Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial

Vis, Christiaan; Schuurmans, Josien; Aouizerate, Bruno; Craggs, Mette Atipei; Batterham, Philip J.; Burhmann, Leah; Calear, Alison L.; Pashoja, Arlinda Cerga; Christensen, Helen; Dozeman, Els; Pedersen, Christian Bonde; Ebert, David Daniel; Etzelmueller, Anne; Fanaj, Naim; Finch, Tracy; Hanssen, Denise; Hegerl, Ulrich; Hoogendoorn, Adriaan W.; Mathiasen, Kim; May, Carl; Meksi, Andia; Mustafa, Sevim; O’Dea, Bridianne; Oehler, Caroline; Piera-Jiménez, Jordi; Potthoff, Sebastian; Qirjako, Gentiana; Rapley, Tim; Rosmalen, Judith; Sacco, Ylenia; Samalin, Ludovic; Skjøth, Mette Maria; Tarp, Kristine; Titzler, Ingrid; Eycken, Erik Van der; Genugten, Claire van; Whitton, Alexis E.; Zenalda, Enrico; Smit, Jan; Riper, Heleen

doi:10.2196/41532

Cited by 10 publications

(19 citation statements)

References 67 publications

(83 reference statements)

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“…In 2018, CEDIP participated in the European Union's Horizon 2020 research project ImpleMentAll (IMA), where the ItFits-toolkit was developed, tested, and found to be effective ( 32 ). ItFits-toolkit was used in iPsych from December 2018 to May 2019.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative data were collected during the implementation of the ItFits-toolkit, which was based on a Stepped Wedge Cluster Randomized Controlled Trial (SWT) design (24). Specifically, survey data were collected in 10 waves at 3-month intervals during the study period using a specially designed functionality in the ItFits-toolkit (35). To measure the degree to which (25).…”

Section: Data Collectionmentioning

confidence: 99%

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Therapist perceptions of the implementation of a new screening procedure using the ItFits-toolkit in an iCBT routine care clinic: A mixed-methods study using the consolidated framework for implementation research

et al. 2023

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IntroductionThis study investigates the implementation of a new, more automated screening procedure using the ItFits-toolkit in the online clinic, Internet Psychiatry (iPsych) (www.internetpsykiatrien.dk), delivering guided iCBT for mild to moderate anxiety and depressive disorders. The study focuses on how the therapists experienced the process.MethodsQualitative data were collected from semi-structured individual interviews with seven therapists from iPsych. The interviews were conducted using an interview guide with questions based on the Consolidated Framework for Implementation Research (CFIR). Quantitative data on the perceived level of normalization were collected from iPsych therapists, administrative staff, and off-site professionals in contact with the target demographic at 10-time points throughout the implementation.ResultsThe therapists experienced an improvement in the intake procedure. They reported having more relevant information about the patients to be used during the assessment and the treatment; they liked the new design better; there was a better alignment of expectations between patients and therapists; the patient group was generally a better fit for treatment after implementation; and more of the assessed patients were included in the program. The quantitative data support the interview data and describe a process of normalization that increases over time.DiscussionThe ItFits-toolkit appears to have been an effective mediator of the implementation process. The therapists were aided in the process of change, resulting in an enhanced ability to target the patients who can benefit from the treatment program, less expenditure of time on the wrong population, and more satisfied therapists.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Therapist perceptions of the implementation of a new screening procedure using the ItFits-toolkit in an iCBT routine care clinic: A mixed-methods study using the consolidated framework for implementation research

et al. 2023

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“…The ItFits-toolkit was rolled out within the IMA trial, as part of a stepped-wedge study design with randomised entry into the intervention phase [13,17]. Between December 2018 and March 2020, two sites crossed-over to the ItFits-toolkit condition every three months, until 12 sites were receiving the ItFits-toolkit.…”

Section: Deployment Of Itfits-toolkit In the Trialmentioning

confidence: 99%

“…In the ImpleMentAll study, ItFits-toolkit was evaluated in a randomised stepped wedge trial, for its effectiveness as a tool for achieving service implementation related outcomes of iCBT interventions, focusing on level of normalisation (embedding and integration into service provision (primary outcome) [16]) and service uptake (secondary outcome) of the iCBT services into routine healthcare, during the trial [13]. The results showed a signi cant, but small, positive effect of ItFits-toolkit on the primary outcome of the normalisation of iCBT services in mental health professionals, and no signi cant effect on service uptake and referrals on patient level [17]. To understand engagement with ItFits-toolkit as a tailoring intervention, we conducted a parallel mixed methods process evaluation [13] alongside the trial effectiveness study [17], to understand the ways in which implementers in the IMA study sites worked with the ItFits-toolkit, and the projects that they developed to enhance iCBT delivery.…”

Section: Introductionmentioning

confidence: 99%

How is tailored implementation undertaken using a self-guided toolkit? Qualitative study of the ItFits-toolkit in the ImpleMentAll project

Finch,

Potthoff,

May

et al. 2023

Preprint

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Background. The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial. Methods. Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum. Sufficient engagement was evident. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews (n=55) with implementation team members (n=30) and observations of support calls (n=19) with study sites. Qualitative data were analysed thematically, using a team-based approach. Results. Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members’ ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, ‘time’, both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success. Conclusion. This study responds directly to McHugh et al.’s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.

