Background: Mental wellbeing across populations is compromised by increased levels of stress, anxiety and depression, especially during COVID-19. The mWELL (Mobilizing Wisdom, Education, and Lifelong Learning) platform is a post-training mobile app that supplements an in-person trauma-informed workshop. The self-monitoring system includes ecological momentary assessment (EMA) and daily diary for users to track context-based emotions (anger, happiness, fear, worry, sadness) and stress in real-time using a 5-point scale. Visual personalized feedback is presented to users for self-awareness with prompts to engage in a lifestyle intervention.

Objective: To demonstrate data visualization at both an aggregate and individual level from a post-training pilot implementation of mWELL in a real-world setting.

Methods: Eleven educators took part in a trauma-informed training and were asked to download and use the mWELL EMA to self-monitor context-based mood data in real-time. Aggregate and individualized EMA data were analyzed over time through the system. We analyzed patterns of use using a system-generated CSV file; qualitative data from a post-use focus group were analyzed.

Results: Our pilot implementation data indicated that 9 out of 11 used EMA across two months; 3 users tracked all emotions on a daily basis. Two users tracked 4 of the 6 emotions. In a focus group, participants indicated the app can be helpful, but noted they only wanted to track certain emotions, not all six. System data analytics showed varying patterns of use and levels of mood across time.

Discussion/Conclusions: While sensors are increasingly used to objectively measure stress levels, they cannot objectively measure emotions directly. Therefore, self-report data on both stress and emotions through EMA along with diary data can serve as 1) a self-management tool for individuals especially between provider visits and 2) connect the data to a counselor for more personalized treatment/advice. mWELL functionality was upgraded as a result of the pilot study and will be demonstrated and discussed.

Background

Digital health tools (DHT) are vital to mitigating the impact of COVID-19 and advancing health equity, especially given the prevalent health disparities experienced by underserved communities in the context of the COVID-19 pandemic. Many patients gain access to DHTs through their primary care clinicians, but primary care clinicians, especially those serving underserved communities, have adopted DHTs at slower rates than others.

Objective/Purpose

To map the landscape of adoption and utilization of DHTs among primary care practices and compare/assess barriers/facilitators to DHT adoption in primary care practices in rural and underserved areas in the Southeast US.

Methods

We examined individual, practice, and policy factors associated with adoption of DHTs. We conducted surveys and focus groups with clinicians in primary care settings across the southeast.

Results

We conducted seven focus groups with 25 clinicians and collected 1,107 surveys. 99% of clinicians used DHTs in the last five years. Respondents used the following DHTs: telehealth (65%), electronic health records (65%), patient portals (50%), health information exchange (45%), prescription drug monitoring programs (40%), remote/home monitoring (30%) and wearable devices (20%). Time (52%) and cost (50%) were barriers to adoption of DHTs. 66% of clinicians reported being “satisfied” to “very satisfied” with DHTs. Focus groups indicated COVID-19 as a major motivator for adopting DHTs among primary care clinicians. Patients’ need for continued services, such as mental/behavioral health therapy, forced clinicians to adapt quickly to DHTs. A major benefit was the use of supplemental tools/apps to connect patients to resources. Challenges included care coordination between providers and internet/broadband access and poor connectivity for patients.

Discussion/Conclusions

This study describes experiences of primary care clinicians adopting DHTs who practice in a region of the country with longstanding health and social inequities. The findings identify opportunities to leverage DHTs to advance health equity and highlight important implications and opportunities for policy improvement.