Ethical approval was obtained from the University of Auckland Human Participants Ethics Committee (reference: UAHPEC22599). Participants in Part One were offered to go into a draw for one of three $50 New Zealand dollar gift vouchers (approximately US $30), and those who were interviewed in Part Two or Part Three were offered a $20 New Zealand dollar gift voucher (approximately US $10) for participating. Participant information sheets were available prior to data collection to ensure informed consent, and any identifiable information was removed during data analysis to ensure anonymity.

A mixed method study was conducted between August 2021 and January 2022 to examine the training and education needs for digital mental health tools in New Zealand. The study consisted of three parts: (1) an online questionnaire, (2) follow-up interviews offered to those who had completed the online survey, and (3) semistructured interviews with educators from psychology and psychiatry training programs. This paper presents findings relevant to education and curriculum needs identified across the 3 studies. Participant information sheets were provided for each study to ensure informed consent. We balanced the need to achieve saturation with the duration and complexity of the project. As interviews progressed, consistent themes emerged among the participants in Part Two and recruitment ceased. We have broadly adhered to the guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ) to report the key characteristics and methods of our study [23].

Respondents were recruited through professional organizations, social media advertisements, and snowball sampling methods. Individuals had to be registered health practitioners working in New Zealand mental health services or students enrolled in psychology or psychiatry training programs to participate in the questionnaire. In New Zealand, the law mandates that individuals working in specific health professions, including nursing, occupational therapy, psychology, and social work, must be registered with their respective regulatory bodies to practice legally [24]. The survey assessed participants’ training, experience, and perceived needs regarding digital mental health tools. Respondents could exit the questionnaire at any time, terminating their participation. Those who did not provide consent were thanked for their time, and the questionnaire was automatically closed.

The section of the survey about training needs contained 6 questions (see questions in Table 1). One question was conditional based on the answer to the previous question. There were 2 yes or no questions, 2 multiple-choice questions, and 2 five-point Likert scales, assessing if participants had received training, what kind of training it was, and what future training might be of interest.

At the conclusion of the online survey, participants were invited to express interest in a follow-up interview. Those who opted in were contacted by a researcher (CR), provided with written information about the study, and offered an opportunity to schedule an interview at a convenient time. Written informed consent was obtained via Google Forms prior to the interview. Participants were given the opportunity to ask questions about the study and withdraw at any time. All those who provided consent completed their interview. One-on-one interviews were conducted online using Zoom and lasted approximately 30-40 minutes. A semistructured interview guide (see questions in Textbox 1) was used to ensure consistency across interviews while allowing for flexibility to explore relevant topics in greater depth. Interviews were audio-recorded, transcribed verbatim, and anonymized for analysis. Participants were not given the opportunity to review their recordings or transcripts nor to provide feedback on the findings.

Program coordinators from psychology and psychiatry training programs across New Zealand’s 7 universities were identified and contacted directly via email. In this study, educators were defined as individuals responsible for curriculum development and revision and those engaged in teaching or teaching coordination within their respective psychology or psychiatry courses. Recruitment was straightforward due to the limited number of relevant programs nationwide. We contacted 10 programs from the clinical, health, and counseling scopes, and 4 agreed to take part. Of the 2 psychiatry programs, 1 agreed to take part. Coordinators who expressed interest in participating were contacted by CR to arrange a short (less than 30 min) interview. The same consent, recording, and transcription procedures used in Part Two were applied. Interviews explored the extent to which digital mental health tools were incorporated into existing curricula, as well as perceived barriers and opportunities for further integration (see Textbox 2).

Data from the survey (Part One) were analyzed using descriptive and inferential statistics to identify trends and patterns in participants’ responses. Qualitative data from Parts Two and Three were transcribed using the Descript software (v32.1.0), with a researcher (CR) verifying each transcript for accuracy. Reflexive thematic analysis, guided by the 6-phase process [25], was conducted using NVivo software (release 1.61; Lumivero). The analysis began with familiarization through repeated readings and initial note-taking. Key features relevant to the research questions were then coded, and these codes were grouped into preliminary themes with the themes derived from the data. Over time, the themes were refined and named to best reflect the data. Both authors engaged in discussions throughout the process to finalize major themes. Given the interpretive nature of the analysis, no cross-coding was performed, prioritizing reflexivity over intercoder reliability [26]. This approach allowed for a deeper exploration of participants’ experiences. Verbatim quotes are included to highlight key findings, with participant qualifications provided for context.

