Concepts for the Integration and Implementation of mHealth Apps for Patients With Mental Disorders: Scoping Review.

Abstract

<h4>Background</h4>Mental and behavioral disorders affect approximately 28% of the adult population in Germany per year, with treatment being provided through a diverse health care system. Yet there are access and capacity problems in outpatient mental health care. One innovation that could help reduce these barriers and improve the current state of care is the use of mobile health (mHealth) apps, known in Germany as Digitale Gesundheitsanwendungen (DiGA). DiGA are certified apps reimbursed by statutory health insurance funds. They are evaluated before use, for example, by proving their medical benefit in clinical studies, or approved for use according to the concept of "coverage with evidence development." Most DiGA currently included in the DiGA directory are approved for use by people with mental disorders. However, the low and stagnant use numbers point to barriers to their uptake and integration in the German health care system. The analysis of concepts for implementation and integration is important to find effective ways to realize the potential of these apps in mental health care.<h4>Objective</h4>This scoping review aimed to identify concepts and frameworks for the successful integration of mHealth apps into international health care systems and how they can be adapted and transferred to DiGA used in the German health care system.<h4>Methods</h4>The scoping review followed the methodological framework for scoping reviews proposed by Arksey and O'Malley. The scientific databases PubMed, Embase, and PsycINFO were searched. A 2-stage (title and abstract, followed by full text) screening process was conducted by 2 different reviewers independently.<h4>Results</h4>A total of 3710 publications were identified. Of these, 20 were included in the review, with 3 additional studies identified through a targeted search. Results are presented in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The literature identified through this scoping review provides an overview of a variety of aspects of mHealth apps for mental disorders and their integration into health care systems. There are different general, organizational, legal, and technical requirements to create a suitable environment, therefore specific concepts for integration and implementation of mHealth apps are necessary. We identified regulatory concepts, for example, directories for mHealth apps, and care-related concepts, for example, training and support of medical professionals. The generated evidence contributes to improved and user-oriented structures and processes, potentially leading to better patient support through mHealth apps.<h4>Conclusions</h4>Evidence already shows that mHealth apps can effectively support patients with mental health disorders. To realize this potential, mHealth apps need to work within the structures and processes of health care systems. Therefore, this scoping review provides insights on the integration of mHealth apps into (outpatient) mental health care.