no emergence of new concepts. Based on this repetition, the research team determined that data saturation had been achieved. The interviewed mental health professionals were between the ages of 21 and 40 years, with a mean age of 29 years. The focus group comprised psychiatry nurses (n = 6), psychiatrists (n = 4), and clinical psychologists (n = 4). Participants had between 1 and 10 years of clinical mental health experience, with an average of 3 years. Ten participants held bachelor’s degrees, one was a psychiatrist specialist (medical doctor), and three held master’s degrees in clinical or community mental health. All participants were directly involved in patient care.

One hundred ninety-one codes were merged into 11 subthemes, which were then combined into four main themes. Four overarching themes identified through thematic analysis were:

• Theme 1, Perceived benefit of mobile mental health app-based intervention to patients with mental health problems

• Theme 2, Mental health professionals’ perception of the mental health app’s role in alleviating their work burden

• Theme 3, Mental health professionals’ perceived challenges about the utilisation of mental health apps by patients

• Theme 4, Suggested mobile mental health app content for patients with depression and anxiety

Theme 1: importance of mobile mental health app-based interventions to patients with mental health problems

This theme explored mental health professionals’ thoughts about the importance of mental health app-based interventions for patients with mental health disorders. It was formed with two subthemes: Subtheme 1, ‘Patients’ well-being,’ supported by 29 participant quotes, and Subtheme 2, ‘Mental Health Accessibility,’ was supported by eight participant quotes (see Table 1).

Table 1.

Themes and subthemes analysis of perceptions, perceived challenges, and suggestions about mental health apps use among clinicians in Ethiopia, 2024

