TY  - JOUR
AU  - Forman-Hoffman, Valerie L
AU  - Pirner, Maddison C
AU  - Flom, Megan
AU  - Kirvin-Quamme, Andrew
AU  - Durden, Emily
AU  - Kissinger, Jennifer A
AU  - Robinson, Athena
PY  - 2023
DA  - 2023/9/27
TI  - Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study
JO  - JMIR Form Res
SP  - e46473
VL  - 7
KW  - adoption
KW  - anxiety
KW  - chatbot
KW  - cognitive behavioral therapy
KW  - conversational agent
KW  - CBT
KW  - depression
KW  - digital health
KW  - medically underserved area
KW  - mental health
KW  - mhealth
KW  - mobile app
KW  - mobile health
KW  - mobile phone
KW  - mood
KW  - psychotherapy
KW  - relational agent
KW  - rural
KW  - satisfaction
KW  - smartphone app
KW  - smartphone
KW  - underserved
KW  - usage
KW  - vulnerable
AB  - Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent–guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 
SN  - 2561-326X
UR  - https://formative.jmir.org/2023/1/e46473
UR  - https://doi.org/10.2196/46473
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37756047
DO  - 10.2196/46473
ID  - info:doi/10.2196/46473
ER  -