Experiences from implementation of internet-delivered cognitive behaviour therapy for insomnia in psychiatric health care: a qualitative study applying the NASSS framework

Abstract

Background: Insomnia is a common diagnosis among patients in psychiatric health care and effective treatments are highly demanded. Previous research suggests that internet-delivered cognitive behavioural therapy for insomnia (ICBT-i) is helpful for a variety of patients and may be effective for psychiatric health care patients. Little is known about implementation of ICBT-i in psychiatric health care. The aim of this study was to explore experiences among therapists and managers who participated in a pilot implementation of ICBT-i in outpatient psychiatric health care, and to identify determinants for the implementation. Methods: Semi-structured interviews were conducted with 7 therapists and 5 managers working in outpatient psychiatric health care and directly involved with the pilot implementation. Data were analysed using qualitative content analysis guided by the NASSS framework, combining inductive and deductive approaches. Results: The analysis revealed 32 facilitators, 21 barriers, and 2 determinants that were both a barrier and a facilitator, organised in 1-5 themes under each of the 7 NASSS domains. Key facilitators included: meeting a demand for treatment options with the ICBT-i programme, the experienced benefits of ICBT-i as a treatment option for insomnia, training and support, engagement and support from managers and the wider system, and a longterm organisation for maintenance of the technology. Key barriers included: low interest in ICBT-i among therapists, difficulty in recruiting patients, perceived low ability in therapists to deliver treatment online, technical problems, and therapists' competing demands leading to low priority of ICBT-i. Complexity analysis assessed two NASSS domains as simple, four as complicated, and one as complex.

Adopt, adapt, or abandon technology-supported person-centred care initiatives: healthcare providers’ beliefs matter

“…According to NASSS, complex conditions and complexity in an underlying condition are associated with non-adoption, abandonment, or limited usefulness of the technologies. Conditions like dementia or multimorbidity often make a patient unable or unwilling to use the supplied technologies [39]. In our study, the healthcare providers described COPD on a continuum from easy to severe, and they acknowledged that patients often had additional challenges, such as anxiety, malnutrition, isolation, and depression.…”

“…The healthcare providers embraced technology-supported PCC to such an extent that the authors decided to reread the interview data, explicitly looking for blind spots, nuances, or discrepancies in their positive attitudes. Their passion for care transformation also differs from Kadesjö Banck and Bernhardsson's study, using the NASSS framework to explore therapists' and managers' experiences during a pilot implementation of internetdelivered cognitive behavioural therapy for insomnia in psychiatric healthcare in Sweden [39]. They report that the key barrier for adoption concerned the adopters of new technology, particularly the therapists and their competing demands leading to low prioritisation of the technological innovation.…”

“…It was first published in 2017 by Trisha Greenhalgh and colleagues [13]. To our knowledge, current publications cover the development and extension of the NASSS framework [35][36][37], empirical applications of the NASSS framework [12,[38][39][40][41][42][43][44][45], reviews and synthesis guided by NASSS [46], and a few research protocols based on the framework [47][48][49].…”

Implementing Automated Text Messaging for Patient Self-management in the Veterans Health Administration: Qualitative Study Applying the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability Framework

“…The NASSS is quickly becoming a prominent meta-framework for identifying complexities and their interactions in studies of technology implementation [ 27 , 28 ]. The framework posits 3 levels of complexity—simple, complicated, and complex—which may predict technology adoption and nonadoption.…”

“…This is the first paper to report qualitative findings from the perspectives of patients and staff on factors affecting the adoption, implementation, and spread of VHA’s new aTS. NASSS, a meta-framework for identifying complex elements and their interactions, was an important tool to help classify these factors and recognize their interplay [ 27 , 28 ]. As health care systems implement new technologies to deliver high-quality, effective, patient-centered care, the multilevel complexities of adoption (or nonadoption), implementation, and sustainment must be studied.…”