Theme	Subthemes	Coding	Quotes
Theme 1, Importance of mobile mental health app-based intervention to patients with mental health problems	Subtheme 1, patients' well-being	28
	Empower patients' self-care behaviour	5	“Mental health apps are essential because they can empower patients' self-care behaviour” [P1] “To access mental health at the grassroots level, an app can be a valuable tool to promote and advocate for mental health” [P12]
	Improve patient-doctor communication	2
	Improve patients' mental health awareness	14	“Mental health is often the most neglected aspect of health. So, if the technology-based app is implemented, especially in our context, people's mental health awareness and knowledge will improve” [P2]
	Improve treatment adherence	3	Mobile mental apps are important because if users consistently use them, they could enhance patients' treatment adherence” [P13]
	Improve treatment-seeking behaviour	3	“In my opinion, mental health apps are one modality to improve the patient's quality of life” [P9]
	Improves patient recovery and reduces relapse	1	“Imagine the app is built and operated using reliable resources. This way, users can feel completely confident in using it, which could help patients recover more effectively from their illnesses and reduce the chances of complications relapse” [P8]
	Subtheme 2, mental health accessibility	8
	Easily accessible	5	“Most recently, people have smartphones, easily access this technology anytime and anywhere. So, it can help them very well” [P2] “The presence of the apps helps the patient to manage their symptoms remotely without assistance” [P4]
	Ensures confidentiality and privacy	3	“The mental health app is very crucial for our patients because even though mental disorders are common in our country, patients are not confident to seek treatment due to stigma and discrimination, and the other challenge is transportation. Mental health apps can bridge the gap between treatment-seeking behaviour and the treatment gap” [P11] “Patients can access mental health apps privately at any time, so that the use of those apps while they are in remote settings can reduce the impact of discrimination and stigma on patients' daily lives” [P8]
Theme 2, Mental health professionals' perception of the mental health app's role in alleviating their work burden	Subtheme 1, time management and efficiency	20
	Reduces mental health professionals' workload	11	“If the app has basic information about a particular mental disorder, yes, it reduces pressure on busy mental health professionals” [P2]
	Reduces unplanned hospital visits and saves time for patients	4	"The app benefits health professionals, “cuts down on unplanned and needless hospital visits [P8] Getting access to mental health information through apps can improve patients' recovery from their illness and decrease relapse. This indirectly impacts the workload of health professionals” [P1]
	Timesaving for healthcare professionals	5	“I believe using an app for patients to access information about their illness can really save time for both psychologists and patients. This way, professionals won't feel as overwhelmed, and everyone benefits. It's a simple step toward making healthcare more efficient and approachable” [P10] Using the app can reduce the time they spend seeking basic information about the disorder and its treatments. [P3]
	Subtheme 2, patient support and engagement	6
	Improve patient support	3	“The app undoubtedly alleviates workload. Our patients can deal with simple or basic mental health issues by themselves by clicking on the app and getting the information they need” [P6]
	Improves patients' self-learning behaviors	3	“There are a lot of frequent and similar questions that come from patients. The presence of an app could be the solution for that” [P6]
Theme 3, Mental health professionals' perceived challenges regarding the utilisation of mental health apps by patients	Subtheme 1, usability and accessibility perceived challenges	19
	Concern about accessibility	8	“My only concern is how our patients are using smartphones; this app is only for those who have smartphones plus educated people. There are a lot of people who cannot read or write. Therefore, my concern is how those patients will be addressed” [P2]
	Challenges about the availability of specific apps for specific disorders	2	“The app feature that includes meditation techniques as supportive therapy is beneficial. However, the meditation content should be adapted to the Ethiopian context. For example, Ethiopian culture and religion should be taken into account when selecting and adapting meditation techniques. The reason is, that Western-style meditation may not suit the Ethiopian community” [P4]
	Challenges about the effectiveness of mental health apps	3	“As for me, the app is important, and I recommend it to my patients. However, the patient must be in stable condition and without active symptoms of the disorder. Because it may create anxiety for them and may worsen the condition” [P6]
	Perceived challenges about who is recommending an app or promotes the app	6	“There are a lot of apps in the app store, but which one helps the patient is my biggest challenge” [P12]
	Subtheme 2, trustworthiness and credibility challenges	26
	Credibility	9	“Yes, the resource to be uploaded in the app should be codesigned by experts, and in the covering or logo, there should be something that describes the validity of the resource uploaded in the app” [P13]
	Should be tested before use and approved	2	“There are many apps in the App Store; my concern is that the app must be tested and validated with a clinical psychologist before it becomes available for use [P].
	Involvement of experts in the development process	2	“In my opinion, it has to be approved or recognized by the Ministry of Health or an institution” [P10]
	Tailored to the cultural context of Ethiopia	8	“The app should have simple language to maximize its usage and understandability by patients” [P5] “An app feature containing mindfulness and meditation techniques as supportive therapy is good. However, the content of the meditation should be adapted to the Ethiopian context” [P8] “For example, Ethiopian culture and religion should be taken into account while selecting and adapting the meditation techniques. The reason is that Western-style meditation may not be suitable for the Ethiopian community” [P7]
	Trustworthiness of the app	9	“The trust issue is also my concern. Password protection is good, but it is not mandatory” [P5] I'm also concerned about the privacy policy. Who is behind the development of this app? If it's a well-known organization, health professionals like myself would be happy to recommend the app and vouch for its trustworthiness. [P13]
Theme 4, Suggested mobile mental health app content for patients with depression and anxiety	Subtheme 1, psychoeducational features	22
	Information about the disorder, causes, symptoms, perpetuating and precipitating factors, treatments, and biopsychosocial aspects of health	10	“Many patients decide to stop taking their medication because they don't have enough clear information about why it's being recommended. That's why it's so important to provide simple, helpful details about the medication for anxiety or depression, explaining why it's recommended, how long to take it, and when it's safe to stop taking treatments” [P1] “I recommend adding educational features about the disorder, including its causes, symptoms, precipitating and perpetuating factors, and available treatments, to the mental health app for better information” [P11]
	Information about warning signs of mental problems and first aid interventions	3	“It's really important if it highlights warning signs of the specific disorder and suggests possible first-aid steps” [P7]
	Case scenarios and life experiences	2	“It could be much better if core symptoms of depression, anxiety, and psychosis are included” [P10]
	Information about the treatments of the disorders	7	“It could be good if the treatment part is included in detail because most patients frequently ask questions about how long the medication will last. Most patients with depression and anxiety disorders have insight into their illness. However, as far as I understand, the treatment part is the biggest challenge for those people” [P3]
	Subtheme 2, self-assessment and monitoring features	12
	Self-assessment questions	7	“It might be helpful to think about using a Self-assessment questionnaire. It offers patients a wonderful chance to reflect on themselves and gain a better understanding of when and why these symptoms happen” [P5]
	Symptom monitoring	5	“The app feature that monitors symptoms truly supports patients in managing their health. [P2]
	Subtheme 3, non-pharmacologic treatment and self-care features	24
	Breathing exercise	5	“Features like breathing exercises in the app can really help support and enhance its importance,” [P1]
	Meditation techniques	9	“App features containing mindfulness techniques as supportive therapy are crucial to be included to enhance app quality and inclusiveness” [P5]
	Mindfulness techniques	3	“I believe mindfulness techniques are essential for reducing distraction, distress, and nervousness; thus, I highly recommend adding this feature during app development” [P14]
	Physical exercise	2	“I suggest including physical exercise as one of the app's functionalities. Physical exercise alleviates mental health symptoms by boosting neurotransmitters like serotonin and dopamine. Regular activity decreases stress, anxiety, and depression, improves sleep and self-esteem, and promotes social connection and routine, which protect mental well-being” [P13]
	Progressive muscle relaxation techniques	2	“Progressive muscle relaxation techniques are very crucial for patients since they foster body-mind interaction” [P8]
	Sleep hygiene	2	“Sleep issues are a common problem among patients with mental health symptoms, so it's really helpful to include sleep as one of the functionalities. Addressing sleep can make a big difference in overall well-being” [P4]
	Subtheme 4, language and multimedia features	11
	App features with text, video, and audio	6	An app that offers a variety of features like text, video, and audio content can appeal to people of all ages. Therefore, I recommend including these diverse options in the app to better serve its users” [P14]
	Use of multiple languages (Amharic and English)	2	“Ethiopia has its own official language, and an app supporting multiple languages such as Amharic and Oromifa alongside English is needed, especially the Amharic version” [P3]
	Use of simple language in the app	3	“It would be much better to use simple language for easier understanding to reach a wider population with different backgrounds” [P4]
	Subtheme 5, profile, and reminder feature	14
	Medication dose and time reminder	6	“An app that features reminders and a profile or report is essential. Because some patients may not adhere to the medication dose, timing, or frequency, particularly when given over 24 h. Therefore, incorporating reminders in the app is the best solution for preventing missed or overdosed medications” [P10]
	Tracking progress	5	“App should have a feature for tracking progress” [P5]
	Upcoming appointments reminder	3	“An app feature containing reminders for upcoming appointments” [P5]

