The digital health movement has been building for nearly a decade, with pharmaceutical companies and healthcare providers using new technology to improve peoples’ lives around the world.
During the COVID-19 pandemic, necessity boosted the pace of development, with many new digital products created to support remote treatment.
Pre-pandemic, it was estimated that more than one in four adults experience a mental health problem each year, with an estimated 792 million adults affected by mental health issues worldwide.
However, the marked decline in mental health relating to the loss of life, social isolation, and the economic downturn accelerated the need to rapidly shift care to digital channels.
In the UK, NHS mental health services have been feeling the strain for years, with healthcare providers often being overwhelmed by the volume of requests, resulting in long waiting lists, clinician burnout and deteriorating quality of care.
Innovation in digital health, and particularly digital therapeutics (DTx), has the potential to help healthcare providers overcome some of the barriers that prevent patients from accessing quality care.
How can we quickly scale-up low-cost approaches to reach millions of people with solutions that are both effective and engaging?
And how can these technologies be leveraged to address long-standing inequities in mental health care?
How could digital therapeutics help?
DTx solutions have a multitude of uses and wide-ranging implications for both individuals and society.
With the right design, the products can be used alongside other treatments or types of therapy to empower patients to take control of their own health and provide personalised care, while lowering the burden of care for clinicians and reducing costs to healthcare systems.
Innovation in the DTx space is also helping to reduce health inequalities, by providing care in new ways (for example, for the homeless or in under-resourced areas) and developing new solutions specifically designed to target vulnerable people while still supporting those who satisfy their health needs through other means.
DTx solutions exist to address treatment gaps and meet needs that are underserved by current services and systems — and there may be no bigger gap in healthcare than in mental health.
Mental health is one of the very few areas where the majority of treatment needs remain unmet across low-, middle-, and high-income countries alike.
Statistics on this treatment gap can be quite harrowing; in high-income countries, up to 50 per cent of people with mental health disorders receive no treatment.
This figure extends up to 90 per cent in low-income, developing settings (Thornicroft G, et al, 2017), which carry the greatest global burden of poor mental health.
Increasing access to mental health support
A key driver for DTx solutions is enabling easier access for patients.
It is estimated that there are 5.2 billion unique mobile phone users in the world today, with 3.8 billion of these being smartphone users; a staggering 48 per cent of the global population.
This represents an enormous opportunity for digital therapeutics to provide unprecedented access to healthcare, particularly for those in harder-to-reach or under-resourced areas.
Because of the increased access to care that DTx can provide, it therefore makes engaging patients to adhere to medium-to-long term care plans more feasible and can lead to significantly improved health outcomes compared to traditional care alone, which may be limited by overburdened healthcare systems.
As well as providing better access generally, DTx solutions can also help to overcome the stigma around mental health treatment.
Many people – particularly males – find it difficult to seek help because of how it might be perceived by friends, family and colleagues.
By allowing individuals to manage treatments, therapies and consultations from the comfort of a chosen location or privacy of their own homes, DTx can improve the uptake of care and ultimately improve patient outcomes.
Improving patient outcomes by boosting engagement
Integrating DTx solutions with social and gaming technology can improve engagement amongst a wide range of patients.
Many behaviour change theories and frameworks include an element of social motivation theory that has been proven to act as an important driver of uptake and adherence to health behaviours.
One of the most influential and widely used behaviour change frameworks at present, the COM-B model, states that social factors are a key driver in creating the opportunity to elicit a behaviour.
By integrating DTx softwares with social platforms, an individual can receive positive reinforcement for their health behaviours and may be more inclined to continue these behaviours.
Likewise, gamification of DTx components can help individuals focus their attention on executing behaviours that achieve a goal or challenge and in turn keep them motivated and engaged with a behaviour change plan.
This ultimately increases the chance that the novel positive health behaviours will become standard, routine behaviours at some stage.
In addition to gamifying mental healthcare, there is strong evidence to suggest that health care plans that are tailored to an individual’s specific needs and consider the individual’s context lead to significantly improved patient outcomes.
DTx can increase the ease at which tailored care plans and personalised therapeutic content can be distributed to patients.
Using a combination of initial clinical prescription, AI algorithms, and machine learning, DTx can create a fully tailored care plan at a fraction of the time and resource cost compared to traditional healthcare systems.
Additionally, the care plan can be easily altered and updated to provide new content, based on the patient’s individual needs and progress as reported by data gathered from the software.
Providing a quality service
While clinical practices are conducted to strict medical and ethical guidelines in the Global West, the quality of care can still fluctuate significantly across healthcare systems.
For example, a patient may receive excellent primary care in one region of the country, but another individual from the same patient population may receive poor treatment in another area of the country due to variables like under-resourcing leading to rushed consultations, under-funding leading to a lack of adequately equipped facilities, or simply human error.
All regulated, high-quality DTx solutions ensure that each and every patient that has access to the software receives the same evidence-based quality of care that is protected from the extraneous variables present in traditional care systems.
Getting it right
Focusing on the benefits that DTx can bring to mental health services paints a rosy picture of future care, but there are challenges that pharmaceutical companies and healthcare providers should consider to ensure that solutions help rather than hinder.
New technological solutions must be acceptable to their target end-users and facilitate clinically significant patient outcomes in order to be successful – and to get this right requires the same scientific rigour as traditional intervention design.
Those creating DTx products need to apply knowledge from behavioural science and a comprehensive understanding of their target users to be successful.
Research, evaluation and measurement are needed throughout each step of the process from identifying target users and their behaviours to benchmarking and monitoring experiences and outcomes.
As long as companies take a patient-centric approach to building their DTx products, and undertake stringent research and monitoring to make sure it is meeting their needs, the possibilities for a wider application of DTx in mental health services are endless, benefitting both service providers and their users.
Jack Burton is Senior Clinical UX Researcher at Graphite Digital.
He specialises in understanding the interactions that patients and clinicians have with digital health products and services to help design teams create effective, user-centred solutions.
