Table 2.
Findings telemental health (TMH) applications (video-conferencing and telephone) and digital mental health intervention tools (VMH) (e.g. apps, social media platforms).
| CFIR domain |
Barriers/negative appraisals |
Reviews |
Facilitators/positive appraisals |
Reviews |
|---|---|---|---|---|
| Intervention characteristics | ||||
| Design (e.g. guided vs unguided; scalability, fidelity, adaptability) | TMH/VMH: designs (phone, guided apps) lack non-verbal cues. Instant chat messages throughout the pandemic too limited for people with severe mental problems (eating disorders); TMH: videoconferencing preferred over audio/telephone | (Appleton et al., 2021; Ardekani et al., 2021; Devoe et al., 2022) | VMH: adaptability (e.g. contextual and cultural) to aim at physical activity, relaxation, mindfulness. | (Keyes et al., 2022; Soklaridis et al., 2020) |
| TMH: improves scheduling of consultations and counseling; time efficient; reduces consultation time. | (Ardekani et al., 2021; Bertuzzi et al., 2021; Keyes et al., 2022; Li et al., 2021; Selick et al., 2021) | |||
| TMH: difficulties to reach all populations (e.g. new patients; people in LMICs; economically disadvantaged) | (Appleton et al., 2021; Li et al., 2021; Tuczyńska et al., 2021) | VMH: quality and usability of e-packages/social media platform for healthcare workers | (Drissi et al., 2021) | |
| VMH: lack of cultural or contextual adaptations (e.g. in LMICs) | (Soklaridis et al., 2020) | TMH care increases treatment adherence/less no-shows | (Ali et al., 2021; Lemieux et al., 2020) | |
| Effectiveness/trialability (appraisals often not based on meta-analyses of RCTs) | VMH: Questionable quality of digital mental health tools (e.g. apps); not effective when used as a standalone therapy. | (Hatami et al., 2022; Murphy et al., 2021) | TMH evaluated as (cost-) effective and feasible/acceptable | (Ali et al., 2021; Ardekani et al., 2021; Bertuzzi et al., 2021; Hatami et al., 2022; Keyes et al., 2022; Lemieux et al., 2020; Linardon et al., 2022 ; Murphy et al., 2021; Selick et al., 2021) |
| TMH/VMH: lack of (long-term) effectiveness studies during COVID-19 | (Abd-Alrazaq et al., 2021; Appleton et al., 2021; Lignou et al., 2022; Thenral & Annamalai, 2020) | TMH: effective evaluation for (early stage of) common mental health disorders | (Abraham, Jithesh, et al., 2021; Chiesa et al., 2021; Mohammadzadeh et al., 2022) | |
| TMH care evaluated as not effective for prevention and rehabilitation care. | (Abraham, Jithesh, et al., 2021) | TMH versus VMH: therapist-guided online therapies more efficacious in reducing depression and anxiety than self-help internet-based treatment or apps. | (Hatami et al., 2022) | |
| VMH: evaluated as being effective for marginalized populations | (Abraham, Jithesh, et al., 2021) | |||
| TMH/VMH effective during COVID (e.g. people already receiving care/with established therapeutic relationship) | (Appleton et al., 2021; Keyes et al., 2022; Linardon et al., 2022 ; Selick et al., 2021) | |||
| VMH (e.g. iCBT) more effective in selected highly motivated patients | (Keyes et al., 2022) | |||
|
Characteristics of individuals involved: | ||||
| Practioners:beliefs, perceptions, knowledge, and self-efficacy in terms of TMH | TMH/VMH: lack of technological literacy and experience in providers | (Bertuzzi et al., 2021; Cabrera et al., 2020; Narvaez, 2022; Siegel et al., 2021) | TMH increases access for young people with mental health problems (de-stigmatizing) | (Keyes et al., 2022) |
| TMH/VMH: concerns about therapeutic relationship/impersonal | (Appleton et al., 2021; Kane et al., 2022; Li et al., 2021; Meloni et al., 2020; Selick et al., 2021; Siegel et al., 2021; Thenral & Annamalai, 2020; Tuczyńska et al., 2021) | Limitations of TMH/VMH less important in medication consultations compared to psychotherapy | (Segenreich, 2022) | |
| TMH: reluctance to use because desire for face-to-face or lack of confidence | (Ardekani et al., 2021; Baumgart et al., 2021; Narvaez, 2022) | TMH: more control over time-schedule | (Keyes et al., 2022; Narvaez, 2022) | |
| TMH: requires more concentration; screen fatigue | (Appleton et al., 2021; Keyes et al., 2022; Siegel et al., 2021) | |||
| TMH: missing essential psychological cues | (Drissi et al., 2021; Siegel et al., 2021) | |||
| TMH: intercultural communication and language | (Keyes et al., 2022) | |||
| TMH: ethical concerns | (Kane et al., 2022) | |||
| TMH: inadequate information to support diagnosis | (Li et al., 2021) | |||
| TMH/VMH: increases pre-existing health inequalities | (Keyes et al., 2022) | |||
| TMH/VMH: perceived inefficacy | (Abraham, Jithesh, et al., 2021) | |||
| Participants:beliefs, perceptions, knowledge, and self-efficacy | TMH/VMH: lack of technological literacy/skills (e.g. cognitively impaired, elderly, young, low SES) | (Abd-Alrazaq et al., 2021; Baumgart et al., 2021; Murphy et al., 2021; Selick et al., 2021; Siegel et al., 2021) | Patient satisfaction TMH for eating disorders | (Devoe et al., 2022) |
| VMH: low literacy in general (e.g. for implementation in LMICs) | (Soklaridis et al., 2020) | Patient satisfaction TMH higher than face-to-face | (Keyes et al., 2022) | |
