Emerging Adults' Experiences of Digital Measurement-Based Care in Routine Mental Health Care: Qualitative Study and Conceptual Synthesis.

Background: Emerging adults (aged 18-29 years) experience a high burden of mental health (MH) concerns during a developmental period marked by increasing autonomy and vulnerability to symptom onset. Many emerging adults face challenges in accessing and sustaining engagement with developmentally appropriate care. Digital measurement-based care (dMBC), which involves the routine use of patient-reported outcome measures (PROMs), has been introduced as an approach to support emerging adult engagement and improve responsiveness of care through ongoing monitoring and informed clinical decision-making. However, its integration into routine care remains variable, and there is limited understanding of how emerging adults experience and engage with dMBC in practice. Objective: This study aimed to examine how emerging adults experience dMBC within routine MH care and identify factors relevant to its use and integration in clinical practice. Methods: Using a descriptive qualitative design, semistructured interviews were conducted with 23 purposively sampled emerging adults who were either actively receiving care or had recently been discharged from 1 of 2 outpatient MH clinics in southern Alberta, Canada. dMBC was delivered through a web-based platform that enabled emerging adults to complete PROMs and view their results, which were also available to clinicians to inform care. All participants completed PROMs at baseline, with subsequent completion varying across participants and over the course of care. Interview data were analyzed using thematic analysis. Results: Four interconnected themes were identified and synthesized into a higher-level conceptual representation of emerging adults' experiences with dMBC: technology, tracking, translation, and therapeutic guidance. Technology captured participants' varied experiences with accessing and using the digital platform, including its usability and accessibility. Tracking reflected how monitoring PROM results over time supported reflection on changes in MH. Translation described how PROM data were interpreted and incorporated into therapeutic discussions, while therapeutic guidance reflected the role of clinician involvement in supporting the use of dMBC in care. Across the themes, participants described variation in the relevance and burden of measurement and in how consistently dMBC was integrated into clinical care. Conclusions: Emerging adults' experiences of dMBC were shaped by both their interactions with digital measurement and the integration of PROMs into routine MH care. The findings highlight the importance of considering dMBC within the broader therapeutic context in which measurement occurs, rather than as a stand-alone digital activity. The conceptual synthesis provides a way of organizing these experiences and can inform future research and implementation efforts focused on the use of dMBC in emerging adult MH services.