Organisational Implementation Climate in implementing internet-based Cognitive Behaviour Therapy for depression

Abstract

Background. Internet-based Cognitive Behaviour Therapy (iCBT) services for depression have been implemented in routine care in 14 European regions. This study aimed to advance understanding of the nature and value of organisational implementation climate in implementing iCBT services from the perspectives of implementers and service deliverers.Methods. A mixed method approach was applied. Based on concept mapping, a workshop with implementers was conducted to qualitatively conceptualise organisational implementation climate conducive to optimizing iCBT use in routine practice. Mental health service deliverers involved in the provision of iCBT services were invited to participate in a cross-sectional survey assessing levels of satisfaction and usability of iCBT, and of the organisational implementation climate. Associations between satisfaction, usability and implementation climate were explored.Results. 16 implementers representing 14 service delivery organisations participated in the workshop. The top-3 characteristics of a strong organisational implementation climate included: (1) clear roles and skills of implementers, (2) feasible implementation targets, and (3) a dedicated implementation team. The top-3 tools for creating a good implementation climate included: (1) job performance feedback, (2) progress monitoring in achieving implementation targets, and (3) guidelines for assessing the impact of iCBT. 111 respondents (73% female) completed the survey. Respondents were generally satisfied delivering iCBT services (MCSQ = 9.11, SD = 1.96, range = 3-15, n = 108) and found their usability slightly below average (MSUS = 63.76, SD = 15.53, range = 0-100, n = 103). They regarded their organisational implementation climate as supportive in implementing iCBT services (MICS = 43.21, SD = 5.62, range = 12-60, n = 89). Organisational implementation climate was weakly associated with usability (r = 0.25, p =.03) and moderately with satisfaction (r = .51, p £ .00).Conclusions. Organisational implementation climate as part of the wider organisational context in which implementation processes take place, is a relevant factor to implementers and service deliverers in implementing iCBT in routine care. The qualitative conceptual findings align with the quantitative approach applied in this study for measuring organisational implementation climate. Implementers can use various practical tools to shape organisational implementation climate to increase acceptance and improve implementation of iCBT in mental health care.

Therapists’ experiences with providing guided internet-delivered cognitive behavioral therapy for patients with mild and moderate depression: a thematic analysis

“…There seemed to be lacking a functioning system to keep allotted iCBT-time free of other appointments and tasks, and that the therapists were forced to find different strategies to cope with this challenge. Similar to findings in other studies (Folker et al, 2018;Meisel et al, 2018;Titzler et al, 2018;Kerst et al, 2020;Smith and Gillon, 2021;Wood et al, 2021;Doukani et al, 2022;Vis et al, 2022), the therapists in this study expressed the need for sufficient training and supervision to provide good treatment. This might not be surprising, but as it is frequently reported it appears to be a challenge that should be considered and addressed when internet-delivered treatment is implemented.…”

“…Previous studies focusing on the therapist's experiences with therapy designed to be delivered online, points to generally positive attitudes to the treatment format (Kerst et al, 2020;Wood et al, 2021;Khan et al, 2022;Vis et al, 2022). Positive attitudes among the therapists were also reported in studies where internet-delivered therapy is provided in combination with face-to-face sessions (Titzler et al, 2018;Mol et al, 2020).…”

“…One commonly reported challenge therapists encounter when implementing internet-delivered treatment is that there is a need for sufficient training and supervision (Folker et al, 2018;Meisel et al, 2018;Titzler et al, 2018;Kerst et al, 2020;Smith and Gillon, 2021;Wood et al, 2021;Doukani et al, 2022;Vis et al, 2022). The training should be specific to the platform that is used in the intervention (e.g., how to navigate the webpage or app) (Wood et al, 2021), and directed at developing and altering therapists' skills and approaches to that of an online format (e.g., how to build a therapeutic alliance without face-to-face meetings) (Smith and Gillon, 2021).…”

“…The training should be specific to the platform that is used in the intervention (e.g., how to navigate the webpage or app) (Wood et al, 2021), and directed at developing and altering therapists' skills and approaches to that of an online format (e.g., how to build a therapeutic alliance without face-to-face meetings) (Smith and Gillon, 2021). To have a dedicated implementation team, that arranges group training where sharing experiences is encouraged and provides ongoing supervision, is described as an important facilitator (Meisel et al, 2018;Wood et al, 2021;Vis et al, 2022).…”

“…Therapists expressed concerns with being unable to assist patients with technical issues and some experienced lack of support from the helpdesk (Mol et al, 2020). To have access to necessary resources such as technical support was described as important, and a characteristic of a supportive organizational climate for implementation of internet-delivered treatment for depression (Vis et al, 2022). Khan et al (2022) concludes that technical difficulties did not hinder the therapists in building good relationships with their patients, which was a concern presented by Titzler et al (2018).…”