Severe mental health problems (SMHPs) such as psychosis are most disabling mental health conditions and cause significant personal, social and economic burdens. Despite the unprecedented achievements in reforming the mental health system in China, challenges for providing high-quality and accessible mental healthcare to people with SMHPs still lie ahead. Digital mental health is a promising solution for these challenges, given its potential to scale up mental healthcare provision was evident in Western, high-income countries. Due to the booming economy and rapid digital technology development, digital health is emerging in China; however, a gap remains in developing and evaluating digital health technologies (DHTs) specifically for managing SMHPs. This thesis aimed to understand how digital mental health could be used to support the management of SMHPs in China. This broad aim encompasses a systematic exploration of the current development of digital mental health in China, an investigation of Chinese mental health professionals and service usersâ perceptions of digital mental health, and an understanding of the feasibility, acceptability, and safety of DHTs in people with SMHPs in a Chinese healthcare context. Chapter 1 of this thesis provides a review of the literature and outlines the rationale, structure, aims, and methodologies of this thesis. Chapter 2 (study 1) describes a systematic review aimed to investigate the development of digital mental health in China and make suggestions for the future development of the field of digital mental health in China by comparing it with the broader field. This review found DHTs were acceptable and usable among Chinese people with mental health problems in general, similar to findings from the West. Compared with the broader digital mental health field, the Chinese studies targeted schizophrenia and substance use disorder more often and investigated social anxiety mediated by shame and culturally specific variants, DHTs were rarely developed in a co-production approach, and methodology quality was less rigorous. Chapter 3 (study 2, N=1270) presents a nationwide online survey study explored the attitudes of mental health professionals toward implementing digital health tools in mental health services in China. Survey respondents reported low levels of knowledge of DHTs and moderate levels of accessibility of DHTs in their hospitals. Respondents expressed positive attitudes towards DHTs and demonstrated moderate levels of perceived feasibility and acceptability of implementing DHTs in clinical services. Chapter 4 (study 3, N=447) describes another online survey study aimed to explore technology use and attitudes towards digital mental health in people with SMHPs in China. Almost all respondents (95.5%) reported owning a smartphone or having access to one, which is comparable to the general population in China (96%). Less than half of the respondents reported frequent health-related usage of digital technologies, implying a lack of knowledge in using digital health technologies. Chapter 5 (studies 4 and 5) presents the research protocol of studies 4 and 5 as well as the details of YouXin app development, in particular, how co-production was conducted. Chapter 6 (study 4, N=40) reports the results of a pre-registered non-randomised validity and feasibility study aimed to evaluate the validity, feasibility, acceptability and safety of the app as a symptom self-monitoring tool for people with psychosis. This study demonstrated YouXin was feasible, acceptable, and safe for symptoms self-monitoring for people with psychosis in China; however, refinements are needed to improve the validity of active monitoring items. Chapter 7 (study 5, N=10) outlines a qualitative exploration of the acceptability of YouXin. The YouXin app was found acceptable for symptom self-monitoring to people with psychosis in China, though suggestions for improvement were identified, indicating the future directions o
Exploring digital mental health for severe mental health problems management in China
Zhang, X. (Author). 1 Aug 2024
Student thesis: Phd