Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review

Nicholas Sims-Rhodes; Hannah E Cornwell; Emily Barena; Vandy Dubre; Kimberly S Elliott; Eman H Nabulsi; Nelly Yuen; Sarah M Sass; Anastasia Miller; Yordanos M Tiruneh; Karan P Singh

doi:10.2147/JMDH.S472060

Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review

J Multidiscip Healthc. 2024 Dec 3:17:5695-5713. doi: 10.2147/JMDH.S472060. eCollection 2024.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, University of Texas at Tyler Health Science Center, Tyler, TX, USA.
² Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
³ Department of Psychology and Counseling, The University of Texas at Tyler, Tyler, TX, USA.
⁴ Robert R. Muntz Library, The University of Texas at Tyler, Tyler, TX, USA.
⁵ Department of Healthcare Policy, Economics and Management, University of Texas at Tyler Health Science Center, Tyler, TX, USA.
⁶ Department of Educational Leadership, Evaluation and Organizational Development, University of Louisville, Louisville, KY, USA.
⁷ Department of Preventive Medicine, University of Texas at Tyler Health Science Center, Tyler, TX, USA.

Abstract

Introduction: During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022.

Objective: The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions.

Methods: This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model.

Results: This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life.

Conclusion: This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.

Keywords: Borghout model barriers and facilitators to technology adoption; COVID-19; PRISMA method; alternative modalities; care delivery challenges; digital mental health; technology adoption; telehealth; telemental health.

Publication types

Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Payments were made through grant funding ($900,000.00) from the Health Care Service Corporation (HCSC)- this is an unrestricted research grant awarded. The funder had no input or influence on the development of or conduct of the research presented in this manuscript. The project was partially funded through HCSC/BCBSTX, Affordable Cures Grant #1122327.