Region Västra Götaland, Centre for Digital Health, The Unit of ePsychiatry, Sahlgrenska University Hospital, Kastellgatan 1, 413 07, Gothenburg, Sweden.
Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden.
BMC Health Serv Res. 2020 Aug 8;20(1):729. doi: 10.1186/s12913-020-05596-6.
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.
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.
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 long-term 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.
The study contributes new knowledge and insights into the implementation process of ICBT-i in psychiatric health care. Our findings highlight the importance of providing training, support, and guidance in online treatment for therapists when implementing a technological innovation. Technical problems should be minimised and the maintenance and demand-side value for the technology must be clear. Support from managers at all levels is crucial, particularly support to therapists in everyday prioritisation among competing demands. Besides taking the identified determinants into account, managing complexity is important for successful scale-up implementation.
失眠是精神卫生保健患者常见的诊断，因此非常需要有效的治疗方法。先前的研究表明，针对失眠的互联网认知行为疗法（ICBT-i）对各种患者都有帮助，并且可能对精神卫生保健患者有效。但是，对于在精神卫生保健中实施 ICBT-i 的情况知之甚少。本研究旨在探讨参与精神卫生保健门诊中 ICBT-i 试点实施的治疗师和管理人员的经验，并确定实施的决定因素。
对在精神卫生保健门诊中直接参与该试点实施的 7 名治疗师和 5 名管理人员进行了半结构化访谈。使用 NASSS 框架指导的定性内容分析方法对数据进行分析，采用归纳法和演绎法相结合的方法。
分析结果揭示了 32 个促进因素、21 个障碍因素以及 2 个既是障碍因素又是促进因素的因素，这些因素在 NASSS 的 7 个领域下的 1-5 个主题中进行了组织。主要促进因素包括：满足了对 ICBT-i 计划治疗选择的需求，将 ICBT-i 作为失眠治疗选择的经验益处，培训和支持，管理者和更广泛系统的参与和支持，以及维持技术的长期组织。主要障碍因素包括：治疗师对 ICBT-i 的兴趣低，招募患者困难，治疗师在线提供治疗的能力低，技术问题以及治疗师的竞争需求导致 ICBT-i 的优先级低。复杂性分析评估了两个 NASSS 领域为简单，四个为复杂，一个为复杂。
本研究为在精神卫生保健中实施 ICBT-i 的实施过程提供了新的知识和见解。我们的研究结果强调了为治疗师提供在线治疗培训、支持和指导的重要性，这对于实施技术创新至关重要。应尽量减少技术问题，并明确技术的维护和需求方价值。各级管理人员的支持至关重要，特别是在日常治疗中，要为治疗师提供竞争需求下的支持，帮助他们确定优先级。除了考虑已确定的决定因素外，管理复杂性对于成功实施扩大规模也很重要。
