Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals?

Abstract

BackgroundWith increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH).ObjectiveThe aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations.MethodsA 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team.ResultsUptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource.ConclusionsA conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients.

Evaluation of a three-phase implementation program in enhancing e-mental health adoption within Indigenous primary healthcare organisations

“…Additionally, experiences reported in the follow-up support records may also not fully represent the experience of others in the organisation. However, the themes identi ed here are similar to those of previous studies within the eld [8,[14][15]; thus, provide a level of con dence regarding the validity and reliability of the present ndings. Another limitation is that the consumers' voices were not heard separately to that of the service providers' during the e-index consultations and follow up interviews.…”

“…To further understand how the implementation program enhanced organisational readiness, participant experiences from case and non-case studies were examined. Similar to the previous ndings with Indigenous organisations, factors such as IT resources and infrastructure, leadership and support, policy and protocols around eMH utilisation and its integration into practice, were identi ed as essential to eMH uptake [8,[14][15]. In accordance with the previous ndings, issues such as insu cient technological and human resources, and not having clear policies and procedures around use of eMH approaches posed as barriers to eMH uptake.…”

“…Issues such as limited time due to high workload and competing priorities (i.e., practical needs of clients for support with housing, food or nance), and practice frameworks that did not allow for one-on-one time, were highlighted as signi cant barriers. Previous ndings with Indigenous organisations also found similar issues [14][15].…”

“…As reported in Raphiphatthana et al the majority of the trainees indicated that organisational readiness is essential to eMH implementation [14]. Similar to other ndings within the eld, lack of information technology (IT) resources as well as insu cient policy and procedures to support eMH use were found to impede eMH adoption [15]. Consequently, Raphiphatthana et al proposed a three-phase implementation program to address organisational readiness for eMH implementation which involved pre-training consultations, training, and follow-up support [14].…”

Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study

“…The science of implementing patient-facing technologies remains underexplored. Yet, the challenges in implementation are often not reported nor perceived important in academic literature [ 31 ]. With the emergence of next generation personal health technologies (eg, wearables, sensors, and medical devices) and their increasing popularity in the general population, further research is required to guide the implementation of patient-facing technologies across health care and personal settings to maximize their potential and prevent harm.…”