A total of 144 people started the survey, and 118 participants completed it. The demographic and professional characteristics of the participants are summarized in Table 2. Most (n=91, 77%) participants identified as female, with a significant proportion (n=65, 55%) aged between 31 and 50 years. Most (n=103, 87%) respondents reported working clinically across various settings, including public health services (n=60) and private practice (n=31). Participants represented a range of specialties, with clinical psychology (n=33, 28%) and psychiatry (n=22, 19%) being the most common.

For a detailed breakdown of participant demographics, including ethnicity, location, and professional background, readers are referred to the full description of the sample published here [21].

Of the 118 clinicians who completed the survey, 75% (n=88) reported having no formal training in digital mental health tools. Despite this, 69% (n=81) had independently sought to learn about them. Among the 30 clinicians who had received training, 18 participated in offsite training (eg, conferences, seminars, or webinars), 17 underwent on-the-job training (eg, onsite workshops), and 5 received training during their undergraduate or postgraduate education. As shown in Table 3, most clinicians recognized the necessity of training to use digital mental health tools effectively and expressed significant interest in further education. Preferred training formats included interactive online tutorials, expert-led webinars, and guidelines from health authorities.

A total of 17 participants were involved in Part Two. Their demographic and professional characteristics are summarized in Table 4. For a detailed breakdown of participant demographics, readers are referred to the full description of the sample published here [22].

We have previously presented the findings from Part Two, which relate to knowledge and attitudes and contain different themes [22]. Two main themes regarding training needs and preferences were identified, each with 2 subthemes, as shown in Figure 1.

A total of 4 participants were involved in Part Three, and their demographic and professional characteristics are summarized in Table 5.

A total of 3 main themes regarding the inclusion of digital health into training programs were identified (Figure 2).

This theme relates to significant challenges in integrating new content, such as digital mental health tools, into existing psychology and psychiatry training programs. With limited time and space, curricula are already densely packed with essential topics that provide the foundation for clinical practice. The pressure to remain clinically relevant further complicates the introduction of digital health, as educators prioritize content that students can immediately apply in real-world settings. While digital health is recognized as important for the future, its inclusion should not come at the expense of other critical areas. Overall, while digital health is acknowledged as a growing and necessary component of mental health care, educators expressed the need for strategic planning to ensure it is integrated in a way that complements, rather than competes with, existing critical content.

To start with, the educators we spoke with noted the difficulty of fitting new material into already crowded curricula. As clinical practice evolves and new knowledge emerges, there is continuous pressure to update and adapt courses. However, participants highlighted that adding content, such as digital health, often requires removing or reducing other subjects—a complex and challenging process.

Another point raised by the educators is the importance of ensuring that what is taught remains clinically relevant. Digital mental health is an emerging area but is not yet fully embedded in everyday clinical practice. Educators expressed concern that if students cannot immediately apply digital health skills after graduation, the value of teaching it could be diminished. For digital health to be integrated, there must be confidence that the tools and knowledge will be directly usable in practice.

A key concern is ensuring that training remains broad enough to meet the needs of various subspecialties in mental health. The volume of content that must be covered in training is substantial, ranging from neuroscience and trauma work to child and family psychology. Educators emphasized that the scope of training is so extensive that incorporating digital health content feels difficult to justify within the constraints of current programs.

The educators highlighted significant variability in how digital mental health content is integrated into training programs. Most programs incorporate this content into existing courses rather than offering dedicated modules, often limiting coverage to 1 or 2 sessions focusing on telehealth and ethical considerations. This reflects the growing reliance on video conferencing during the COVID-19 pandemic. Only 1 program offered a semester-long course providing comprehensive exposure to digital mental health.

The inclusion of digital mental health content is typically driven by educators who recognize its growing importance rather than by direct student demand. Some students enter training with prior experience in digital interventions, reducing perceived teaching needs. However, feedback on the value of this content is inconsistent, leaving educators unsure about its emphasis in curricula.

