Digital Navigators for Acceptance and Competence Development with Mental Health Apps

The study aims to promote the use of digital health applications (DiGAs) to improve mental health and provide timely treatment for underserved populations. Currently, DiGAs are only used by a small proportion of patients and practitioners in Germany. In order to solve this care problem, employees of medical teams, such as medical assistants, are to be trained as so-called 'digital navigators'. These digital navigators support stakeholders in the selection and use of mental health apps, impart the necessary digital skills, improve adherence and relieve the burden on those providing treatment.

As part of the pilot project, digital navigators will be implemented as an example in GP and outpatient psychiatric care in a rural region of Brandenburg. Firstly, a preliminary study will be conducted to determine the acceptance and expectations of the digital navigators using interviews and focus groups. The researchers then complete a training program at Harvard Medical School and adapt the 'Harvard Digital Navigator Training' to the German framework conditions. This adaptation process is supported by discussion groups with patients and practitioners.

In the next step, medical assistants in six study centres will receive the adapted training. A central tool available to them is the DiGAnavigator.de website, a guide for DiGAs. The digital navigators help with the integration of DiGAs into the treatment of 48 patients with mental illnesses and accompany them over a period of 12 weeks.

Finally, the implementation will be evaluated. The evaluation analyses the implementation hurdles and the effects on the eHealth literacy of patients and professionals. The eHealth Literacy Scale (eHeals) and the Digital Health Literacy Index (DHLI) will be used for this purpose. An accompanying process evaluation analyses the acceptance, effects and implementation barriers of the digital navigators. In addition, both patients and staff are surveyed regarding their digital and technical skills as well as their willingness and ability to change before and after the intervention. Furthermore, the severity of the patients' illness will be recorded and compared before and after the intervention using validated scales. To ensure sustainable implementation, the long-term aim is to provide accredited training to become a digital navigator.

• Willingness and competence to change [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Digital competence [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Technical competence [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Psychological Health of Patients (level of functioning) [Time frame: After completion of the 12-week intervention (T1)]
• Psychological Health of Patients (symptom severity, treatment response and the efficacy of treatment) [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Psychological Health of Patients (depressive symptoms; self-report) [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Psychological Health of Patients (depressive symptoms; clinician-administered) [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Psychological Health of Patients (anxiety) [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Psychological Health of Patients (insomnia) [Time frame: Before (T0) and after completion of the 12-week intervention (T1)]
• Identification of implementation barriers to the introduction of digital navigators [Time frame: After completion of the 12-week intervention (T1)]
• Identification of implementation barriers to the introduction of digital navigators [Time frame: After completion of the 12-week intervention (T1)]
• Use of Digital Health Applications and the effects of counseling and support by Digital Navigators [Time frame: After completion of the 12-week intervention (T1)]