Access and Use of Digital Technology Among Patients with Serious Mental Illness Receiving Outpatient Psychiatric Care in Durban, South Africa

Background and Purpose: Access to mental healthcare remains largely limited in low- and middle-income countries (LMICs), contributing to the widening mental health treatment gap. Interest towards the use of information and communication technology (ICT) in mental healthcare in LMICs has grown in recent years, stemming from the robust evidence of effective mobile health (mHealth) programs across diverse areas of health in these regions. Studies have explored ICT as a promising method to increase access to evidence-based treatments for people with mental health conditions in low-resource settings. However, data on ICT access and use in mental healthcare is limited in LMICs. Exploring ICT use among individuals with mental health conditions in low-resource contexts where community-based programs and access to mental health information is limited, could inform the development of effective ICT-based interventions to improve mental health literacy, support help-seeking behavior, and enhance access to treatment. Using a cross-sectional survey design, this study aimed to understand access, use, and perception of ICT among people with serious mental illness in KwaZulu-Natal province in South Africa.

Methods: Adult patients with schizophrenia and other psychotic disorders receiving treatment at an urban psychiatric hospital in Durban, South Africa were recruited to complete a one-time survey. Survey measures included a socio-demographic and clinical questionnaire, and the New Technologies and Mental Health Survey to assess participants’ 1) access and frequency of internet use, 2) electronic device and mobile phone ownership, 3) ICT use for mental health reasons (e.g., seeking mental health information on the Internet), and 4) attitudes toward using mobile technology for mental health treatment. Multiple ordinal logistic regressions were conducted to test the association between socio-demographic factors and ICT use in this sample.

Results: Of the 165 participants (mean age: 41 years ± 14.2), 54.5% were male, 37.6% were employed, and most (93.3%) lived in an urban area. Most participants reported having access to the internet (93%) and a smartphone (89.8%). Regression results showed that age (AOR=0.94, 95% CI=0.88-1.00) and marital status (AOR=0.26, CI =1.62-253.74) were associated with internet use, while age (AOR=0.95, CI=0.9-1.00), marital status (AOR=3.64, CI=1.03-12.90), income (AOR=4.02, CI=1.69-9.54), employment status (AOR=0.16, CI=0.06-0.44), and living with HIV (AOR=5.41, CI=1.39-21.07) were associated with frequency of internet use. Older participants had lower odds of using a mental health care app (AOR=0.93, CI=0.88-0.99). Participants with higher income had increased odds of seeking mental health information digitally (AOR=4.33, CI=1.13-7.54).

Conclusions and Implications: People living with serious mental illness in KwaZulu-Natal, South Africa largely have access to digital technology. Differences in ICT use and attitudes toward mHealth are influenced by sociodemographic factors. This study provides baseline data on digital technology among South Africans with mental healthcare needs and suggests the potential applicability of a digital intervention to improve mental health outcomes for populations in low-resource settings.