{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,8]],"date-time":"2026-04-08T17:42:48Z","timestamp":1775670168826,"version":"3.50.1"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T00:00:00Z","timestamp":1756944000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Prescription Digital Therapeutics (PDTs) hold unique potential to improve mental health in underserved rural areas. However, potential users' perceptions towards PDTs and community-specific differences in barriers to care are not well-understood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an online survey of 351 U.S. adults with \u22651 mental health condition and care-seeking behaviors. Descriptive statistics and non-parametric tests were used to evaluate rural and non-rural differences in demographics, social determinants of health, current barriers to mental health treatment, and the perceived value of PDTs. Key limitations of this approach include self-reported rurality and digital access bias associated with online survey distribution.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Barriers to mental healthcare impacted 60% of all rural respondents, and rurality was associated with unique challenges like lower incomes, lower education levels, substantial Medicaid enrollment, and further distances from care. Rural respondents were also more likely to be completely unfamiliar with digital apps for mental health treatment. 89% of all respondents thought PDTs could address at least one barrier to care and about 97% of respondents were likely to use a PDT recommended by their provider.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Existing gaps in care and positive perceptions towards PDTs demonstrate unique promise for these modalities to address unmet mental health needs. However, lower PDT familiarity among rural respondents suggests a need for provider intervention and policy reforms.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2025.1655446","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:06Z","timestamp":1756964106000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Assessing rural populations\u2019 barriers to mental healthcare and perceptions towards prescription digital therapeutics: a cross-sectional survey"],"prefix":"10.3389","volume":"7","author":[{"given":"Grace","family":"Danon","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cody E.","family":"Dunn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Robins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arundati","family":"Nagendra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuck","family":"Strand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Palko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Colborn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jackie","family":"Menjivar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junko","family":"Saber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"B1","volume-title":"The State of Mental Health in America","author":"Reinert","year":"2024"},{"key":"B2","volume-title":"The State of Mental Health in America","author":"Reinert","year":"2024"},{"key":"B3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/B978-0-323-90045-4.00005-8","article-title":"Chapter 2\u2014Using digital therapeutics to target gaps and failures in traditional mental health and addiction treatments","volume-title":"Digital Therapeutics for Mental Health and Addiction: The State of the Science and Vision for the Future","author":"Jacobson","year":"2023"},{"key":"B4","article-title":"Nation\u2019s urban and rural populations shift following 2020 census","year":"2022"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1682","DOI":"10.2105\/ajph.94.10.1682","article-title":"The importance of place of residence: examining health in rural and nonrural areas","volume":"94","author":"Eberhardt","year":"2004","journal-title":"Am J Public Health"},{"key":"B6","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1017\/cts.2020.42","article-title":"A call to action to address rural mental health disparities","volume":"4","author":"Morales","year":"2020","journal-title":"J Clin Transl Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"S199","DOI":"10.1016\/j.amepre.2018.01.004","article-title":"Geographic variation in the supply of selected behavioral health providers","volume":"54","author":"Andrilla","year":"2018","journal-title":"Am J Prev Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: transportation barriers to health care access","volume":"38","author":"Syed","year":"2013","journal-title":"J Community Health"},{"key":"B9","doi-asserted-by":"crossref","DOI":"10.15620\/cdc\/154767","volume-title":"Declines in Telemedicine use Among Adults: United States, 2021 and 2022","author":"Lucas","year":"2024"},{"key":"B10","article-title":"Rural America at a glance: 2024 edition. U.S. Department of Agriculture, Economic Research Service","author":"Farrigan","year":"2024"},{"key":"B11","doi-asserted-by":"publisher","first-page":"s30","DOI":"10.1111\/jrh.12228","article-title":"Differences in access to and use of electronic personal health information between rural and urban residents in the United States","volume":"34","author":"Greenberg","year":"2018","journal-title":"J Rural Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"231","DOI":"10.1177\/01600176231202457","article-title":"A