Another challenge is the rapid evolution of digital mental health, with new tools emerging regularly. Educators reported difficulty keeping teaching materials up-to-date and ensuring relevance amid the overwhelming variety of available tools.

The educators also noted hesitancy to endorse specific tools due to commercial ties, which may conflict with the academic emphasis on neutrality.

A lack of expertise among teaching staff further complicates efforts to expand digital mental health education. Many educators noted that the responsibility for this content often falls on those already stretched thin, with some clinicians hesitant to engage with digital tools.

Educators universally acknowledged that digital mental health is a rapidly expanding field with increasing relevance to clinical practice. As digital interventions become more integrated into mental health services, educators expect digital health to take on a greater role in training curricula. They anticipate that, over time, there will be more dedicated teaching to ensure students are adequately prepared for the realities of clinical work. Without this knowledge, graduates risk being underprepared for the evolving demands of day-to-day practice.

Educators highlighted that the continued growth of digital mental health is inevitable and warned that failing to incorporate it into training could leave students at a disadvantage. They emphasized the need to familiarize students with available tools and interventions to ensure they are equipped to navigate the digital landscape upon entering the workforce.

The findings from the survey (Part One) revealed that three-quarters of clinicians lacked formal training in digital mental health tools, though the majority (69%) had independently sought to learn about them. Reported training was often informal, occurring through offsite conferences, webinars, or self-directed efforts, with minimal integration into academic programs. Clinicians broadly agreed that training is essential to effectively utilize digital mental health tools, and interest in such training was notably high. Preferred formats included interactive online tutorials, expert-led webinars or podcasts, and official guidelines from health authorities.

Despite strong interest in upskilling, follow-up interviews (Part Two) revealed significant barriers to engaging in digital mental health training. Clinicians frequently cited heavy workloads and competing responsibilities as key obstacles, limiting their capacity to explore or evaluate digital tools. A lack of leadership and institutional support further compounded hesitancy around adopting digital interventions, particularly in public health settings where clinicians were reluctant to implement tools without approval from governing bodies. The absence of official guidance left clinicians feeling burdened by the need for self-directed learning, leading to inconsistencies in the adoption of digital health tools.

The educators (Part Three) recognized the importance of integrating digital health into student training. However, they highlighted challenges such as overloaded curricula and the need for educators to stay current with digital health innovations or rely on external expertise. They also highlighted the importance of continuous learning to keep pace with technological advancements, underscoring the need for flexible, responsive training models rather than one-off, static courses. There was optimism that as tools become more widely accepted and used, formalized training will follow. This perspective suggests that while digital health training faces immediate challenges, the long-term trajectory points toward increasing adoption and curriculum inclusion.

Given the constraints of packed curricula and heavy clinical workloads, our findings support the implementation of concise, on-demand training (eg, prerecorded sessions with supporting materials) that is directly applicable to clinical practice. Such training should be readily accessible to both students and fully qualified clinicians across the health system. Preferred formats, such as interactive online tutorials and webinars or podcasts, underscore the importance of flexible, accessible, on-the-job learning. The increased adoption of webinars and distance learning during the global pandemic highlights an opportunity to meet this demand, as clinicians have shown a growing interest in engaging with digital education. Advances in online learning technology further support the efficient delivery of these training initiatives [11,27].

Our findings align with existing literature, highlighting persistent gaps in clinician training for digital mental health tools. Two New Zealand studies by Van Kessel [28] and Wilson [29] identified limited knowledge as a key barrier to adoption in New Zealand, with significant clinician interest in training. The first study by Van Kessel [28] reported that 75% of the clinical psychologists were interested in training that and 78% were willing to use digital tools if provided with training. Similarly, we found that 83% (n=92) of the respondents believed training was necessary, and over half (n=63) expressed strong interest, underscoring a pervasive, cross-disciplinary need for training. The findings from Van Kessel [28] combined with our study highlight the importance of targeted, practical training formats, such as online tutorials, expert-led webinars, and guidelines from health authorities. Our results extend these insights by emphasizing the need for flexible, time-efficient training that accommodates the demands of students and practicing clinicians. However, despite growing recognition of digital health’s importance, systemic progress has been limited, hindered by crowded curricula, lack of institutional leadership, and educator expertise. This reinforces the need for coordinated efforts to address structural barriers and bridge the training gap.

