Desirability in Real-World Blended Care for Psychosis: Insights from the Development and Pilot Study of Digital NAVIGATE

Abstract

Blended care, a psychosocial intervention merging face-to-face therapy with digital tools, holds significant potential for enhancing psychosis treatment outcomes by extending access and increasing patient engagement with therapeutic materials. Recent blended care interventions for psychosis were solely developed within controlled research conditions, and an attempt to transition one of these interventions into real-world practice yielded inadequate engagement and effectiveness. This suggests that the development context of blended care may significantly impact its implementation potential. This study represents the first attempt to both develop and research a blended care intervention in a real-world setting, directly addressing the specific challenges and unmet needs within NAVIGATE, a coordinated speciality care program for individuals who have experienced a first-episode psychosis. Both clients and practitioners agreed on the potential benefits of integrating digital tools into NAVIGATE, and clients expressed a willingness to adopt them once available. However, when the digital program became available, clients' actual desire to incorporate it into their usual care was unexpectedly low. We observed a strong correlation between clients' expressed desire to use Digital NAVIGATE before engaging with it and their subsequent engagement with the digital tools. These findings highlight a distinction between clients’ attitudes towards digital tools adaptation before being offered to use them, and their actual intention and desire to utilize such tools during the treatment they receive. These findings underscore the need to reassess current frameworks for developing and implementing digital mental health tools, particularly within existing mental health programs.