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Background: Mental health care counselors have a high intention to use e-mental health (EMH), whereas actual use is limited. Facilitating future use requires insight into underlying factors as well as eligibility criteria that mental health care counselors use in their decision to apply EMH.
Objective: The aim of this study was to unfold the intention and underlying reasons for mental health counselors to use EMH and to unveil the criteria they use to estimate patient eligibility for EMH. The theoretical framework was based on the reasoned action approach model, the Unified Theory of Acceptance and Use of Technology, and the Measurement Instrument for Determinants of Innovation model.
Methods: To empirically validate our theoretical model, a web-based survey was conducted among mental health care counselors (n=132). To unveil the eligibility criteria, participants were asked to rank their reasons for considering EMH suitable or unsuitable for a patient.
Results: The mean intention to use EMH was positive (mean 4.04, SD 0.64). The mean use of EMH before the COVID-19 pandemic was 38% (mean 0.38, SD 0.22), and it was 49% (mean 0.49, SD 0.25) during the pandemic. In total, 57% of the patient population was considered eligible for EMH. Usefulness and benefits (β=.440; P<.001), Task perception (β=.306; P=.001), and Accessibility (β=.140; P=.02) explained the intention to use EMH (F=54.151; P<.001; R=0.559). In turn, intention explained patient eligibility (F=34.716; P<.001; R=0.211), whereas intention and patient eligibility explained EMH use (F=41.047; P<.001; R=0.389). Patient eligibility partially mediated the relationship between intention to use EMH and EMH use, with a larger direct effect (c'=0.116; P<.001) than indirect effect (c=0.065, 95% CI 0.035-0.099; P<.001). Mental health counselors assessed patients' eligibility for EMH mainly through the availability of computers and the internet and patient motivation.
Conclusions: To stimulate the use of EMH, intention and patient eligibility need to be influenced. Intention, in turn, can be enhanced by addressing the perceived usefulness and benefits of EMH, perceived accessibility, and task perception. Access to a computer and patients' motivation to use EMH are important in facilitating patient eligibility. To cause an impact with EMH in general practice, mental health counselors need to be convinced of the benefits of EMH and transfer this enthusiasm to the patient. It is recommended to involve mental health counselors in the development of EMH to increase the (perceived) added value and use.
