Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis

Abstract

Background The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods We used qualitative semistructured focus group discussions that were guided by Bryan Weiner’s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting “change efficacy” included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For “change commitment,” participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883

Patient and Therapist Perceptions of a Publicly Funded Internet-Based Cognitive Behavioral Therapy (iCBT) Program for Ontario Adults During the COVID-19 Pandemic: Qualitative Study

“…For several clients, the asynchronous communication modality was appreciated as it reduced the barriers associated with stigma for those who were reluctant to engage in traditional therapy formats, many for the first time. These findings are consistent with the literature that posits a key advantage of iCBT is in reducing stigma and, thereby, improving service access [ 37 , 38 ]. Moreover, the absence of a waitlist in both iCBT programs ensured that clients could receive timely access to care, which is crucial given that waitlists are a large barrier to mental health care in Ontario.…”

Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research

“…When looking for new services and supports for older communities who are underserved, CBOs want programs that fit organization, staff and community strengths and needs, are culturally appropriate and flexible, have stable funding, and provide accessible training and capacity building. These findings align with similar formative research to identify strengths and needs of trusted community-based organizations as partners in evidence-based health promotion that reach community members who are often marginalized or stigmatized ( 29 , 49 , 50 ).…”

Intervensi Kesehatan Mental Berbasis Teknologi Internet

“…Penelitian kualitatif terarah yang dilakukan di Albania dan Kosovo tentang penerapan intervensi terapi perilaku kognitif berbasis internet untuk kasus depresi di seluruh layanan kesehatan mental komunitas menunjukkan bahwa sebagian besar peserta menyambut baik inovasi penerapan ICBT karena dapat meningkatkan akses ke perawatan untuk orang-orang yang terisolasi secara geografis dan mengurangi stigma yang terkait dengan perawatan kesehatan mental (Doukani, et al, 2021). Berbeda dengan penerapan internet of things (IoT) pada kesehatan mental diperoleh bahwa Penerapann IoTT pada kesehatan mentall belumm maksimal.…”