Clinician attitudes, social norms and intentions to use a computer-assisted intervention

Buti, Allison L.; Eakins, Danielle; Fussell, Holly E.; Kunkel, Lynn E.; Kudura, Aisha G.; McCarty, Dennis

doi:10.1016/j.jsat.2012.08.220

Cited by 18 publications

(14 citation statements)

References 18 publications

(23 reference statements)

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“…Health professional factors relevant to the uptake of web-based therapies were raised in 9 of 11 quantitative studies (n=4536) [ 22 , 23 , 31 - 33 , 44 - 47 ], 6 of 14 qualitative studies (n=96) [ 25 - 28 , 38 , 48 ], and 3 of 4 mixed-methods studies (n=407) [ 17 , 30 , 43 ]. Quantitative studies raised few health professional issues.…”

Section: Resultsmentioning

confidence: 99%

Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives

Davies¹,

Shepherd²,

Beatty³

et al. 2020

J Med Internet Res

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Background Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. Objective Our objective in this review was to summarize what is known about health care professionals’ perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. Methods We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals’ views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. Results We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. Conclusions Without health professionals’ support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. Trial Registration PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk

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Section: Resultsmentioning

confidence: 99%

Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives

Davies¹,

Shepherd²,

Beatty³

et al. 2020

J Med Internet Res

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“…Past studies examined the use of IMIs in general in different target groups ( Topooco et al, 2017 ; Andersson et al, 2009 ; Alkhaldi et al, 2014 ; Merkel, 2017 ; Andersson and Hedman, 2013 ). Previous studies with therapists used mainly quantitative surveys, had no link to theories of behavior change, and asked therapists, most of whom had no user experience, to report their attitude, acceptance, and intention to treat with IMIs ( Wangberg et al, 2007 ; Whitfield and Williams, 2004 ; Topooco et al, 2017 ; Buti et al, 2013 ; Perle et al, 2013 ). One qualitative study with focus groups aimed to identify the optimal usage of blended treatment protocols for depression; but therapists differed in their user experience and assessed BT protocols that were developed on the basis of a prior quantitative survey ( van der Vaart et al, 2014 ).…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective

Titzler

Saruhanjan

Berking

et al. 2018

Internet Interventions

133

136

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IntroductionBlended therapies (BT) combine face-to-face (f2f) sessions with internet- and mobile-based interventions (IMIs). However, the use of blended interventions in routine care is still rare and depends on the acceptance of key health care professionals such as the therapists. Little is yet known about the therapists' perspective on and experiences with blended approaches. The aim of this pilot study was to identify barriers and facilitators, as perceived by psychotherapists, for implementing a blended therapy for depression.MethodsSemi-structured expert interviews were conducted with five therapists, who were part of the German study arm of the FP7-project E-Compared (www.e-compared.eu). All patients (N = 173) were treated in the context of a registered RCT (DRKS00006866) in which the clinical and cost-effectiveness of BT for depression, consisting of ten internet- and mobile-based cognitive behavioral therapy modules and six f2f sessions, was compared to the treatment usually provided by general practitioners. To identify barriers and facilitators an interview guide based on the theoretical domains framework (TDF) was developed. The interviews were audio-recorded, transcribed verbatim and analyzed using a qualitative content analysis by two independent coders.ResultsThe results revealed 29 barriers and 33 facilitators, which are hindering or enabling factors on the levels of ‘implementation in the health care system’, ‘therapy’, ‘therapists’ and ‘patients’. Key barriers stated by all therapists were ‘Limited customizability and autonomy of decisions concerning blending the therapy’ (number of statements, k = 44); ‘Disease-related contraindications for BT’ (k = 25); ‘Negative affect was caused by burden through technical problems’ (k = 18); ‘Limited number of f2f sessions hindered the therapy process’; and ‘Establishment of therapeutic alliance was burdened by technical issues’ (each k = 15). Key facilitators stated by all therapists were: ‘Patients’ interest, willingness and motivation to participate’ (k = 22); ‘Patients' access to online content between f2f sessions and after therapy end’ (k = 20); ‘Preset structure of IMI-part guided the treatment course of BT’ (k = 18); and ‘Effective help with BT in a short time frame’ (k = 15), as well as ‘Reduction of the treatment gap’ (k = 13).DiscussionTherapists supported the implementation of BT for depression. Results indicated the consideration of a wide range of determinants: among others, the possibility of individualizing the treatment; the autonomy of decision making in respect to the ratio and number of online and f2f sessions; the necessity of providing training; the need to develop a concept of embedding BT in the health care system and funding the additional effort; and the use of sophisticated technical solutions.

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“…Recent studies call for an examination of perceived barriers to implementing computer- and mobile-assisted interventions to uncover sources of provider resistance and organizational impediments to the use of these innovative tools. 25,26 To address this gap in knowledge, the current study aimed to answer the following question: What are the primary barriers to use of technology-based therapeutic tools identified by care decision-makers (i.e., health care providers with consistent influence over the content and types of clinical care delivered at their organizations) in behavioral health care settings? …”

Section: Introductionmentioning

confidence: 99%

Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care

Ramsey

Lord

Torrey

et al. 2014

J Behav Health Serv Res

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This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision-makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision-makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost, privacy), potential end-users (e.g., technology literacy, attitudes about technology), organization structure and climate (e.g., budget, infrastructure), and factors external to organizations (e.g., broadband accessibility, reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools.

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Clinician attitudes, social norms and intentions to use a computer-assisted intervention

Cited by 18 publications

References 18 publications

Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives

Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives

Barriers and facilitators for the implementation of blended psychotherapy for depression: A qualitative pilot study of therapists' perspective

Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care

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