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Newsletter | South Central MIRECC

Banner of the SC MIRECC communique newsletter

Winter 2019, Volume 21, Issue 1 - In this Issue

Little Rock Site Update
Researchers Awarded ORH Funds for FY19
VISN 16 Providers Train in ACT
Research to Practice | Veteran Attitudes about Smartphone App Use for MH Care
Clinicians, Researchers & Staff Recognized with SC MIRECC Awards
Recent Publications
Pilot Study Research Program Applications Due April 1
Implementation, Design and Analysis Support Available for Affiliates

Research to Practice | Veteran Attitudes about Smartphone App Use for Mental Health Care

Summary by Sonora Hudson, MA and Derrecka Boykin, PhD

Resesarch to Practice Logo

An article by VA researchers recently reported results of a study examining Veterans’ openness to using smartphone apps for mental health care to assess whether age or rurality was an influence. The work, which involved interviews with 66 Veterans in Maine, Arkansas and California, appeared in JMIR Mhealth Uhealth.

Although the VA is a leader in creating mental health apps, results of surveys about Veterans’ attitudes toward this new technology have been conflicting. An estimated 47% to 76% of Veterans own smartphones, yet engagement levels remain low. Use of mental health apps by rural Veterans could increase their chances for receiving support remotely. This study appears to be the first to explore barriers and facilitators to use in rural Veterans. Differences in attitudes between younger and older Veterans was also examined, given varied findings on use within the aging population.

Participants, who screened positive for PTSD, alcohol use disorder or major depressive disorder at a VA healthcare appointment during the previous year and endorsed distress related to their condition(s), were recruited from 9 community-based outpatient clinics. Veterans with psychosis or dementia diagnoses were excluded. Geographic diversity was achieved by including at least 1 metropolitan facility and 1 rural facility within the 3 clinics sampled per state. Participants completed a battery of self-report questionnaires in addition to a semi-structured qualitative interview developed by the study researchers. The former was based on the State of the Art Access Model, which describes 5 domains thought to influence access to health care (geographical, temporal, financial, cultural and digital).

Participants ranged in age from 20 to 69 years, and 28 (42%) resided in rural areas. No significant differences were noted in age, race, sex, income, employment status or level of education between rural and urban Veterans. Statements about smartphone app use tended to be “strongly positive or negative in nature,” reported the authors, who looked at attitudes within the 5 themes they identified within the data: treatment effectiveness, ease of use, culture and identity, facilitators and barriers.

Main findings included that:

  • Urban Veterans were more positive about app effectiveness than rural Veterans.
  • Beliefs about effectiveness did not vary, based on age.
  • Statements about the ineffective, unhelpful nature of apps were more often made by rural Veterans.
  • Veterans mentioning apps and smartphones as user friendly and simple were more often urban than rural, with younger Veterans tending to find them easy to use.
  • Rural, older Veterans more frequently found smartphone technologies unwieldy, complicated and mentally testing to learn to use.
  • More rural than urban Veterans felt new technologies were in opposition to their personal values and destructive within society.
  • Rural Veterans reported more barriers to use than urban Veterans.
  • Mental health apps were thought to be more impersonal than 1-to-1 time with a therapist; the adjunctive nature of this tool needs to be emphasized.
  • Many Veterans were unaware of VA mental health apps.

The authors conclude by identifying potential ways to increase use of mental health apps, such as by addressing financial and wireless access, digital literacy, accessibility for the physically impaired, and disseminating information to patients and providers.

This article may be accessed at

*MIRECC Affiliates in bold

Citation: Connolly SL, Miller CJ, Koenig CJ, Zamora KA, Wright PB, Stanley RL, & Pyne JM (2018). Veterans’ attitudes toward smartphone app use for mental health care: Qualitative study of rurality and age differences. JMIR Mhealth Uhealth, 6, e10748.


Last updated: May 2, 2019