review of the literature about broadband internet connections and rural development (1995\u22122022)","volume":"47","author":"Mack","year":"2023","journal-title":"Int Regional Sci Rev"},{"key":"B13","volume-title":"The Role of Medicaid in Rural America","author":"Foutz","year":"2017"},{"key":"B14","volume-title":"Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion","author":"Hoadley","year":"2018"},{"key":"B15","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1111\/jrh.12335","article-title":"Differences in rural and urban health information access and use","volume":"35","author":"Chen","year":"2019","journal-title":"J Rural Health"},{"key":"B16","doi-asserted-by":"publisher","first-page":"101761","DOI":"10.1016\/j.dhjo.2024.101761","article-title":"Rural disability, self-reliance, and the utilization of mental health services","volume":"18","author":"Santore","year":"2024","journal-title":"Disabil Health J"},{"key":"B17","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1177\/1090198120974963","article-title":"The role of rural and urban geography and gender in community stigma around mental illness","volume":"48","author":"Schroeder","year":"2021","journal-title":"Health Educ Behav"},{"key":"B18","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1007\/s13187-015-0862-8","article-title":"\u201cEverybody knows everybody else\u2019s business\u201d-privacy in rural communities","volume":"31","author":"Leung","year":"2016","journal-title":"J Cancer Educ"},{"key":"B19","first-page":"813","article-title":"Management of mental disorders in rural primary care: a proposal for integrated psychosocial services","volume":"48","author":"Badger","year":"1999","journal-title":"J Fam Pract"},{"key":"B20","doi-asserted-by":"publisher","first-page":"5301","DOI":"10.1007\/s12325-022-02320-0","article-title":"The rise of prescription digital therapeutics in behavioral health","volume":"39","author":"Brezing","year":"2022","journal-title":"Adv Ther"},{"key":"B21","doi-asserted-by":"publisher","first-page":"19","DOI":"10.3390\/pharmacy13010019","article-title":"Therapeutic evaluation and utilization analysis of mental health prescription digital therapeutics within the current regulatory landscape","volume":"13","author":"Xia","year":"2025","journal-title":"Pharmacy (Basel)"},{"key":"B22","doi-asserted-by":"publisher","first-page":"e10536","DOI":"10.1002\/btm2.10536","article-title":"Digital therapeutics in the clinic","volume":"8","author":"Phan","year":"2023","journal-title":"Bioeng Transl Med"},{"key":"B23","article-title":"List of existing PDTs (Q1 2024)","year":"2024"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e36115","DOI":"10.1016\/j.heliyon.2024.e36115","article-title":"A comprehensive survey of the clinical trial landscape on digital therapeutics","volume":"10","author":"Yao","year":"2024","journal-title":"Heliyon"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.4103\/jfmpc.jfmpc_105_20","article-title":"Role of digital therapeutics and the changing future of healthcare","volume":"9","author":"Dang","year":"2020","journal-title":"J Family Med Prim Care"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e211149","DOI":"10.1001\/jamahealthforum.2021.1149","article-title":"Resolving key barriers to advancing mental health equity in rural communities using digital mental health interventions","volume":"2","author":"Graham","year":"2021","journal-title":"JAMA Health Forum"},{"key":"B27","doi-asserted-by":"publisher","first-page":"130","DOI":"10.7812\/TPP\/23.134","article-title":"The impact of digital health solutions on bridging the health care gap in rural areas: a scoping review","volume":"28","author":"Maita","year":"2024","journal-title":"Perm J"},{"key":"B28","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1038\/s41746-022-00663-0","article-title":"A framework for digital health equity","volume":"5","author":"Richardson","year":"2022","journal-title":"NPJ Digit Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1186\/s12913-022-07584-4","article-title":"Towards digital health equity\u2014a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era","volume":"22","author":"Kaihlanen","year":"2022","journal-title":"BMC Health Serv Res"},{"key":"B30","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1177\/1073110519857314","article-title":"Broadband access as a public health issue: the role of law in expanding broadband access and connecting underserved communities for better health outcomes","volume":"47","author":"Bauerly","year":"2019","journal-title":"J Law Med Ethics"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e24387","DOI":"10.2196\/24387","article-title":"Barriers to and facilitators of user engagement with digital mental health interventions: systematic review","volume":"23","author":"Borghouts","year":"2021","journal-title":"J Med Internet Res"},{"key":"B32","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.jad.2024.07.089","article-title":"Provider and patient barriers and facilitators to integration of digital mental health applications in routine clinical care","volume":"363","author":"Seegan","year":"2024","journal-title":"J Affect Disord"},{"key":"B33","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1002\/cpt.3292","article-title":"Trust in the food and drug administration: a national survey study","volume":"116","author":"Feldman","year":"2024","journal-title":"Clin Pharmacol Ther"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e42941","DOI":"10.2196\/42941","article-title":"Patient trust in physicians matters\u2014understanding the role of a mobile patient education system and patient-physician communication in improving patient adherence behavior: field study","volume":"24","author":"Wu","year":"2022","journal-title":"J Med Internet Res."