Race and socioeconomic status as predictors of willingness to use internet-based treatments or face-to-face psychotherapy: A nationally representative study

Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. One key factor in this debate involves the extent to which racial and ethnic minoritized and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: We examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay (WTP) for DMHIs vs. one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N = 423, women: n = 204, age: M = 45.15, SD = 16.19, Non-Hispanic White: n = 293) via Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment for 1) free, 2) for a small fee, 3) as a maximum dollar amount, and 4) as a percentage of their total monthly income. At the end of the study there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity were associated with willingness to pay higher amounts of one’s income, as a percent or the dollars, and was also associated with information-seeking for DMHIs in the behavioral task. By and large, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs and 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental healthcare for racial and ethnic minoritized individuals and economically disadvantaged groups.