Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review

Abstract

Background More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. Objective This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. Methods From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. Results We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. Conclusions Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020186387 International Registered Report Identifier (IRRID) RR2-10.1177/20552076211035988

Implementation of e–Mental Health Interventions for Informal Caregivers of Adults With Chronic Diseases: Mixed Methods Systematic Review With a Qualitative Comparative Analysis and Thematic Synthesis

“…Intervention implementation outside of a research setting was rarely explored. Other reviews focused on the implementation of eHealth interventions for different groups of informal caregivers [ 27 , 46 , 47 ] similarly found that there was a lack of reporting of implementation determinants related to the inner and outer setting.…”

“…Although the literature identifies several barriers to the implementation of e–mental health interventions in real-world settings [ 28 , 42 - 44 ], few reviews have focused on barriers to and facilitators of implementing eHealth interventions for informal caregivers [ 27 , 45 - 47 ]. To the best of our knowledge, no review has focused specifically on the implementation of e–mental health interventions for informal caregivers.…”

Digital Health Implementation Strategies Coproduced With Adults With Acquired Brain Injury, Their Close Others, and Clinicians: Mixed Methods Study With Collaborative Autoethnography and Network Analysis

“…These were the (1) condition of ABI, (2) technology used to deliver the interventions in the Social Brain Toolkit, (3) supply- and demand-side value propositions of the Social Brain Toolkit, and (4) adopters of the Social Brain Toolkit. Qualitative survey and interview data pertaining to these 4 domains were anonymously and visually presented via a screen-shared slideshow summary, in combination with preliminary systematic review findings [ 41 ], followed by 1 to 3 prompt questions for group discussion. Plain English questions are available in the study protocol, with a detailed outline of time allocations and procedures provided in supplementary materials [ 10 ].…”

“…It has been recommended that researchers consult stakeholders to identify implementation barriers and tailored strategies [ 37 ]. Therefore, this study aimed to coproduce this implementation knowledge with stakeholders [ 10 ] to support the deployment of implementation strategies: (1) at intervention launch, (2) iteratively during initial pilot (convers-ABI-lity) and 12-month implementation-effectiveness hybrid studies (interact-ABI-lity and social-ABI-lity) [ 41 ], and (3) in future versions. The Australian development team includes speech-language pathologist researchers LT, RR, and MB from the University of Sydney and EP and MM from the University of Technology Sydney, with advisory and steering committees comprising people with living experience of ABI and clinicians supporting them.…”

Managing challenging behaviours in adults with traumatic brain injury: A scoping review of technology-based interventions

“…Future studies will need to better define the challenging behaviours targeted by the intervention, all the while better identifying the triggers that may be technologically monitored in the most beneficial way for users. This gap could be addressed by involving users in the ongoing development [82][83][84] This review identified the lack of exploitation of available technologies to address the management of challenging behaviours (e.g., artificial intelligence, smart technologies). Future studies may draw on commercialised technologies or existing research in other populations to gather additional ideas on the technologies that could be used and/or adapted for use with the ABI population.…”