Conceptualizing Immigrant Help-Seeking In the Digital Age: A Network Episode Model (NEM-IM) Adaptation for Telemental Health Service Use

Background and Purpose: LEP immigrants face continued barriers to mental health care, including language discordance, cultural stigma, and provider shortages. Telemental health services (TMH) may reduce some of these barriers by connecting individuals with culturally and linguistically matched providers across geographic boundaries. However, existing theoretical models do not account for how migration contexts, social networks, and digital technologies together influence TMH utilization among immigrants. The Network Episode Model (NEM-II), while widely applied to study help-seeking among racial and ethnic minority populations, has not been adapted for immigrant TMH navigation, despite immigrants' distinctive network characteristics and ongoing acculturation processes. This study refined and extended the NEM-II by developing the Network Episode Model for Immigrants (NEM-IM), grounded in the TMH experiences of LEP immigrants.

Methods: We conducted semi-structured interviews with 30 LEP immigrants (15 Korean speakers, 15 Mandarin speakers) who had used language-matched TMH within the past three years. All participants were born outside the U.S., with varied lengths of U.S. residence (27% five years or fewer, 33% five to ten years, 37% over ten years). Licensed bilingual social workers conducted interviews in participants' primary languages. Data analysis employed an abductive approach, iterating between empirical data and the original NEM-II to identify conceptual gaps and propose theoretical refinements. Atlas.ti was used for data management.

Results: The analysis produced the NEM-IM, organized around five interconnected domains. The Social Content or Episode Base was expanded to incorporate immigration background, digital access, and pre-migration experiences, with COVID-19 accelerating digital adoption. The Social Support System was reconceptualized as spanning offline, online, and transnational ties, with co-ethnic referrals and technological assistance identified as key network functions. Two distinct career trajectories were introduced: an Acculturation Career encompassing behavioral, cognitive, and affective dimensions across public and private domains, and a Wellbeing and Mental Health Career tracking recognition of need, patient role adoption, and evolving engagement. The Treatment System domain revealed strategic decision-making across provider locations, with 33% of participants accessing providers exclusively in their home countries and 20% using both home-country and U.S.-based providers. Participants prioritized cultural understanding, language concordance, cost, and scheduling flexibility, with TMH's geographic independence enabling access that the local U.S. system could not provide.

Conclusions and Implications: TMH utilization among LEP immigrants is shaped by migration experiences, acculturation processes, online and transnational social networks, and cross-border access possibilities. The NEM-IM offers a conceptual adaptation that can inform future research on immigrant mental health service use. Findings point to the need for expanded recruitment of bilingual mental health providers within the U.S., cross-state licensure policies that increase access to language-concordant clinicians, acculturation-informed training for TMH providers, and community-based digital literacy programs tailored to LEP immigrants.