| Concerns over efficacy | (Abraham, Jithesh, et al., 2021; Meloni et al., 2020) | |||
| Limited access or availability to use the TMH and VMH technology (WiFi, webcam, smartphone) | (Abraham, Jithesh, et al., 2021; Appleton et al., 2021; Devoe et al., 2022; Siegel et al., 2021) | Increased anonymity | (Thenral and Annamalai, 2020) | |
| Perceptions of low efficacy/effectiveness | (Murphy et al., 2021) | Willingness of users | (Murphy et al., 2021) | |
| Increases pre-existing (digital) inequalities | (Abraham, Jithesh, et al., 2021; Murphy et al., 2021) | |||
| Unwillingness/low motivation to participate in TMH or VMH | (Abraham, Jithesh, et al., 2021; Drissi et al., 2021; Selick et al., 2021) | |||
| TMH/VMH: Distractions/less concentration | (Li et al., 2021) | |||
| TMH/VMH: Perception of being impersonal/preference for face-to-face/low satisfaction | (Ardekani et al., 2021; Hatami et al., 2022; Li et al., 2021; Linardon et al., 2022) | |||
| TMH does not replace face-to-face for severe mental health problems (e.g. eating disorders) | (Gao et al., 2022) | |||
| Inner setting: | ||||
| Specific organization or setting in which a TMH/VMH will be deployed (e.g. clinic led communication, guidelines, organizational support). | Lack of organizational support for technological implementation/no support person to manage technology | (Murphy et al., 2021; Selick et al., 2021; Tuczyńska et al., 2021) | Organizational (technical) support (second person to assist) | (Ardekani et al., 2021; Li et al., 2021) |
| Time constraints to use TMH and VMH due to competing tasks COVID-19 | (Narvaez, 2022; Siegel et al., 2021) | Guidelines available from (international) professional bodies | (Appleton et al., 2021; Segenreich, 2022) | |
| TMH or VMH not made available in organizations | (Murphy et al., 2021) | Decrease of waiting lists | (Bertuzzi et al., 2021) | |
| Lack of equipment for TMH virtual platforms Inadequate IT infrastructure |
(Keyes et al., 2022; Mohammadzadeh et al., 2022; Selick et al., 2021; Siegel et al., 2021) | Good quality of internet Computer in private area |
( Selick et al., 2021) |
|
| Outer setting: | ||||
| Patient needs accurately known and prioritized by the organization (e.g. payment and funding; privacy and ethics; regulations). | Limited privacy (i.e. home setting patient) | (Drissi et al., 2021; Meloni et al., 2020; Thenral & Annamalai, 2020) | TMH: home setting (valid information socio-environmental determinants) | (Abraham, Jithesh, et al., 2021; Li et al., 2021; Selick et al., 2021) |
| Confidentiality | (Abraham, Jithesh, et al., 2021; Appleton et al., 2021) | |||
| Security and safety issues/risks | (Murphy et al., 2021) | |||
| Removal regulatory barriers | (Kane et al., 2022) | |||
| Lack/limited access for homeless, technologically uncomfortable (older people), cognitively impaired, young children and people from rural areas. | (Abd-Alrazaq et al., 2021; Cabrera et al., 2020; Li et al., 2021; Yue et al., 2020) | Increased access for marginalized people (from rural areas, migrants, refugees); for people with discontinued care for severe mental health disorders; young people | (Abraham, Jithesh, et al., 2021; Appleton et al., 2021; Gao et al., 2022; Kane et al., 2022) | |
| Lack of knowledge of support needed for technology in organizations | (Keyes et al., 2022) | Time for setting treatment | (Abraham, Jithesh, et al., 2021) | |
| Lack of sufficient funds and resources | (Mohammadzadeh et al., 2022) | Offering geographical flexibility | (Siegel et al., 2021) | |
| Implementation Process: | ||||
| Active efforts undertaken to integrate telemental- and virtual mental health (clinical and technological integration) | Failed integration/acceptance in organizational or national systems | (Abd-Alrazaq et al., 2021) | Organization facilitating access to TMH (in general) | (Abraham, Jithesh, et al., 2021; Ali et al., 2021; Chiesa et al., 2021; Keyes et al., 2022) |
| Lack of insurance coverage | (Appleton et al., 2021; Murphy et al., 2021) | More easily reimbursed | (Baumgart et al., 2021) | |
| Lack of information for staff | (Lemieux et al., 2020) | Delivered at lower costs/increased cost-effectiveness | (Thenral & Annamalai, 2020; Yue et al., 2020) | |
| Limited use or access to available technologies | (Kane et al., 2022; Lemieux et al., 2020; Li et al., 2021) | |||
| Lack of training/shortage of trained or skilled staff | (Keyes et al., 2022; Lemieux et al., 2020; Soklaridis et al., 2020) | Training and education of staff in TMH and guided VMH | (Keyes et al., 2022; Li et al., 2021; Siegel et al., 2021) | |
| Sustainability and adoption (e.g. include more stakeholders) | (Abd-Alrazaq et al., 2021; Chiesa et al., 2021) | Delivery of higher level digital performance | (Kane et al., 2022) | |
Telemental health (TMH) is the use of synchronous therapist contact through telecommunications or videoconferencing technology to provide mental health services. Virtual mental health interventions (VMH) are asynchronous forms of therapist contact through computer, web-based, and mobile delivery of therapy (e.g. apps and chats for training, and web-based peer and social support programs and platforms). Q = total score based on the relevant AMSTAR-2 items.