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With the rapid development of information technology and mobile devices, an increasing number of mobile medical services and platforms have emerged. However, China’s current mental health situation necessitates further discussion and research on how to provide more patient-centered services in the face of many challenges and opportunities.
This study aims to explore the attitudes and preferences of mental health service stakeholders regarding mobile mental health services and discuss the challenges and opportunities faced by mobile technology developers in China.
A web-based survey was conducted by following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist. A total of 586 valid questionnaires were collected. Respondents included 184 patients or their family members, 225 mental health professionals, and 177 people from the general population. Data analysis was completed using SPSS 24.0.
Among the various problems perceived regarding the current mental health medical environment, difficulty in finding appropriate psychologists and limited visit times ranked highest. Social media (n=380/586, 64.9%) was the most preferred platform among all participants, whereas professionals showed a higher preference for smartphone apps (n=169/225, 75.1%). Professional instruction, psychological consultation, and mental health education (ranked top 3) were the most commonly identified needs. Mental health professionals generally emphasized more on treatment-related mobile mental health service needs, especially medication reminders (χ22=70.7;
In terms of service flow, mobile services could be used to expand service time and improve efficiency before and after diagnosis. More individualized mobile mental health service content in more acceptable forms should be developed to meet the various needs of different mental health stakeholders. Multidisciplinary training and communication could be incorporated to facilitate the integration and cooperation of more well-rounded service teams. A standard medical record system and data format would better promote the development of future intelligent medical care. Issues such as ensuring service quality, solving safety risks, and better integrating mobile services with regular medical workflows also need to be addressed.
Of the 1.39 billion people in China, more than 16 million are affected by severe mental disorders [
There has been an explosive growth of app markets worldwide since 2015, with Android and iOS platforms releasing more than 165,000 health-related apps, approximately 7% of which target mental health issues [
In April 2018, the general office of the State Council of China promulgated the
As mentioned, the use of advanced devices and technologies to provide more convenient mental and psychological services are not only urgent needs of the government and the public, but also inevitable trends of social development. However, whether the mobile services provided by enterprises, technology companies, or medical institutions can truly fulfill the needs of patients, family members, physicians, and the general population remains to be determined. Current studies on attitude or acceptance are mainly from countries with advanced electronic health (eHealth) experience, such as the United States, Australia, or Canada, which cannot represent the situation in China [
An open web-based survey was designed following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) checklist [
With the aim of understanding the differences in needs and preferences between different stakeholders to help bridge discrepancies and increase acceptance for future mobile services, the sample was divided into 2 major groups: service providers and service demanders. Service providers consisted of mental health professionals, who are the most direct providers and are considered to have some authority and knowledge concerning what kinds of services are necessary and beneficial. Service demanders were divided into 2 types: (1) patients with mental illness from mental health institutes and their family members; and (2) individuals in the general population. Recent epidemiological data suggest that most mental disorders have become increasingly common across China in the past 30 years [
Participants were recruited voluntarily, and the questionnaire was accessible to all visitors who opened the link or scanned the QR code. Incomplete responses and multiple entries (via Internet Protocol Address) were automatically checked by the
Data analyses were performed using IBM SPSS version 24.0 (IBM Corp). Descriptive statistics were used to describe the study sample. Chi-square tests for single- and multiple-choice questions were applied to analyze whether the reported differences between the 3 groups were significant. Independent sample median tests were used for the preference ranking questions.
The basic information of all participants is presented in
With regard to mobile device use, 83.2% (n=133/184) of patients and family members, 92.4% (n=208/225) of mental health professionals, and 91.5% (n=162/177) of respondents from the general population reported high or relatively frequent use. A significant difference of
Demographic characteristics of the patients, family members, and the general population (N=361).
