Exploring barriers and facilitators for mental health professionals delivering behavioural activation to young people with depression: qualitative study using the Theoretical Domains Framework

Abstract

Background Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice. Aims We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study. Method Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT). Results Nine MHPs were interviewed. Thirteen of fourteen TDF domains were relevant, including perceived professional identity, beliefs about own capabilities and perceived positive or negative consequences of using manualised behavioural activation, social influences, memory and attention, and environmental resources. Fourteen theory-linked BCTs were identified as possible strategies to help clinicians overcome barriers (e.g. integrating behavioural practice/rehearsal, prompts and persuasive communications within training, and supervision). Conclusions Behavioural science approaches (TDF, TTT) helped conceptualise key barriers and facilitators for MHPs delivering manualised behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research–practice gap in clinical psychology.

Perceived Barriers and Facilitators to a Healthy Diet among Cancer Survivors: A Qualitative Exploration Using the TDF and COM-B

“…The main limitation of this study, as with most qualitative research, is that the sample size is relatively small. However, it is in line with other COM-B [28,49] and dietary studies [50][51][52], and greater than several [53][54][55]. This study was mainly conducted with female breast cancer survivors; at the same time, this is reflective of many studies on cancer survivors.…”

Barriers and enablers to implementing intranasal ketamine for Primary Care Paramedics in Canada – A parallel convergent mixed methods study

“…The two authors developed a coding guide based on the constructs of the TDF 28 informed by existing studies. 29 Where data could be assigned to more than one domain, the authors came to an agreement on a dominant domain. To ensure fidelity of the coding, the authors coded two transcripts together then completed the remaining coding independently.…”

Barriers and facilitators to cervical cancer screening for women from culturally and linguistically diverse backgrounds; a qualitative study of GPs

“…21 It has been widely applied across healthcare-related research focused on changing clinical and professional behaviours, including understanding barriers and facilitators to behaviours related to healthcare outcomes. [21][22][23] Therefore, using TDF, this study aims to explore GPs' perspectives on the barriers and facilitators to CCS for women from CALD backgrounds. By discovering the views of those who primarily provide CCS in the community, we aim to gain a deeper understanding of the barriers faced in every-day clinical practice, and insights into factors that can be used to increase participation in CCS for these women.…”

“…The Theoretical Domains Framework (TDF) is a conceptual, validated framework that has synthesised 33 behavioural theories forming 14 domains, and is a useful tool to support researchers in understanding the environmental, social and cognitive influences on behaviour 21. It has been widely applied across healthcare-related research focused on changing clinical and professional behaviours, including understanding barriers and facilitators to behaviours related to healthcare outcomes 21–23…”