Modeling Psychological and Social Factors Affecting the Acceptance of Digital Mental Health Interventions: A Multilevel Structural Modeling Approach
Keywords:
Digital mental health, technology acceptance, digital trust, digital health literacy, social stigma, thematic analysis, multilevel modelAbstract
This study aimed to identify and conceptually model the relationships among psychological, social, technological, and structural factors influencing the acceptance and sustained use of digital mental health interventions among adults residing in Tehran. An exploratory qualitative design using inductive thematic analysis was employed. The participants were 24 adults residing in Tehran who were purposively recruited with maximum variation according to their status as active users, discontinued users, or nonadopters of digital mental health interventions. Data were collected exclusively through individual semistructured interviews lasting between 45 and 75 minutes. Interviews continued until theoretical saturation was reached. Initial saturation was identified after the twenty-first interview, followed by three additional interviews to confirm the stability and comprehensiveness of the emerging categories. The verbatim transcripts were organized and analyzed using NVivo 14 through initial coding, constant comparison, category development, theme refinement, and construction of a multilevel conceptual network. Five major categories were identified: cognitive appraisal and psychological readiness; digital trust, safety, and clinical credibility; social legitimacy and human connectedness; user-experience fit and intervention personalization; and structural conditions, accessibility, and digital equity. Acceptance emerged as a dynamic process involving initial awareness, appraisal of benefits and risks, limited experimentation, formation or erosion of trust, and eventual sustained use or disengagement. Perceived usefulness, digital self-efficacy, autonomy, and emotional readiness operated at the individual level. Professional endorsement, family and peer attitudes, stigma, and human support were influential at the interpersonal level. Privacy protection, evidence-based content, usability, cost, technical infrastructure, regulation, and integration with formal health services shaped acceptance at the intervention, organizational, and policy levels. Acceptance of digital mental health interventions cannot be adequately explained solely by ease of use or general attitudes toward technology. It results from interactions among individual, relational, technological, organizational, and societal conditions. Perceived trust functioned as a cross-level mechanism connecting these domains. Human-centered and culturally responsive design, transparent privacy practices, evidence disclosure, optional professional support, digital mental health literacy programs, equitable access, and regulatory oversight are required to improve adoption and sustained engagement.
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