Cha Biblia S, Eikey Elizabeth V, Mukamel Dana B, Palomares Kristy J, Schueller Stephen M, Sorkin Dara H, Stadnick Nicole A, Stoeckl Sarah Elizabeth, Zheng Kai, Schneider Margaret L
Department of General Internal Medicine, University of California, Irvine, CA, USA.
School of Medicine, University of California, 100 Theory, Suite 120, Irvine, CA, 92697, USA.
Adm Policy Ment Health. 2025 Apr 19. doi: 10.1007/s10488-025-01441-2.
Peers are individuals with lived experience of mental health challenges trained to provide support to others with similar challenges. Help@Hand was a multi-site project that integrated peers into digital mental health intervention (DMHI) implementation. This study uses the Consolidated Framework for Implementation Research (CFIR) to frame challenges reported by peers when implementing DMHIs. Individuals leading the local peer workforce completed quarterly online surveys about perceived challenges to DMHI implementation. Biannual interviews probed for details on survey-reported challenges. 103 quarterly surveys and 39 bi-annual interviews were collected from key informants at 11 Help@Hand sites between Summer 2020 and Fall 2022. One challenge was tied directly to DMHIs; namely, device distribution. Several related to the Implementation Process, including challenges with recruiting qualified peers and integrating peers into DMHI implementations; communication and collaboration; and translation. Challenges in the Individual domain included unclear peer roles and multi-tasking across various projects. Inner Setting challenges included structural barriers to hiring peers, issues with communication and project management, and workforce turnover. Outer Setting challenges related to environmental technology readiness, COVID-19, unclear decision-making processes across the collaborative, and uneven communication between sites' peers. Funding uncertainty bridged the Inner and Outer Settings. Using the CFIR model to frame challenges to DMHI implementation yielded useful lessons, especially when peers are engaged as partners in planning and implementation process. Successful implementation will be enhanced by ensuring adequate environmental readiness for tech-based interventions, clear role definition, streamlined peer hiring processes, and well-delineated lines of communication locally and across sites.
同伴是指那些有心理健康挑战亲身经历且经过培训能够为有类似挑战的其他人提供支持的个体。“援手相助”（Help@Hand）是一个多地点项目，该项目将同伴纳入数字心理健康干预（DMHI）的实施过程中。本研究使用实施研究综合框架（CFIR）来梳理同伴在实施数字心理健康干预时所报告的挑战。当地同伴工作团队的负责人每季度完成一次关于数字心理健康干预实施中所感知挑战的在线调查。每半年进行一次访谈，深入了解调查中所报告挑战的细节。在2020年夏季至2022年秋季期间，从“援手相助”项目11个地点的关键信息提供者处收集了103份季度调查和39份半年访谈。其中一个挑战直接与数字心理健康干预相关，即设备分发。还有几个挑战与实施过程有关，包括招募合格同伴以及将同伴纳入数字心理健康干预实施过程中的挑战、沟通与协作以及翻译方面的挑战。个体领域的挑战包括同伴角色不明确以及在多个项目中同时处理多项任务。内部环境挑战包括招聘同伴的结构性障碍、沟通和项目管理方面的问题以及员工流动率。外部环境挑战涉及环境技术准备情况、新冠疫情、合作中决策过程不明确以及各地点同伴之间沟通不均衡。资金不确定性跨越了内部和外部环境。使用CFIR模型来梳理数字心理健康干预实施中的挑战产生了有益的经验教训，特别是当同伴作为合作伙伴参与规划和实施过程时。通过确保对基于技术的干预有足够的环境准备、明确角色定义、简化同伴招聘流程以及在本地和各地点清晰划分沟通线路，将有助于成功实施。