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“…In this article, we aim to advance current approaches to stakeholder engagement by describing the systematic development of an initial conceptual model for implementation-stakeholder engagement. As part of a multinational, Horizon 2020-funded study, 31,32 we conducted an in-depth qualitative investigation of stakeholder engagement activities undertaken by implementation teams who used a toolkit designed to support the tailored implementation of digital mental health services across nine countries. We developed an initial Implementation-STakeholder Engagement Model (I-STEM) through our investigation of what happens when implementers are structured into iterative cycles of stakeholder engagement across various phases of the implementation process, but where they retain considerable flexibility in how they approach this engagement work.…”

Section: Introductionmentioning

confidence: 99%

Towards an Implementation‐STakeholder Engagement Model (I‐STEM) for improving health and social care services

Potthoff

Finch

Bührmann

et al. 2023

Health Expectations

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BackgroundThe implementation science literature acknowledges a need for engagement of key stakeholders when designing, delivering and evaluating implementation work. To date, the literature reports minimal or focused stakeholder engagement, where stakeholders are engaged in either barrier identification and/or barrier prioritisation. This paper begins to answer calls from the literature for the development of tools and guidance to support comprehensive stakeholder engagement in implementation research and practice. The paper describes the systematic development of the Implementation‐STakeholder Engagement Model (I‐STEM) in the context of an international, large‐scale empirical implementation study (ImpleMentAll) aimed at evaluating the effectiveness of a tailored implementation toolkit. The I‐STEM is a sensitising tool that defines key considerations and activities for undertaking stakeholder engagement activities across an implementation process.MethodsIn‐depth, semistructured interviews and observations were conducted with implementers who were tailoring implementation strategies to integrate and embed internet‐based cognitive behavioural therapy (iCBT) services in 12 routine mental health care organisations in nine countries in Europe and Australia. The analytical process was informed by principles of first‐ and third‐generation Grounded Theory, including constant comparative method.ResultsWe conducted 55 interviews and observed 19 implementation‐related activities (e.g., team meetings and technical support calls). The final outcome of our analysis is expressed in an initial version of the I‐STEM, consisting of five interrelated concepts: engagement objectives, stakeholder mapping, engagement approaches, engagement qualities and engagement outcomes. Engagement objectives are goals that implementers plan to achieve by working with stakeholders in the implementation process. Stakeholder mapping involves identifying a range of organisations, groups or people who may be instrumental in achieving the engagement objectives. Engagement approaches define the type of work that is undertaken with stakeholders to achieve the engagement objectives. Engagement qualities define the logistics of the engagement approach. Lastly, every engagement activity may result in a range of engagement outcomes.ConclusionThe I‐STEM represents potential avenues for substantial stakeholder engagement activity across key phases of an implementation process. It provides a conceptual model for the planning, delivery, evaluation and reporting of stakeholder engagement activities. The I‐STEM is nonprescriptive and highlights the importance of a flexible, iterative approach to stakeholder engagement. It is developmental and will require application and validation across a range of implementation activities.Patient or Public ContributionPatient contribution to ImpleMentAll trial was facilitated by GAMIAN‐Europe at all stages—from grant development to dissemination. GAMIAN‐Europe brings together a wide variety of patient representation organisations (local, regional and national) from almost all European countries. GAMIAN‐Europe was involved in pilot testing the ItFits‐toolkit and provided their views on the various aspects, including stakeholder engagement. Patients were also represented in the external advisory board providing support and advice on the design, conduct and interpretation of the wider project, including the development of the ItFits‐toolkit.Trial registrationClinicalTrials.gov NCT03652883. Retrospectively registered on 29 August 2018.

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Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial

Cited by 10 publications

References 67 publications

Therapist perceptions of the implementation of a new screening procedure using the ItFits-toolkit in an iCBT routine care clinic: A mixed-methods study using the consolidated framework for implementation research

Therapist perceptions of the implementation of a new screening procedure using the ItFits-toolkit in an iCBT routine care clinic: A mixed-methods study using the consolidated framework for implementation research

How is tailored implementation undertaken using a self-guided toolkit? Qualitative study of the ItFits-toolkit in the ImpleMentAll project

Towards an Implementation‐STakeholder Engagement Model (I‐STEM) for improving health and social care services

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