Characteristic | Patients and family members (n=184), n (%) | General population (n=177), n (%) | Chi-square ( |
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Male | 83 (45.1) | 55 (31.1) |
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Female | 101 (54.9) | 122 (68.9) |
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<18 | 9 (4.9) | 1 (0.6) |
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18-25 | 33 (17.9) | 51 (28.8) |
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26-30 | 48 (26.1) | 62 (35.0) |
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31-40 | 40 (21.7) | 33 (18.6) |
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41-50 | 39 (21.2) | 18 (10.2) |
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51-60 | 14 (7.6) | 11 (6.2) |
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>60 | 1 (0.5) | 1 (0.6) |
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Single | 76 (41.3) | 94 (53.1) |
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Married or living with partner | 102 (55.4) | 74 (41.8) |
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Divorced | 5 (2.7) | 7 (4.0) |
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Widowed | 1 (0.5) | 2 (1.1) |
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Elementary school and below | 3 (1.6) | 0 (0.0) |
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Junior high school | 29 (15.8) | 7 (4.0) |
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High school | 43 (23.4) | 9 (5.1) |
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Vocational school | 40 (21.7) | 26 (14.7) |
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Bachelor degree | 54 (29.3) | 85 (48.0) |
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Postgraduate and above | 15 (8.2) | 50 (28.2) |
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Very poor | 22 (12.0) | 6 (3.4) |
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Fairly poor | 30 (16.3) | 7 (4.0) |
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Moderate | 106 (57.6) | 138 (78.0) |
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Fairly good | 23 (12.5) | 25 (14.1) |
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Very good | 3 (1.6) | 1 (0.6) |
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Schizophrenia | 62 (33.7) | 60 (33.9) |
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Bipolar disorder | 32 (17.4) | 37 (20.9) |
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Depressive disorder | 29 (15.8) | 128 (72.3) |
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Anxiety disorder | 19 (10.3) | 113 (63.8) |
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Obsessive-compulsive disorder | 8 (4.3) | 72 (40.7) |
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Phobia | 1 (0.5) | 33 (18.6) |
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Panic disorder | 3 (1.6) | 18 (10.2) |
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Eating disorder | 0 (0.0) | 10 (5.6) |
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Sleep disorder | 13 (7.1) | 86 (48.6) |
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Paranoid mental disorder | 3 (1.6) | 38 (21.5) |
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Schizoid affective disorder | 3 (1.6) | 16 (9.0) |
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Mental disorder caused by epilepsy | 1 (0.5) | 13 (7.3) |
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Mental retardation with mental disorders | 1 (0.5) | 15 (8.5) |
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Other | 9 (4.9) | 8 (4.5) |
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aNot applicable.
Demographic characteristics of mental health professionals (n=225).
Characteristic | Mental health professionals, n (%); (n=225) | |
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Male | 85 (37.8) |
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Female | 140 (62.2) |
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<18 | 0 (0.0) |
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18-25 | 22 (9.8) |
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26-30 | 53 (23.6) |
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31-40 | 82 (36.4) |
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41-50 | 44 (19.6) |
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51-60 | 23 (10.2) |
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>60 | 1 (0.4) |
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Chief physician/chief nurse | 17 (7.6) |
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Deputy chief physician/deputy chief nurse | 25 (11.1) |
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Attending physician/supervisor nurse | 64 (28.4) |
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Resident physician/nurse | 57 (25.3) |
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Assistant physician/nurse | 22 (9.8) |
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Medical related major student | 28 (12.4) |
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Other | 12 (5.3) |
Frequency of mobile device use and perceived problems of mental health services in China (N=586).
