Background: For more than a decade, digital health has shown promise in enabling wider access to information, education and health services for the general population at lower cost. However, recent studies have shown mixed results leading to some disappointment in the benefits of eHealth technologies. In this context, community health promotion represents an interesting and effective conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation.
Goal: Understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was linked to the use of the ‘tool.
Methods : The study was nested within a cluster randomized controlled trial that was conducted to assess the effectiveness of promotion, with before and after observation (NCT03565562). Data from questionnaires, observations and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relationships between context, type of implementation and promotion, and use of the tool.
Results: Three distinct promotion patterns emerged based on locality profiles associated with specific SB usage rates. From highest to lowest utilization rate, they are listed as follows: privileged urban localities, investing in health that have implemented high-intensity and digital promotion, demonstrating a greater ability to take ownership of the project ; urban but less privileged localities which, despite relatively little experience in the implementation of health policies, have managed to implement traditional and high-intensity promotion; and rural localities, with little experience in solving health problems, which implemented low-intensity promotion but could not overcome the challenges related to their local context.
Conclusion : These results indicate the substantial influence of the local context on the reception of digital tools. The urban and socio-economic status profiles of localities, as well as their pre-existing health investment and experience, appear to be key in shaping the promotion and implementation of e-health tools in terms of intensity and use. of digital communication. The more digital channels are used, the higher the utilization rates, which ultimately leads to the overall success of the intervention.