Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory (Preprint)

Abstract

BACKGROUND Most people with common mental disorders, including many of those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialized mental healthcare. However, the potential uptake by general practitioners (GPs) is unclear. OBJECTIVE This mixed-method pre-implementation study aimed to (a) assess GPs’ intent-to-adopt MHSVC in their practice and (b) identify predictors for early intent-to-adopt (quantitative strand) and (c) characterise GPs with early intent-to-adopt based on the Diffusion of Innovations Theory (DOI) (qualitative strand). METHODS Applying a convergent parallel design, we combined a survey in 177 GPs followed up with focus groups and individual interviews in a sample of five early adopters and one non-adopter. We identified predictors for intent-to-adopt though a cumulative logit model for ordinal multicategory responses with proportional odds structure to the data. Two coders independently analysed the qualitative data deriving common characteristics across the five early adopters. We interpreted the qualitative findings accounting for the generalised adopter categories of the DOI. RESULTS This study found that (1) about one in two GPs assumed that patients benefit from a MHSVC service model, (2) about one in three GPs intended to adopt such a model, (3) the availability of a designated room was the only significant predictor for intent-to-adopt in GPs, and (4) supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC. Finally, (5) characteristics of supporting and non-supporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. CONCLUSIONS There is a significant proportion of GPs who may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Future work should focus on measures to foster the intention to adopt among hesitant GPs. CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012487.