Characteristic | Patients and family members (n=184), n (%) | Mental health professionals (n=225), n (%) | General population (n=177), n (%) | Chi-square ( |
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Very often | 75 (40.8) | 131 (58.2) | 106 (59.9) |
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Fairly often | 78 (42.4) | 77 (34.2) | 56 (31.6) |
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Moderate | 24 (13.0) | 13 (5.8) | 15 (8.5) |
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Not often | 7 (3.8) | 1 (0.4) | 0 (0.0) |
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Almost not use | 0 (0.0) | 3 (1.3) | 0 (0.0) |
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Difficult to find a suitable psychological counselor or institution | 49 (26.6) | 105 (46.7) | 115 (65.0) |
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Limited visit time with the doctor | 80 (43.5) | 99 (44.0) | 84 (47.5) |
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Heavy economic burden | 67 (36.4) | 84 (37.3) | 64 (36.2) |
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Heavy transportation burden for nonlocal patients | 50 (27.2) | 100 (44.4) | 34 (19.2) |
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Difficult to make an appointment to a fixed doctor | 29 (15.8) | 71 (31.6) | 42 (23.7) |
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Lack of simpler procedures for regular medicine purchase | 40 (21.7) | 77 (34.2) | 23 (13.0) |
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Extremely long waiting time | 47 (25.5) | 39 (17.3) | 32 (18.1) |
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Difficult to make appointments | 46 (25.0) | 35 (15.6) | 28 (15.8) |
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Other | 8 (4.4) | 16 (7.1) | 4 (2.3) |
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Social media (WeChat or QQ) | 134 (72.8) | 123 (54.7) | 123 (69.5) |
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Smartphone apps | 78 (42.4) | 169 (75.1) | 104 (58.8) |
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Text message | 25 (13.6) | 19 (8.4) | 9 (5.1) |
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Phone call | 35 (19.0) | 45 (20.0) | 16 (9.0) |
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Websites | 21 (11.4) | 36 (16.0) | 30 (16.9) |
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Other | 5 (2.7) | 6 (2.7) | 5 (2.8) |
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Regarding the current inconvenience of or the unmet needs for mental health services, the difficulty of finding a suitable psychologist (n=269/586, 45.9%) and the limited visit time with the doctor (n=263/586, 44.9%) were most frequently mentioned (χ218=142.2;
Among the frequently used platforms for web-based health services in China, there are social media such as WeChat and QQ, smartphone apps, text messages, phone calls, and websites. Social media (n=380/586, 64.8%) and apps (n=351/586, 59.9%) were most commonly chosen by the respondents. A total of 72.8% (n=134/184) of patients and family members reported a willingness to use social media and 42.4% (n=78/184) for apps, whereas 54.7% (n=123/225) of mental health professionals were more interested in the former and 75.1% (n=169/225) in the latter; the figures were 69.5% (n=123/177) and 58.8% (n=104/177), respectively, for the general population. The results are shown in
There were significant differences in the preference toward mainstream social media among the 3 groups of participants (χ22=17.0;
A multichoice ranking question was provided to determine whether there are differences among respondent groups regarding various categories of mobile mental health services. A total of 11 options were provided for ranking in the questionnaire including 9 categories of services,
Except for guidance for a healthy lifestyle, all other items were significantly different among the 3 groups. Mental health professionals generally emphasized many items, especially medication reminders (χ22=70.7;
Preferences for categories of mobile mental health services among the 3 groups.
Categories | Rankinga | Chi-square ( |
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25th percentile | Median | 75th percentile |
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Patients and family members | 2 | 5b,c | 11 |
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Mental health professionals | 2 | 4b | 9 |
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General population | 3 | 6c | 11 |
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Patients and family members | 2 | 6c | 11 |
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Mental health professionals | 3 | 7c | 11 |
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General population | 2 | 3b | 11 |
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Patients and family members | 3 | 7c | 11 |
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Mental health professionals | 2 | 5b | 8 |
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General population | 2 | 4b | 11 |
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Patients and family members | 3 | 6 | 11 |
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Mental health professionals | 3 | 6 | 11 |
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General population | 2 | 5 | 11 |
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Patients and family members | 3 | 7c | 11 |
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Mental health professionals | 2 | 4b | 7 |
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General population | 6 | 11d | 11 |
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Patients and family members | 3 | 9c | 11 |
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Mental health professionals | 3 | 5b | 9 |
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General population | 4 | 9c | 11 |
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Patients and family members | 5 | 11c | 11 |
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Mental health professionals | 3 | 6b | 11 |
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General population | 5 | 11c | 11 |
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Patients and family members | 3 | 7b | 11 |
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Mental health professionals | 4 | 9b | 11 |
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General population | 5 | 11c | 11 |
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Patients and family members | 5 | 11c | 11 |
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Mental health professionals | 5 | 8b | 11 |
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General population | 5 | 11c | 11 |
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aThe presence of b, c, and d of the median column indicates whether there are statistically significant differences in the median ranking among the 3 groups in each category. The same letter indicates no significant difference between groups; otherwise, there are significant differences. No b, c, or d means no significant difference was detected among all 3 groups.
bNo significant differences between groups for these numbers.
cNo significant differences between groups for these numbers.
dNo significant differences between groups for these numbers.
