Implementation of eMental Health care: viewpoints from key informants from organizations and agencies with eHealth mandates

Abstract

BackgroundThe use of technology such as computers, tablets, and smartphones to improve access to and the delivery of mental health care (eMental Health care) is growing worldwide. However, despite the rapidly expanding evidence base demonstrating the efficacy of eMental Health care, its implementation in clinical practice and health care systems remains fragmented. To date, no peer-reviewed, key-informant studies have reported on the perspectives of decision-makers concerned with whether and how to implement eMental Health care.MethodsFrom September to November 2015, we conducted 31 interviews with key informants responsible for leadership, policy, research, and/ or information technology in organizations influential in the adoption of technology for eMental Health care. Deductive and inductive thematic analyses of transcripts were conducted using the Behavior Change Wheel as an organizing framework. Frequency and intensity effect sizes were calculated for emerging themes to further explore patterns within the data.ResultsKey informant responses (n = 31) representing 6 developed countries and multiple organizations showed consensus on common factors impacting implementation: individual and organizational capacities (e.g., computer literacy skills [patients and providers], knowledge gaps about cyber security, limited knowledge of available services); motivational drivers of technology-based care (e.g., extending care, data analytics); and opportunities for health systems to advance eMental Health care implementation (e.g., intersectoral research, rapid testing cycles, sustainable funding). Frequency effect sizes showed strong associations between implementation and credibility, knowledge, workflow, patient empowerment, electronic medical record (EMR) integration, sustained funding and intersectoral networks. Intensity effect sizes showed the highest concentration of statements (>10% of all comments) related to funding, credibility, knowledge gaps, and patient empowerment.ConclusionThis study provides previously unavailable information about key informant perspectives on eMental Health care implementation. The themes that emerged, namely the need to intensify intersectoral research, measure/monitor readiness to implement, define cost-utility benchmarks, raise awareness about available technologies, and test assumptions that ‘proven’ technologies will be easily integrated can inform the design and evaluation of eMental Health care implementation models.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-017-0474-9) contains supplementary material, which is available to authorized users.

OpenSIMPLe: A real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder

“…Therefore, the final implementation of a potentially widely available intervention could have been compromised if retention continued to drop. Moreover, upscaling of an open platform could potentially be affected by socio-demographic, cultural and technical factors (Aranda-Jan et al, 2014;Wozney et al, 2017b).…”

“…Despite the initial optimism around IBPs in the mental health field and some positive findings regarding their efficacy, few projects have successfully implemented the platforms they evaluated (Buntrock et al, 2016;Firth et al, 2017;Wozney et al, 2017a). Most remained as research-only platforms never accomplishing their ultimate aim of becoming mental healthcare services in the real world (Meurk et al, 2016;Wozney et al, 2017a).…”

“…Despite the initial optimism around IBPs in the mental health field and some positive findings regarding their efficacy, few projects have successfully implemented the platforms they evaluated (Buntrock et al, 2016;Firth et al, 2017;Wozney et al, 2017a). Most remained as research-only platforms never accomplishing their ultimate aim of becoming mental healthcare services in the real world (Meurk et al, 2016;Wozney et al, 2017a). Conversely, many platforms and smartphone applications (apps) which were not properly evaluated ended up being widely available mainly due to an increasing pressure of stakeholders (Ruwaard and Kok, 2015) and the lack of clear validation guidelines and policies to regulate these new technologies (Charani et al, 2014;Lewis and Wyatt, 2014;Torous et al, 2016).…”

A “P5” Approach to Healthcare and Health Technology

“…On the other hand, eHealth has proven to promote patient engagement (Ahern et al 2008;Barello et al 2016), which is, as written above, patients' commitment to their own healthcare journey and ability to manage life commitments (e.g., work) despite illness (Riva et al 2015). This is also related to the possibility for technology to promote knowledge/literacy and empower decision-making (Kondylakis et al 2012(Kondylakis et al , 2013Norman and Skinner 2006;Wozney et al 2017); indeed, information on health, therapy, and disease are made more accessible and easy to understand, and decisions to be taken may be represented and explained in the context of technology-enhanced decision support systems.…”

Organisational Implementation Climate in implementing internet-based Cognitive Behaviour Therapy for depression

“…Both perceived appropriateness and acceptability by mental health service providers are known to be important determinants of successful implementation of iCBT services in routine care [15][16][17][18]. Appropriateness refers to the perceived and proven t of iCBT in treating common mental disorders and acceptability concerns the perception of users including patients and service providers that the iCBT service is palatable or satisfactory in its use [19].…”