title: Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study.
abstract: BACKGROUND
  With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom.
  
  
  OBJECTIVE
  To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns.
  
  
  METHODS
  We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication.
  
  
  RESULTS
  Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact.
  
  
  CONCLUSIONS
  A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services.
authors.affiliation: Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.
authors.forename: Minnie
authors.identifier: http://orcid.org/0000-0001-7232-7836
authors.initials: M
authors.lastname: Rai
authors.forename: Simone N
authors.identifier: http://orcid.org/0000-0002-2736-9639
authors.initials: SN
authors.lastname: Vigod
authors.forename: Jennifer M
authors.identifier: http://orcid.org/0000-0003-4194-6049
authors.initials: JM
authors.lastname: Hensel
keywords: barriers; e-communication; mental health; social media; technology