Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health

Abstract

Background Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. Objective The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting—forensic mental health care—by means of participatory development with therapists. Methods The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. Results In phase 1, it became clear that the therapists’ main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. Conclusions The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed.

A Perspective on the Integration of eHealth in Treatment of Offenders: Combining Technology and the Risk-Need-Responsivity Model

“…However, there is a gap between the current situation and the potential of eHealth: uptake in practice is lagging behind on expectations ( 14 , 17 ). An explanation for this gap is that eHealth is often used as a separate addition instead of in a blended way ( 20 ). Blended care refers to the combination of “offline,” in-person treatment with “online” technologies ( 21 ).…”

Das Beste aus zwei Welten: Eine systematische Übersicht zu Faktoren der Implementierung einer “Blended Therapy” (Gemischte Therapie) in der Psychotherapeutischen Routineversorgung

“…Im Fokus der Forschung steht weiterhin die Frage, in welchem Format die blended therapy am besten angeboten werden sollte. Entsprechende Empfehlungen geben sieben qualitative [Wilhelmsen et al, 2013;Wentzel et al, 2016;Paul et al, 2019;Titzler et al, 2019;Urech et al, 2019;Kip et al, 2020;Mol et al, 2020;Valentine et al, 2020], zwei Mixed-Methods-[van der Vaart et al, 2014] sowie eine quantitative Studie [Kemmeren et al, 2019]. Die Publikationen geben Aufschluss über Einsatzmöglichkeiten, Inhalte und Struktur der Therapie.…”

“…Die Frage nach der Indikation ist dementsprechend von relevanter Bedeutung im Implementierungsprozess. Impulse zur Beantwortung dieser Frage geben acht qualitative Publikationen [Wilhelmsen et al, 2013;Wentzel et al, 2016;Etzelmueller et al, 2018;Titzler et al, 2018;Paul et al, 2019;Urech et al, 2019;Kip et al, 2020;Mol et al, 2020] sowie eine quantitative Studie [Kemmeren et al, 2019]. Es wird davon ausgegangen, dass die blended therapy nicht für alle Patient*innen gleichermaßen angemessen sei [Paul et al, 2019].…”

“…B. Sprachfertigkeiten). Das individuelle Reflektieren könnte bei Patient*innen, die es nicht gewohnt sind ihre Gedanken und Gefühle offen mitzuteilen, unerwartet starke Emotionen auslösen, die nicht direkt in einem therapeutischen Gespräch aufgefangen werden [Kip et al, 2020]. Im Bereich der Fähigkeiten und Fertigkeiten wird weiterhin das Vorhandensein technischer Fertigkeiten als vorteilhaft angesehen, um Patient*innen durch die Nutzung digitaler Medien nicht zu überfordern [Paul et al, 2019].…”

“…Während zu den Einflussfaktoren Alter und Symptomschwere widersprüchliche Befunde vorliegen, scheinen bestimmte Fähigkeiten und Fertigkeiten sowie komorbide Erkrankungen mit dem Therapieerfolg in Zusammenhang zu stehen [Etzelmueller et al, 2018;Kemmeren et al, 2019;Paul et al, 2019]. Die multiplen Gestaltungsmöglichkeiten sollten bereits vor Beginn der Therapie gemeinsam mit den Patient*innen diskutiert werden [Wentzel et al, 2016;Kip et al, 2020].…”