Wilson [29] also emphasized the critical role of health professionals in promoting digital interventions, noting that clinician recommendations significantly increase public uptake. Similarly, our findings suggest that training can positively influence clinician attitudes and confidence, driving higher adoption rates. Survey respondents and interview participants expressed enthusiasm for digital health tools but also conveyed feelings of uncertainty and a lack of support from employers and health authorities. This suggests that systemic leadership and investment are critical for fostering digital health adoption.

Our findings also resonate with international literature. Research in Germany [30] found that while clinicians lacked familiarity with eHealth tools, they were interested in training and recognized the potential benefits of digital interventions for prevention and self-help. Across the European context, similar themes were highlighted, where organizations recognized the potential of digital treatments to improve access and reduce costs but faced challenges such as integration difficulties and limited organizational knowledge [31]. These studies align with our findings. New Zealand clinicians have reported a strong desire for training and highlighted the absence of structural and leadership support, leaving them to navigate adoption individually.

In Australia, Sturk et al [32] examined clinician attitudes toward the Head to Health website, a government initiative providing digital mental health tools, and found that training played a key role in its adoption. While most clinicians were initially unaware of the resource, many became willing to recommend it to clients after receiving training. Consequently, participants called for broader promotion and better integration of digital tools into health care systems. Similarly, New Zealand clinicians in our study emphasized the importance of training and system-wide guidance to build confidence and increase the adoption of digital tools. These parallels suggest shared regional opportunities to foster digital mental health adoption through targeted training and systemic integration.

Significant variation in teaching digital competencies was revealed across German medical schools, highlighting the need for well-defined training to ensure clinical competence. Personal use of digital technology does not guarantee clinical proficiency, a sentiment echoed in our findings [33]. New Zealand clinicians strongly advocated for accessible, structured training, emphasizing the need for systemic leadership and investment to ensure clinicians are equipped to integrate digital tools into practice effectively [16,34].

Finally, a review focusing primarily on research in the United States further emphasized the importance of targeted digital literacy training for health workers, demonstrating its potential to advance digital health equity. This review highlighted that such training consistently delivers promising outcomes, whether broad or tool-specific [35]. Similarly, our findings reveal a strong demand among New Zealand clinicians for short, accessible training formats tailored to their clinical needs, reinforcing the global call for practical digital health education.

This study’s primary strength lies in its mixed methods design, combining survey data with in-depth interviews to comprehensively explore digital mental health training needs and preferences among the New Zealand mental health workforce. Including multiple perspectives—clinicians, trainees, and educators—allowed for a nuanced understanding of both frontline experiences and systemic challenges within training programs.

Despite these strengths, the study has several limitations. The sample size for the follow-up interviews (n=17) and educator interviews (n=4) is small, limiting the generalizability of the findings. In particular, the small educator sample means the views captured may not represent the full diversity of perspectives across training institutions.

The sample of participants was skewed toward older and female participants, reflecting broader workforce demographics but potentially limiting insight into the perspectives of younger clinicians, who may have different experiences with technology. As generational shifts occur, younger clinicians will likely bring greater digital literacy and enthusiasm for digital tools, which may influence future training needs.

The clinicians who opted to participate in follow-up interviews may have been particularly vocal, concerned, or enthusiastic about digital mental health, potentially resulting in an overrepresentation of specific viewpoints. Additionally, they may have been primed by the survey questions, influencing the themes that emerged during the qualitative phase of the study [3,15,36].

This study underscores the pressing need for enhanced training in digital mental health tools for clinicians and trainees in New Zealand. The findings reveal that while clinicians recognize the value of digital tools, most have not received formal training and instead rely on self-directed learning. This reflects not only the proactive nature of clinicians but also the lack of structured, accessible training pathways. Educators similarly acknowledged the importance of integrating digital health into curricula but face barriers due to already overloaded programs.

To address these challenges, the following key recommendations emerge:

By addressing these areas, digital mental health tools can become more embedded in clinical workflows, improving patient outcomes and streamlining service delivery. These recommendations reflect not only clinician preferences but also the broader systemic need to support digital innovation in mental health care through structured, responsive, and practical training initiatives.