},{"key":"B35","doi-asserted-by":"publisher","first-page":"e48000","DOI":"10.2196\/48000f","article-title":"Mapping factors that affect the uptake of digital therapeutics within health systems: scoping review","volume":"25","author":"van Kessel","year":"2023","journal-title":"J Med Internet Res"},{"key":"B36","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s13104-024-06687-x","article-title":"The digital divide in rural and regional communities: a survey on the use of digital health technology and implications for supporting technology use","volume":"17","author":"Jongebloed","year":"2024","journal-title":"BMC Res Notes"},{"key":"B37","doi-asserted-by":"publisher","first-page":"e10748","DOI":"10.2196\/10748","article-title":"Veterans\u2019 attitudes toward smartphone app use for mental health care: qualitative study of rurality and age differences","volume":"6","author":"Connolly","year":"2018","journal-title":"JMIR Mhealth Uhealth"},{"key":"B38","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1038\/s41746-022-00573-1","article-title":"Health app policy: international comparison of nine countries\u2019 approaches","volume":"5","author":"Ess\u00e9n","year":"2022","journal-title":"NPJ Digit Med"},{"key":"B39","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.euros.2023.07.003","article-title":"Digital therapeutics in urology: an innovative approach to patient care and management","volume":"55","author":"Rodler","year":"2023","journal-title":"Eur Urol Open Sci"},{"key":"B40","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1007\/s00296-022-05261-7","article-title":"Real-world usage of digital health applications (DiGA) in rheumatology: results from a German patient survey","volume":"43","author":"Labinsky","year":"2023","journal-title":"Rheumatol Int"},{"key":"B41","article-title":"Addressing the barriers to people-centered clinical research: recommendations for system-wide action","year":"2024"},{"key":"B42","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/bf03193146","article-title":"G*power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav Res Methods"},{"key":"B43","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1212\/CPJ.0000000000000906","article-title":"Rapid implementation of outpatient teleneurology in rural appalachia: barriers and disparities","volume":"11","author":"Strowd","year":"2021","journal-title":"Neurol Clin Pract"},{"key":"B44","doi-asserted-by":"publisher","first-page":"010502","DOI":"10.11613\/BM.2021.010502","article-title":"Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies","volume":"31","author":"Serdar","year":"2021","journal-title":"Biochem Med (Zagreb)"},{"key":"B45","article-title":"How we define rural","year":"2025"},{"key":"B46","article-title":"Rural classifications\u2014What is rural?","year":""},{"key":"B47","volume-title":"Defining Rural at the U.S. Census Bureau: American Community Survey and Geography Brief","author":"Ratcliffe","year":"2016"},{"key":"B48","article-title":"Social determinants of health (SDOH)","year":"2024"},{"key":"B49","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1093\/pch\/3.3.189","article-title":"Eating disorders in adolescents: Principles of diagnosis and treatment","volume":"3","author":"Dibden","year":"1998","journal-title":"Paediatr Child Health"},{"key":"B50","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1017\/S0033291706007082","article-title":"Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the national comorbidity survey replication","volume":"36","author":"Nock","year":"2006","journal-title":"Psychol Med"},{"key":"B51","article-title":"Quick facts","year":""},{"key":"B52","doi-asserted-by":"publisher","first-page":"102297","DOI":"10.1016\/j.pmedr.2023.102297","article-title":"Travel for medical or dental care by race\/ethnicity and rurality in the U.S.: findings from the 2001, 2009 and 2017 national household travel surveys","volume":"35","author":"Akinlotan","year":"2023","journal-title":"Prev Med Rep"},{"key":"B53","doi-asserted-by":"publisher","first-page":"21501319241266114","DOI":"10.1177\/21501319241266114","article-title":"Evaluating the connection between rural travel time and health: a cross-sectional analysis of older adults living in the northeast United States","author":"Hearn","year":"2024","journal-title":"J Prim Care Community Health"},{"key":"B54","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1542\/peds.2012-2354","article-title":"Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study","volume":"131","author":"Barbaresi","year":"2013","journal-title":"Pediatrics"},{"key":"B55","doi-asserted-by":"publisher","first-page":"20552076241277441","DOI":"10.1177\/20552076241277441","article-title":"Exploring the potential of digital therapeutics: an assessment of progress and promise","volume":"10","author":"Armeni","year":"2024","journal-title":"Digit