Subtheme 1, patients’ well-being

Patients’ well-being was supported by 29 participant quotes, reflecting diverse perspectives on how mobile mental health apps enhanced mental health awareness, patient–doctor relationships, patient recovery, treatment adherence, mental health-seeking behaviour, and empowered patient confidence, as well as strategies for decreasing perceived stigma associated with mental health. Most participants agreed that mobile mental health apps could improve patients’ well-being by enhancing awareness among patients and empowering their self-care behaviours.

Subtheme 2, mental health accessibility

Interviewees disclosed how the use of mental health mobile apps can address disadvantaged populations and provide easy access to mental health in one click on portable devices. The participants highlighted that ease of accessibility potentially supports patients. Ensuring confidentiality and privacy were the most important issues raised by participants, as mobile mental health apps can help individuals access mental health services autonomously. Five of the participants (P2, P4, P8, P12, P14) mentioned that mental health apps can be easily accessed anytime and anywhere and have the power to address mental health issues.

Theme 2: mental health professionals’ perception of the mental health app's role in alleviating their work burden

This theme captures mental health professionals’ reflections on how patients’ use of mental health apps may contribute to reducing their professional workload. Participants described potential benefits in two key areas: subtheme 1, Time Management and Efficiency (supported by 20 quotes of participants), and subtheme 2, Patient Support and Engagement (supported by 6 quotes).

Subtheme 1, time management and efficiency

Apps use by patients were perceived as tools that could streamline routine tasks, such as symptom tracking, accessing educational information, self-care techniques, and scheduling appointments. This was seen to free up clinician time for more complex or relational aspects of care. The use of mobile mental health apps by patients can reduce unplanned hospital visits and save clinician time. Ten participants mentioned that the use of mental health apps could reduce the workload of health professionals.

Subtheme 2, patient support and engagement

Six professionals noted that app use by patients for mental health conditions could enhance patient autonomy and engagement between sessions, offering self-guided resources, reminders, and mood monitoring features. These functions were viewed as complementary to clinical care, potentially reducing the intensity or frequency of in-person interventions.

Theme 3: mental health professionals’ perceived challenges about the utilisation of mental health apps by patients

The theme highlighted mental health professionals’ perceived challenges about recommending mobile mental health apps to their patients. This was the second most prominent theme, supported by 45 quotes. It consists of two subthemes, Subtheme 1, ‘Usability challenges,’ with 19 quotes, and Subtheme 2, ‘Trustworthiness and credibility challenges,’ with 26 quotes. The interviewees expressed several perceived challenges, including the effectiveness, credibility, and trustworthiness of the application. Additionally, the majority of the quotes reported consider whether the app is thoughtfully designed to fit the unique cultural context of Ethiopia.

