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vida: extract claims from 2026-04-21-smartphone-mental-health-apps-efficacy-attrition

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- Source: inbox/queue/2026-04-21-smartphone-mental-health-apps-efficacy-attrition.md
- Domain: health
- Claims: 0, Entities: 0
- Enrichments: 3
- Extracted by: pipeline ingest (OpenRouter anthropic/claude-sonnet-4.5)

Pentagon-Agent: Vida <PIPELINE>
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domains/health/generic-digital-health-deployment-reproduces-existing-disparities-by-disproportionately-benefiting-higher-income-users-despite-nominal-technology-access-equity.md
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@ -34,3 +34,10 @@ Topics:
**Source:** JMIR 2024 e59939
FQHCs adopting telemental health showed 5-7 percent increase in visit rates among Medicaid and low-income groups, demonstrating that institutional deployment context matters. However, standalone apps (BetterHelp, Headspace, Calm) cost $260-400/month with no Medicaid coverage and predominantly serve insured/higher-income/younger/White users. Text therapy (Talkspace, BetterHelp messaging) costs $65-100/week with virtually no Medicaid coverage in any state. The disparity is structural: commercial apps optimize for paying customers, while safety-net institutions lack resources to deploy digital tools at scale.
## Extending Evidence
**Source:** npj Digital Medicine 2025; Lancet Digital Health 2025
Mental health app attrition mechanisms are structurally inequitable: limited digital literacy (structural barrier for underserved), privacy concerns (higher in marginalized populations), lack of cultural/linguistic adaptation for non-English speakers, and poor usability that assumes technical sophistication. Even in best-case RCT conditions with motivated participants, 64% attrition suggests real-world underserved populations would face substantially higher dropout rates, creating a selection effect where apps work only for the already-advantaged completer minority.