Median comparison of the ranking of different categories of mobile mental health services among the 3 groups. The X-axis: 1. Web-based professional instruction; 2. Web-based psychological consultation; 3. Mental health knowledge; 4. Guidance for healthy lifestyle; 5. Medication reminder and side effects monitoring; 6. Symptom monitoring; 7. Collection of mental health resources; 8. Web-based prescription; 9.Web-based peer support. The Y-axis represents the median ranking of each category of the 3 groups.
Most service receivers had an above moderate level of willingness to pay for mobile mental health services. The risk of leaked personal information and the professionalism of web-based services were frequently chosen as concerns with regard to these web-based services.
A total of 76.0% (n=171/225) of mental health professionals believed that mobile mental health services can be fairly or very beneficial to their clinical work. Given proper payment, most mental health professionals showed willingness to provide these services. However, almost half of the mental health professionals were concerned about the potential disadvantages of web-based services that were listed on the questionnaire, especially the danger of leaked personal information, insufficient time and energy investment, and medical safety.
Acceptance of and concerns regarding web-based services of patients, family members, and the general population (n=361).
Characteristic | Patients and family members (n=184), n (%) | General population (n=177), n (%) | |
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Very willing to accept | 89 (48.4) | 74 (41.8) |
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Fairly willing to accept | 50 (27.2) | 53 (29.9) |
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Indifferent | 38 (20.7) | 42 (23.7) |
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Tend to not accept | 7 (3.8) | 7 (4.0) |
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Not accept | 0 (0.0) | 1 (0.6) |
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Very helpful | 50 (27.2) | 46 (26.0) |
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Fairly helpful | 88 (47.8) | 84 (47.5) |
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Indifferent | 39 (21.2) | 41 (23.2) |
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Tend to not be helpful | 7 (3.8) | 5 (2.8) |
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Cannot be helpful | 0 (0.0) | 1 (0.6) |
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Very willing | 33 (17.9) | 29 (16.4) |
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Fairly willing | 64 (34.8) | 60 (33.9) |
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Indifferent | 68 (37.0) | 64 (36.2) |
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Tend to not be willing | 18 (9.8) | 19 (10.7) |
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Not willing | 1 (0.5) | 5 (2.8) |
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Leakage of personal information | 105 (57.1) | 127 (71.8) |
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Difficult to learn on mobile devices | 60 (32.6) | 77 (43.5) |
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Difficult to keep recording and learning | 66 (35.9) | 84 (47.5) |
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Not able to truly solve my problems | 86 (46.7) | 82 (46.3) |
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Not professional or authoritative enough | 71 (38.6) | 98 (55.4) |
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Other | 6 (3.3) | 7 (4.0) |
Acceptance of and concerns with web-based services among mental health professionals (n=225).
Characteristic | Mental health professionals (n=225), n (%) | |
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Very support | 103 (45.8) |
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Fairly support | 69 (30.7) |
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Indifferent | 32 (14.2) |
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Tend to not support | 15 (6.7) |
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Not support | 6 (2.7) |
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Very helpful | 65 (28.9) |
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Fairly helpful | 104 (46.2) |
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Neither helpful nor unhelpful | 51 (22.7) |
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Tend to not be helpful | 3 (1.3) |
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Cannot be helpful | 2 (0.9) |
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Very helpful | 67 (29.8) |
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Fairly helpful | 104 (46.2) |
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Neither helpful nor unhelpful | 49 (21.8) |
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Tend to not be helpful | 3 (1.3) |
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Cannot be helpful | 2 (0.9) |
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Very willing | 80 (35.6) |
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Fairly willing | 62 (27.6) |
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Indifferent | 72 (32.0) |
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Tend to not be willing | 8 (3.6) |
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Not willing | 3 (1.3) |
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Leakage of personal information | 125 (55.6) |
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Increased workload | 105 (46.7) |
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Not enough time and energy | 145 (64.4) |
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Medical safety is not guaranteed | 132 (58.7) |
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Unnecessary disturbance | 107 (47.6) |
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Other | 4 (1.8) |
What service providers prioritize may not be urgent from the perspective of service receivers. However, few studies have shed light on the needs concerning electronic-mental health (e-mental health) services from different stakeholders’ perspectives. Considering the current status of mental health in China and the fast-emerging eHealth trend worldwide, in-depth discussion is needed regarding the underlying contradiction between supply and demand in the current Chinese mental health services as well as the opportunities to solve these challenges and provide better patient-centered services through eHealth technologies.