All study participants expressed perceived challenges, including issues like the digital divide and equity. For example, patients in rural or underserved areas might face obstacles such as limited internet access, low digital literacy, or language barriers. Apps may also fail to be inclusive of different mental health experiences. Furthermore, participants stated that mobile mental health apps support traditional services but do not fully assist patients in the same way. For example, most apps are not prepared to handle emergencies or acute mental health episodes, leaving users at risk during critical moments.

Theme 4: suggested mobile mental health app content for patients with depression and anxiety

This theme examined the recommendations of mental health professionals regarding the essential content for a mobile mental health app designed for individuals with depression and anxiety. This theme received the highest number of quotes (83). We organized this theme into five subthemes to make it easier to understand. Subtheme 1 ‘Psychoeducation’ included 22 quotes, while Subtheme 2 ‘Self-assessment and Symptom monitoring’ had 12 quotes. Subtheme 3, ‘non-pharmacologic treatment and self-care,’ was the most extensive with 24 quotes. Subtheme 4 ‘language and multimedia’ received 11 quotes, and Subtheme 5 ‘Profile, and reminder’ included 14 quotes.

Information about the disorder, including causes, symptoms, perpetuating and precipitating factors, and treatments, received the highest quotes. Self-assessment received ten quotes. Breathing exercises, meditation, mindfulness, physical activity, progressive muscle relaxation, and sleep hygiene features received the second-highest quote from participants, followed by psychoeducation. Most interviewees suggested app features involving text, video, and audio, and emphasized the importance of using simple language to reach a broader audience.

Discussion

The results of this qualitative study provide the first evidence-based insights in Ethiopia on healthcare professionals’ perceptions, perceived challenges, and recommendations regarding the use of mobile mental health apps by individuals with mental disorders. The results of this research indicated that every focus group discussant (all 14 mental health professionals) acknowledged the benefits of mobile mental health apps for individuals with mental disorders. As per the study, participants' use of mobile mental health apps could improve patients’ treatment outcomes, mental health awareness, treatment adherence, and modern mental health treatment-seeking behaviour. Our finding is in line with other studies conducted in India [16], and Poland [15]. Their finding confirmed that utilization of digital mental health apps plays a significant role in improving treatment adherence. For example, in Poland, about 86% of health professionals believed that mobile mental health app use supports patients, and 74% declared they would recommend patients use mobile mental health app [15]. In the present study, the easy accessibility of mental health apps anywhere and anytime was identified as a key benefit of mobile mental health apps. Mobile mental health app-based awareness creation, self-assessment, and self-care are more accessible, flexible, cost-effective, and convenient. They help users to access relevant information about mental health at any time and at any location with no assistance [13]. The accessibility of mobile mental health apps not only promotes mental health awareness but also ensures privacy in using the app. The accessibility of these apps empowers the patients’ self-care behaviors [12].

Time management and reducing unplanned hospital visits were other positive findings from the focus group discussions. Most of the participants perceived that mental health app use could reduce the work burden on mental health professionals by reducing doctor contact time with patients.

Our finding is consistent with the study conducted among mental health professionals working in USA [13]. Another study conducted in Nigeria also supports the current research. The study demonstrated that mobile-based interventions enhance patient-provider communication and save time for both parties [17]. mHealth applications are viewed as supplementary aids that streamline healthcare tasks, patient follow-up, and monitoring. Furthermore, these mobile mental health apps enhance patient adherence and foster a sense of empowerment [11].

This study identified key perceived challenges such as accessibility, availability, effectiveness, trustworthiness, and credibility of mobile mental health apps when deciding whether to recommending them patients. Even though the use of digital technology to improve mental health interventions has a superior advantage in terms of cost, accessibility, and stigma reduction [45], lack of trust or credibility are potential barriers to its uptake. Our findings align with another study conducted in Australia, which identified the primary perceived challenges as a lack of information on the effectiveness of mobile mental health apps and a perceived lack of credibility [28]. Even though health professionals who recommended mental health apps to their patients worried about the privacy, safety, and trustworthiness of the app, patients were not much concerned about privacy and data safety issues regarding health app use [29]. It does not mean that patients ignore app credibility or trustworthiness, but they prioritize access.

