Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives

Abstract

Background Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. Objective Our objective in this review was to summarize what is known about health care professionals’ perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. Methods We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals’ views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. Results We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. Conclusions Without health professionals’ support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. Trial Registration PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk

Online therapy: an added value for inpatient routine care? Perspectives from mental health care professionals

“…The primary incentives to implement e-mental health into health care services, perceived by different organisations throughout Europe, are expected cost-effectiveness and increased access [ 14 ]. A recent systematic review revealed flexibility with timing and location as the main benefits of implementing e-mental health [ 18 ]. However, reaching patients that you might not reach otherwise cannot be seen as a benefit of e-mental health in inpatient treatment settings, where patients are already receiving care.…”

“…In 2014, different European stakeholders considered the low feasibility of delivery within existing health care systems to be a primary barrier for integrating internet-delivered psychotherapy [ 14 ]. Other barriers include the potential clinical inferiority of e-mental health compared with treatment as usual, limited internet literacy and access and suspected reluctance of mental health professionals and patients [ 14 , 20 ], as well as the confidentiality and security of patient data [ 18 ].…”

“…The authors summarized eight key success factors, including ‘strong clinical, Information Technology (IT) and organisational governance’, ‘use of well-developed and validated ICBT programmes’, ‘safe and effective provision of online therapy programmes’ and ‘well trained and supported therapists’. Recent systematic literature reviews revealed the acceptance of patients and professionals and the appropriateness of e-mental health in addressing patients’ mental health disorders as facilitators [ 18 , 22 ]. Davies et al [ 18 ] found that health professionals supported online therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access and low need for tailored content.…”

“…Recent systematic literature reviews revealed the acceptance of patients and professionals and the appropriateness of e-mental health in addressing patients’ mental health disorders as facilitators [ 18 , 22 ]. Davies et al [ 18 ] found that health professionals supported online therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access and low need for tailored content. The availability and reliability of the technology required for e-mental health applications and the interoperability of these applications with other existing technologies are further facilitators [ 22 ].…”

“…The availability and reliability of the technology required for e-mental health applications and the interoperability of these applications with other existing technologies are further facilitators [ 22 ]. Additionally, researchers have emphasised the need for targeted training of professionals and organisational support to manage changed workflows [ 18 ]. Therapists who gained first experience with blended treatment reported that having sufficient training on how to work in a blended way and how to communicate online are key components for enabling online therapies [ 19 ].…”