In comparison with previous studies on acceptance and preferred mobile mental health services, the findings of this study shared some similarities, as expected. First, e-mental health services have been proven to be generally acceptable with a high willingness to use, even though they are not perceived to be as helpful as face-to-face services [
This study adds to the body of literature in a few substantial ways. First, some studies have shown that low e-mental health awareness (e-awareness) and the digital divide of patients with severe mental illness might hinder the future use and perceived helpfulness of mobile services [
Second, previous studies have found that the vast majority of respondents preferred traditional face-to-face services to mobile mental health services, which put traditional medical services and mobile medical services on opposing sides [
Third, to our knowledge, this is the first study on the preference for different types of mobile medical services and the first to compare among different stakeholders. Therefore, it is difficult to compare our findings with those arising from other countries’ situations, but the results of this study still provide valuable indications for the future development of mobile mental health services. This survey showed that mental health professionals generally place more emphasis on symptoms and treatment, such as monitoring and access provision, whereas service demanders are more focused on psychological counseling and convenient prescription. The emphasis of professionals on medical issues might be due to their tendency to diagnose and provide treatment plans based on symptoms, whereas psychological counseling services are not commonly integrated with current mental health institutions in China [
The urgent needs for professional instruction and psychological therapy seems to be intrinsic for patients and family members with mental illnesses, but many underlying problems in the current Chinese mental health environment provide no simple solution to these seemingly simple needs. eHealth services seem to be a promising solution, but there are some systemic challenges to be solved that are critical for their application and further development.
First, mental health human resources in China are limited. Due to the lack of social workers and family physicians and the imperfect hierarchical diagnosis and treatment system, patients are used to crowding into first-class hospitals for treatment. However, limited human resources and heavy work burdens make it difficult for physicians and nurses in hospitals to provide personalized and continuous disease management, which leads to the urgent need for more professional instruction, as shown in this study [
Telemedicine services seem to be a promising solution to help patients who lack convenient access to local services to obtain high-quality mental health services. The authors conducted a rough search on 2 App Store optimization websites,
However, there are several challenges that require further attention. On the one hand, the time consumption and workload disruption might hinder the sustainable willingness of more professionals to provide such services, as Granja and Janssen noted [
Second, professional mental health publicity and education resources for the general population are insufficient. The various kinds of mental health information that flood the internet are not necessarily effective or safe. First, nonindividualized health education information is not as helpful as what personal physicians or counselors can provide for patients to solve their mental health problems [
Third, the inconformity of medical information impedes the development of medical big data. For a long time, the inconsistency of data standards and the irregularity of data formats have been important factors hindering the development of big data in China [
The survey showed that all groups generally have high acceptance for mobile mental health services, with different preferences. However, the application of mobile mental health in China still faces many challenges along with great opportunities to improve the current service flow, service content, and service quality. The following are some suggestions for the application of mobile mental health in China based on the worldwide trends of mobile health and China’s national conditions.
To reduce the threshold and obstacles for the public to positively seek and accept mental health services, professional mobile platforms could be equipped to establish more coherent service flows. For the general population, there could be platforms providing mental health education, early symptom screening, self-help psychological intervention, and smooth referral services to professional psychological counseling or psychiatric institutions. For patients with severe disorders who need more systematic diagnosis and treatment, mobile devices can be used to provide pretreatment guidance before a formal visit by asking patients to fill in disease-related information in advance, which could not only provide more referential information for physicians in the very limited outpatient visit time but also expand the content of service and enhance the sense of being cared for. After the first visit with a clear diagnosis, web-based prescription and drug delivery services after video conferences could be used to change repeated brief follow-ups to high-quality web-based instruction, with all the information gathered from previous visits and daily EMA data on mobile platforms. Transforming the repetitive and tedious routine through web-based services might help reduce the travel time and economic burden of patients and relieve the crowded environment in large medical institutions.
