Imaginaries of digital health: Unpacking the platformization of mental health through users' practices

Clinical Snapshot

Key Findings

• P Value: Not applicable - qualitative study

• Effect Size: Not applicable - qualitative study

• Primary Outcome: Persistent tension between algorithmic efficiency promises and situated practice realities in digital mental health platforms

• Nnt Or Sensitivity: Key themes: infrastructural misalignments, practices of domestication, reconfiguration of therapeutic settings

• Confidence Interval: Not applicable - qualitative study

Clinical Application

Findings suggest need for improved platform design considering user domestication practices and infrastructural challenges Relevant to Australian telehealth expansion post-COVID, particularly for Medicare-subsidised psychological services and emerging digital mental health platforms Mental health service users engaging with digital platforms, particularly in European healthcare contexts

Abstract

The platformization of healthcare is reshaping the organization of mental health services, redefining access, relationships, and meanings of care. This paper examines how users experience and negotiate the platformization of mental health through the case of Unobravo, an Italian digital platform offering online psychotherapy. Drawing on Science and Technology Studies and digital health literature, the study explores how platform imaginaries of efficiency, accessibility, and personalization are enacted and contested in everyday practices. Adopting a mixed-methods design, the research combines qualitative interviews (N = 12) with a quantitative survey (N = 3870) to analyse users' narratives and patterns of engagement. Findings reveal a persistent tension between the promise of algorithmic efficiency and the realities of situated practice. While users value the flexibility and accessibility provided by digital infrastructures, they also encounter infrastructural misalignments, such as unstable connections and opaque algorithmic matching processes. These challenges are addressed through practices of domestication that reconfigure the therapeutic setting, integrating care into mobile and domestic environments. By analysing user practices, the paper investigates how mental health is domesticated through digital platforms and shaped by platform imaginaries, reconfiguring the therapeutic setting as a datafied and everyday space.