Across the United States, significant disparities persist in mental health care. Individuals with lower socioeconomic status (SES) face increased barriers to accessing and engaging in treatment. In response, mobile health (mHealth) advancements have emerged as promising tools to address practical and clinical barriers to mental health care access. While mHealth has enabled greater access, strategies for sustaining mHealth engagement need more attention, as increased engagement is associated with improved outcomes. In this article, we present four innovative mHealth approaches and discuss strategies to increase engagement among individuals with low SES: (1) guided mHealth, combining asynchronous telehealth with clinician supervision; (2) simulated therapeutic communication via generative artificial intelligence; (3) real-time, personalized support with just-in-time adaptive interventions; and (4) streamlined clinician referrals via artificial intelligence software. We detail advantages that facilitate engagement, limitations that risk early drop-off, and suggestions for improving equity and cultural relevance in mHealth tools and platforms. We also outline ethical considerations, cultural and place-based adaptations, and community-engaged participatory design, as these efforts are paramount for aligning mHealth with the needs of under-resourced communities.
Pineiro et al. (Wed,) studied this question.