Health"},{"key":"B56","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jaac.2013.09.001","article-title":"Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit\/hyperactivity disorder: united States, 2003\u22122011","volume":"53","author":"Visser","year":"2014","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"key":"B57","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1093\/ijnp\/pyac058","article-title":"Challenges and strategies for the recruitment of patients with schizophrenia in a research setting","volume":"25","author":"Deckler","year":"2022","journal-title":"Int J Neuropsychopharmacol"},{"key":"B58","doi-asserted-by":"publisher","first-page":"S184","DOI":"10.5005\/jp-journals-10071-23815","article-title":"An introduction to statistics: choosing the correct statistical test","volume":"25","author":"Ranganathan","year":"2021","journal-title":"Indian J Crit Care Med"},{"key":"B59","volume-title":"Income and Poverty in the United States: 2020","author":"Shrider","year":"2021"},{"key":"B60","volume-title":"Who Lives in Rural America?","author":"Ramakrishnan","year":"2024"},{"key":"B61","article-title":"Educational Attainment in Rural Areas","year":"2022"},{"key":"B62","volume-title":"Income in the United States: 2023","author":"Guzman","year":"2024"},{"key":"B63","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1186\/s12875-019-1015-7","article-title":"Impact of rural address and distance from clinic on depression outcomes within a primary care medical home practice","volume":"20","author":"Wong","year":"2019","journal-title":"BMC Fam Pract"},{"key":"B64","doi-asserted-by":"publisher","first-page":"674","DOI":"10.18553\/jmcp.2020.19418","article-title":"AMCP partnership forum: digital therapeutics\u2013what are they and where do they fit in pharmacy and medical benefits?","volume":"26","year":"2020","journal-title":"J Manag Care Spec Pharm"},{"key":"B65","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.5455\/njppp.2023.13.09464202302102023","article-title":"Digital therapeutics\u2014a new era in health care","volume":"13","author":"Shah","year":"2023","journal-title":"Natl J Physiol Pharm Pharmacol"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1186\/s12913-024-11313-4","article-title":"The right care in the right place: a scoping review of digital health education and training for rural healthcare workers","volume":"24","author":"Woods","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B67","doi-asserted-by":"publisher","first-page":"e42719","DOI":"10.2196\/42719","article-title":"Barriers to and facilitators of digital health among culturally and linguistically diverse populations: qualitative systematic review","volume":"25","author":"Whitehead","year":"2023","journal-title":"J Med Internet Res"},{"key":"B68","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1007\/s10488-023-01292-9","article-title":"Leveraging implementation science to integrate digital mental health interventions as part of routine care in a practice research network","volume":"51","author":"Youn","year":"2024","journal-title":"Adm Policy Ment Health"},{"key":"B69","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13722-023-00387-w","article-title":"Implementation and workflow strategies for integrating digital therapeutics for alcohol use disorders into primary care: a qualitative study","volume":"18","author":"Mogk","year":"2023","journal-title":"Addict Sci Clin Pract"},{"key":"B70","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1093\/tbm\/ibz140","article-title":"Lessons learned from service design of a trial of a digital mental health service: informing implementation in primary care clinics","volume":"10","author":"Graham","year":"2020","journal-title":"Transl Behav Med"},{"key":"B71","doi-asserted-by":"publisher","first-page":"e25866","DOI":"10.2196\/25866","article-title":"Approaches for implementing app-based digital treatments for drug use disorders into primary care: a qualitative, user-centered design study of patient perspectives","volume":"23","author":"Glass","year":"2021","journal-title":"J Med Internet Res"},{"key":"B72","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1037\/amp0000686","article-title":"Implementation strategies for digital mental health interventions in health care settings","volume":"75","author":"Graham","year":"2020","journal-title":"Am Psychol"},{"key":"B73","doi-asserted-by":"publisher","first-page":"e17662","DOI":"10.2196\/17662","article-title":"Workshop on implementation science and digital therapeutics for behavioral health","volume":"8","author":"Lord","year":"2021","journal-title":"JMIR Ment Health"},{"key":"B74","doi-asserted-by":"publisher","first-page":"854665","DOI":"10.3389\/fmed.2022.854665","article-title":"Success factors for scaling up the adoption of digital therapeutics towards the realization of P5 medicine","volume":"9","author":"Prodan","year":"2022","journal-title":"Front Med (Lausanne)"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1655446\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:35:09Z","timestamp":1756964109000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1655446\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,4]]},"references-count":74,"alternative-id":["10.3389\/fdgth.2025.1655446"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1655446","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,4]]},"article-number":"1655446"}}