Doukani Asmae, Cerga Pashoja Arlinda, Fanaj Naim, Qirjako Gentiana, Meksi Andia, Mustafa Sevim, Vis Christiaan, Hug Juliane
Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
Global Public Health, United Kingdom Health Security Agency, London, United Kingdom.
JMIR Form Res. 2021 Nov 1;5(11):e29280. doi: 10.2196/29280.
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.
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.
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.
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.
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.
ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883.
使用数字心理健康项目，如基于互联网的认知行为疗法（iCBT），有望提高心理健康服务的质量并扩大其可及性。然而，关于在东欧实施iCBT的可行性，开展的研究非常少。
本研究旨在定性评估阿尔巴尼亚和科索沃各地社区心理健康中心（CMHCs）实施针对抑郁症的iCBT的组织准备情况。
我们采用了定性半结构化焦点小组讨论，该讨论以布莱恩·韦纳的组织变革准备模型为指导。问题广泛探讨了实施变革的共同决心（变革承诺）以及对自身集体实施能力的共同信念（变革效能）。数据收集于2017年11月至12月之间。从阿尔巴尼亚的3个CMHCs和科索沃的4个CMHCs招募了一系列在CMHCs工作或与其相关联的医疗保健专业人员，这些中心正在参与一项在9个国家实施iCBT的大型跨国试验（地平线2020实施全项目）。使用定向定性内容分析法对数据进行分析，该方法结合了归纳法和演绎法。
进行了6次焦点小组讨论，涉及69名心理健康护理专业人员。来自科索沃（36/69，52%）和阿尔巴尼亚（33/69，48%）的参与者大多为女性（48/69，70%）和护士（26/69，38%），平均年龄为41.3岁。定向定性内容分析揭示了一些可能影响在社区心理健康环境中实施针对抑郁症的数字CBT干预措施的障碍和促进因素。虽然变革承诺很高，但由于一系列情境因素，变革效能有限。影响“变革效能”的障碍包括iCBT与临床不匹配、影响求助行为的高度污名化、人力资源短缺、技术基础设施差以及工作量大。促进因素包括对接受iCBT培训有高度兴趣和能力。对于“变革承诺”，参与者大多表示欢迎创新，并且iCBT可以增加地理上孤立人群获得治疗的机会，并减少与心理健康护理相关的污名。
总之，参与者对iCBT在促进心理健康护理创新、增加服务可及性和减少污名方面给予了积极评价。然而，在接触目标治疗人群、心理健康污名文化、信息和通信技术基础设施不发达以及经过适当培训的医疗保健劳动力有限等方面也突出了一系列障碍，这些障碍降低了实施针对抑郁症的iCBT的组织准备情况。可以通过以下方式解决这些障碍：（1）开展面向公众的消除心理健康污名化运动；（2）进行服务层面的调整，使工作人员有时间、资源和临床监督来提供iCBT；（3）为医疗保健专业人员建立合适的临床培训课程。
ClinicalTrials.gov NCT03652883；https://clinicaltrials.gov/ct2/show/NCT03652883