The current focus group discussion indicates that participants agreed on recommending an app that relies on credible sources, has been evaluated for effectiveness, and is trustworthy. Although a high number of healthcare professionals reported perceived benefits of apps, only a small percentage recommend them to their patients. The possible reason for this could be a lack of information and the suitability of the app for the patients [16]. For example, within 30 days, 90% of patients who download a mental health app stop using it. It could be a result of not knowing which app is reliable to use and its sources, or not knowing how to use them [26].

In this study, information about disorders (causes, symptoms, and treatments) is the most proposed app functionality to patients, followed by warning signs of mental illness and first aid. All participants consistently emphasized the critical role of accessible mental health information in addressing barriers to help-seeking behaviours. The provision of clear, contextually relevant information was perceived as a key enabler for using the app. The findings of this study are in agreement with those of a study conducted in India [25], and England [13]. For instance, a popular app features content recommended by Berry and his colleagues were information about medication, diagnosis, symptoms, coping strategies, appointments, and medication [13]. For example, research conducted in England reported that many patients suffer a relapse of the illness due to inadequate information about the illnesses. A single mental health app providing psychoeducation, symptom monitoring, self-assessment, and self-care (meditation, mindfulness, and relaxation techniques) is the most popular [20].

This paper also discovered that app features providing self-care management such as mindfulness, breathing exercises, meditation, physical activity, and sleep hygiene, were suggested for the patients. It coincides with a recent American Psychiatric Association report that recommended mindfulness, meditation, breathing exercises, appointments, and medication reminders as the most useful features of an app for patients [20]. These app features can help to reduce anxiety and depression, improve sleep, and increase overall wellbeing. Furthermore, these features can help to reduce healthcare costs by providing accessible and affordable mental health support. Also, previous research has established that mobile mental health app features with psychoeducation content, sleep hygiene, and physical exercise were the most prevalent suggested app features [21, 22].

In this study, during the focus group discussion, it was also suggested that the app content be presented in plain language and customized to fit Ethiopian cultural norms. According to the study conducted by Bucci and his colleagues [41], the content should also be tailored to the target audience [45]. According to this study, mental health professionals suggested medication reminders, appointment reminders, and tracking symptoms and progress tracking for apps. These features were proposed to help patients stay on track with their treatment plans and manage their mental health more effectively. Additionally, these features could help to reduce feelings of anxiety and stress associated with managing mental health. Using a standalone mobile mental health app that is accessible anywhere and anytime is an ideal way to provide modern therapeutic approaches [19]. Another, qualitative study by Steare et al. also found that symptoms and medication tracking helped users' capacity for self-care and recovery goals [46].

Limitation

We acknowledged the absence of triangulation with no complementary in-depth interviews. The study’s findings may be influenced by the gender imbalance among participants, with only two of the fourteen being female. This could be because females are underrepresented among Ethiopian health professionals. Furthermore, the study was conducted at a single institution. These factors are acknowledged as limitations affecting the generalizability and interpretive depth of the results.

Conclusions

The use of mobile mental health apps has two significant perceived benefits. Firstly, it has the potential to enhance patient self-care. Secondly, it could potentially decrease the workload of mental health professionals and reduce the hours of contact with patients. However, study participants expressed concerns about the app’s accessibility, availability, effectiveness, trustworthiness, and credibility. Psychoeducational, self-assessment and self-monitoring, self-care, multimedia, and reminder features of the app received positive feedback from study participants for patients. Therefore, these app features will provide valuable insights for mental health app developers and policymakers, particularly in low-income countries like Ethiopia.

Supplementary Information

Below is the link to the electronic supplementary material.

Authors contributions

Yonas Deressa Guracho: Conceptualization, data collection and curation, formal analysis, investigation, methodology, validation, writing-original draft, writing review and editing. Susan J. Thomas: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, writing—review and editing. Khin Than Win: Conceptualization, data curation, formal analysis, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing.

Funding

This research did not receive funding.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations. Also, the authors assert that all procedures contributing to this work comply with the ethical standards of the Human Research Ethics Committee (HREC) of the University of Wollongong under ethics number 2023/122. Furthermore, the Institutional Review Board (IRB) of Bahir Dar University School of Medicine and Health Sciences approved it with protocol number 797/2023. Consent was also obtained from the Amanuel Mental Specialized Hospital Review Board, referred to as AM/146/416. Informed consent was obtained from all participants involved in the study.

Consent for publication

The authors confirm that there are no financial, institutional, or personal conflicts of interest that could have influenced the publication of this paper.

Clinical trial number

This study was not prospectively registered, an oversight that is addressed in the limitations section.

Competing interest

The authors declare no competing interests.