Engaging Stakeholders in the Development of a National Digital Mental Health Strategy: Reflexive Thematic Analysis

Abstract

BACKGROUND: Recent advances in digital health technology offer the potential to overcome established access barriers to mental health support, such as stigma and geographical location. The World Health Organization recommends integrating digital technologies into mental health care, underscoring the need for countries to develop national digital mental health (DMH) strategies to guide efforts. The rate of development and availability of DMH tools currently outpaces the existing policy or regulatory guidance required to guide their use. In Ireland, a key requirement of the national mental health strategy, Sharing the Vision, was the development of a national DMH strategy. Key stakeholders in DMH research, policy, practice, and lived experience were brought together as part of a focused stakeholder engagement event to develop a shared vision for digital mental health in Ireland. OBJECTIVE: This study aimed to explore the views of DMH stakeholders to set priorities for the development of a national DMH strategy. METHODS: Forty-seven stakeholders were each assigned to 1 of 6 focused strategy discussion groups. Invited stakeholders included experts in DMH research, clinical practice, and mental health advocacy and policy, together with those with lived experience of accessing mental health services. Qualitative data were analyzed using a reflexive thematic analysis approach. Researchers followed the 6-step framework proposed by Braun and Clarke. Reflexive thematic analysis emphasizes intentionality and critical thought, highlighting researchers' deliberate interpretation of data while being aware of how their perspectives shape the conclusions. RESULTS: A total of 5 major themes were identified: inclusive access, being user-led, trust, education and training, and connectedness. These major themes were related to 15 subthemes. The inclusive access theme comprised inclusivity, accessibility, and early intervention subthemes. The user-led theme encompassed coproduction, choice, and needs-led subthemes. Compelling narrative; regulation, policy, and governance; and evidence base subthemes were identified within the theme of trust. The subthemes of digital literacy, mental health literacy, and transformation were identified within the education and training theme. Finally, the connectedness theme incorporated the subthemes of integration, relationships, and stigma. CONCLUSIONS: Overall, delegates viewed digital technology as a potential enabler of accessible and inclusive mental health support. However, it was also seen as a potential barrier to access and inclusion if concerns regarding data privacy, education and training needs, regulation, and the need for a more a robust evidence base were not addressed. Coproduction at all stages was identified as key to reducing access barriers, enhancing inclusion, and maintaining trust. Themes identified informed a follow-on consensus-seeking process to further refine and prioritize the proposed actions of the first national DMH strategy.

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