Rosa Hernandez-Ramos, Stephen M Schueller, Judith Borghouts, Kristina Palomares, Elizabeth Eikey, Margaret Schneider, Nicole A Stadnick, Kai Zheng, Dana B Mukamel, Dara H Sorkin
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Abstract
Background: Technology-enabled services (TESs) have the potential to increase access to mental healthcare. However, little research has focused on how TESs can be integrated into publicly funded service settings. As part of the state-wide Help@Hand project, Marin County conducted a pilot implementation of myStrength, a digital cognitive behavioral therapy platform, to explore its potential to reduce loneliness among isolated older adults. We evaluated the pilot impact using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.
Method: A single-site 6-month pilot implementation recruited English (n = 15) and Spanish-speaking (n = 15) isolated older adults who received a digital literacy course followed by 8 weeks of myStrength access and human support. We evaluated factors related to reach, effectiveness, adoption, and implementation using the perspectives of users and County staff. Descriptive statistics were used to examine reach, adoption, and implementation. Nonparametric tests, including Friedman and Wilcoxon signed-rank, were used to examine effectiveness.
Results: Reach: Compared to overall county demographics, platform users were majority female (93.1% vs. 50.5%), ethnoracialized (62.1% vs. 24.2%), and of lower socioeconomic status (Mdn = $35,000 vs. $131,008). Effectiveness: Users reported a significant (z = -2.62, p < .001) decrease in loneliness. Adoption: Users logged into myStrength an average of 10 times and completed 33 activities during the 8 weeks of myStrength use. Implementation: Each pilot staff (N = 20) spent an average of 19.8 hr (SD = 16.51) supporting users' use of myStrength during the pilot. Pilot staff reported several adaptations to meet the needs of users.
Conclusions: Successes included reaching the target population, reducing loneliness, and user adoption. However, pilot staff invested significant time to support those with lower digital literacy skills. As such, although TESs may address unmet needs, their use with underserved populations may require upfront and ongoing support provided by the settings where they are implemented.
Plain language summary title: Testing a New Digital Therapy Tool for Isolated Older Adults in County Mental Health Services.
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