Treatment adherence among individuals with mental illness remains a pressing public health issue. Tele-mental health care (TMH) can improve care access and continuity. This study applied the theory of planned behavior (TPB) to examine how intrinsic motivations influence intentions and use of TMH among Medicaid beneficiaries and providers.
Methods:
A survey was provided to both Medicaid beneficiaries (N = 179) and providers (N = 188) across five Community Mental Health Centers in Kentucky. Electronic surveys collected demographic characteristics, frequency of TMH use, and TPB-based variables. Hierarchical linear regression models assessed predictors of intention toward TMH use (for beneficiaries) or care delivery (for providers), while logistic regressions examined predictors of the frequency of TMH use or care delivery.
Results:
Among beneficiaries, attitudes (β = 0.30, p < 0.001), subjective norms (β = 0.23, p < 0.001), and perceived behavioral control (β = 0.33, p < 0.001) significantly predicted intentions to use TMH (Adjusted R2 = 0.75, p < 0.001). For providers, subjective norms (β = 0.45, p < 0.001) were the strongest predictor, followed by attitudes (β = 0.31, p < 0.001) and perceived behavioral control (β = 0.21, p < 0.001) (Adjusted R2 = 0.72, p < 0.001). The frequency of TMH care delivery was associated with intentions among providers (odds ratio [OR] = 2.16, p = 0.02). Among beneficiaries, non-White ethnicity (OR = 3.70, p = 0.007) and higher education (OR = 3.80, p < 0.001) predicted frequency of TMH use.
Conclusion:
TPB-based variables predicted intentions to engage with TMH services among our sample of Medicaid beneficiaries and providers. However, TPB-based variables were limited in predicting frequency of TMH use. This finding highlights a critical intention–behavior gap, suggesting that structural and systemic barriers could be addressed to support TMH implementation within community mental health settings.
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