It should be emphasized that to ensure the acceptance and perceived usability among professionals, all of these mobile services should be optimized in the current mental health service mode without disturbing the regular workflow or increasing the burden of staff [
Psychological intervention is one of the services of most concern for the public, patients, and family members. Web-based psychological intervention services may be self-helped or professionally guided, synchronous, or asynchronous [
At present, there are many search engines on the internet that provide a variety of mental health knowledge, but most of them are delivered either as a professional reference or with unguaranteed quality, which might lead to inaccurate self-diagnosis [
The lack of mental health human resources and limited visit time at clinics in China leads to individualized professional instruction for disease-related questions being the most important requirement of patients and family members. A stepped health care system could be introduced to mental health institutions by integrating AI technology and human professionals. After learning and training, the AI robot could be used to complete the screening and identification work and automatically answer some simple professional questions, but as a guarantee, medical assistants could be equipped to solve more complex problems that the robot cannot address. Important decision-making problems, such as prescription or emergencies, including suicide or self-injury, can be referred to a physician. With the help of mobile technology and AI, the burden of physicians could be reduced, and more personalized services could be provided.
Peer support has been considered an important way of improving mental health that provides more perspectives and support for patients and family members. Mobile devices are widely used social tools and educational platforms for peer support in synchronous or asynchronous forms, but the activation of, commitment to, access to, and effectiveness of mobile peer support apps await further research [
Symptom monitoring and medication reminders provided by mobile tools were not as prioritized by patients and family members as they were by mental health professionals. Professionals might habitually pay more attention to symptoms and side effects and hope to have a more comprehensive understanding of the variation of medical indicators. However, patients might think these are redundant and even reminders of pain. A mutually beneficial approach is necessary. Motivational research has proven that external and intrinsic factors, such as the sense of accomplishment and control, increase of personal benefit, and formation of habits, could facilitate adherence to mobile services [
In the past 15 years, China’s mental health services have greatly improved with the conduction of a national program named
Considering the current divided training system between psychiatry and psychology in China [
There are some limitations to this study. First, respondents representing mental health professionals and the general population were collected from the social media accounts of the researchers, and the respondents representing patients and family members are mainly collected from one mental health department of a provincial hospital. The similar background of the participants limits this survey in gathering perspectives from community-level medical institutes or patients with limited resources or literacy. Multicentered research is needed for a more well-rounded understanding. Second, this study is conducted with the prerequisite that all participants have smartphones and use WeChat and thus cannot address the needs of people who do not frequently use smartphones or WeChat. However, with the rapidly increasing number of cyber citizens and the large number of WeChat users in China, understanding the needs of this part of the public first is more feasible and promising. Third, it was unpractical to conduct an assessment on cognitive ability before consent was obtained for a questionnaire, and there is a possibility that some patients did not fully understand the questionnaire items. However, as the results of patients and family members are very similar, we tend to believe that there is only a minor possible influence.
This study investigated the preferences, acceptance, and concerns regarding mobile mental health services of different mental health stakeholders and discussed the potential of mobile health services to relieve the urgent mental health needs of current China. Psychological therapy, professional instruction, and mental health education are most needed, which reflects the current problems of mental health services in China, such as the severely imbalanced supply and demand, doubtful and insufficient public education materials, incoherent mental health services flow, and the lack of standardization of medical information. However, challenges always accompany opportunities. With the high acceptability of mobile health services, mobile technologies have the potential to build a smoother mental health workflow, enrich urgently needed service categories, and improve the overall service quality. More practice and research are needed in the future to continuously maximize the advantages of technology while avoiding privacy risks and medical security issues.
Survey of preferences for mobile mental health services.
artificial intelligence
augmented reality
Checklist for Reporting Results of Internet E-Surveys
electronic health
electronic-mental health
e-mental health awareness
ecological momentary assessment
Quick Response code
virtual reality
The authors thank all participants for providing their perspectives in this study. They are also thankful for the assistance in language editing provided by American Journal experts, and further language editing by Katherine Cohen from Northwestern University.
This study was funded by the National Key R&D Program of China (2017YFC1311102) and Fundamental Research Funds for the Central Universities of Central South University (2019zzts361).
YT drafted the questionnaire and manuscript and analyzed the data. ZT and YQ helped with the questionnaire and analysis of the data. HT and HX helped with the questionnaire and revised the manuscript. JC supervised and assisted with the entire process.
None declared.