Barriers and Facilitators to Peer-Supported Implementation of Mental Health Mobile Applications with Veterans in Primary Care

Mental health disorders are highly prevalent among veterans in primary care, yet most of these patients do not receive adequate treatment due to provider time constraints, patient travel costs, and stigma associated with mental health care. Mobile health (mHealth) can overcome these impediments to care access; however, poor patient engagement with mHealth limits its routine implementation. Peer specialists may increase patient engagement with mHealth by offering supportive accountability and support through shared experiences. This study sought to identify barriers and facilitators of peer-supported mHealth implementation with veteran primary care patients. Qualitative interviews, guided by the Consolidated Framework of Implementation Research ([CFIR] Damschroder et al., 2009 ), were conducted with 28 key informants (17 peer specialists and 11 primary care providers) from 14 sites participating in a Department of Veterans Affairs national evaluation of peers in primary care. Thematic analysis was used to identify CFIR determinants to peer-supported mHealth implementation. CFIR barrier domains included Inner Setting (e.g., lack of implementation infrastructure, limited peer training on mHealth, and ineffective promotion of mHealth) and Characteristics of Individuals (e.g., lack of knowledge of the peer role and limited tech literacy). CFIR facilitator domains comprised Intervention Characteristics (e.g., strong support for peers in this role), Characteristics of Individuals (e.g., role alignment with a holistic care approach), and Outer Setting (e.g., emphasizing app benefits, the importance of app demonstrations, and follow-up encounters). The findings inform the development of a strategy for implementing peer-supported mental health mobile apps with veterans in primary care.