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- Gervind, Elisabet, et al.
(author)
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The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM framework
- 2024
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 35
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Journal article (peer-reviewed)abstract
- Background: Internet-Based Cognitive Behavioral Therapy (iCBT) holds great potential in addressing mental health issues, yet its real-world implementation poses significant challenges. While prior research has predominantly focused on centralized care models, this study explores the implementation of iCBT in the context of decentralized organizational structures within the Swedish primary care setting, where all interventions traditionally are delivered at local Primary Care Centers (PCCs).Aim: This study aims to enhance our understanding of iCBT implementation in primary care and assess the impact of organizational models on the implementation's outcome using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.Method: A mixed-methods research design was employed to identify the factors influencing iCBT implementation across different levels, involving patients, therapists and managers. Data spanning two years was collected and analyzed through thematic analysis and statistical tests. The study encompassed 104 primary care centers, with patient data (n = 1979) sourced from the Swedish National Quality Register for Internet-Based Psychological Treatment (SibeR). Additionally, 53 iCBT therapists and 50 PCC managers completed the Normalization Measure Development Questionnaire, and 15 leaders participated in interviews.Results: Our investigation identified two implementation approaches, one concentrated and one decentralized. Implementation effectiveness was evident through adherence rates suggesting that iCBT is a promising approach for treating mental ill-health in primary care, although challenges were observed concerning patient assessment and therapist drift towards unstructured treatment. Mandatory implementation, along with managerial and organizational support, positively impacted adoption. Results vary in terms of adherence to established protocols, with therapists working in concentrated model showing a significantly higher percentage of registration in the quality register SibeR (X2 (1, N = 2973) = 430.5774, p = 0.001). They also showed significantly higher means in cognitive participation (Z = - 2.179, p = 0.029) and in reflective monitoring (Z = - 2.548, p = 0.011). Discussion: Overall, the study results demonstrate that iCBT, as a complex and qualitatively different intervention from traditional psychological treatment, can be widely implemented in primary care settings. The study's key finding highlights the substantial advantages of the concentrated organizational model. This model has strengths in sustainability, encourages reflective monitoring among therapists, the use of quality registers, and enforces established protocols.Conclusion: In conclusion, this study significantly contributes to the understanding of the practical aspects associated with the implementation of complex internet interventions, particularly in the context of internetbased cognitive-behavioral therapy (iCBT). The study highlights that effective iCBT integration into primary care requires a multifaceted approach, taking into account organizational models, robust support structures, and a commitment to maintaining quality standards. By emphasizing these factors, our research aims to provide actionable insights that can enhance the practicability and real-world applicability of implementing iCBT in primary care settings.
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| 2. |
- Gervind, Elisabet, et al.
(author)
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The transference of research results to practise: Organization and implementation outcomes of iCBT in primary care – a mixed methods study using the RE-AIM framework
- 2022
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In: SWESRII 2022.
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Conference paper (other academic/artistic)abstract
- Background: Healthcare systems all over the world are working in dynamic and resource-constrained contexts. Implementation science plays a critical role in ensuring that costly research results are implemented and improve public health. Implementation of iCBT in regular care has given mixed results and has rarely been documented on the basis of a scientific framework for implementation research. Aim: The overall aim of the present study is to contribute to knowledge about how iCBT can be implemented and organized in primary care. The current study also explores naturalistic variability in two different organizational formats, concentrated and decentralized. Method: A mixed quantitative-qualitative design was used to identify factors that impact the implementation of iCBT across multiple levels, including patient, therapists, leaders and organization. The scientific framework RE-AIM with the dimensions reach (those in the target group participating in the program), effectiveness (effects after completion of the program), adoption (actors who accept the program), implementation (compliance with the program according to protocol), maintenance (sustainability over time) was used to evaluate the implementation. Results: 104 primary care centres participated in the study. Outcomes on patient-data (n=1979) were gathered between 2018 and 2021 from the quality register SibeR. Fifty-four iCBT-therapists, answered the NoMAD-questionnaire and fifteen leaders were interviewed. The materials are currently being analysed.
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| 3. |
- Månsson, Kristoffer N T, et al.
(author)
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Development and Initial Evaluation of an Internet-Based Support System for Face-to-Face Cognitive Behavior Therapy: A Proof of Concept Study
- 2013
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In: Journal of Medical Internet Research. - : Journal of Medical Internet Research / JMIR Publications. - 1438-8871. ; 15:12
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Journal article (peer-reviewed)abstract
- Background: Evidence-based psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective in treating several anxiety and mood disorders. Nevertheless, issues regarding adherence are common, such as poor patient compliance on homework assignments and therapists drifting from strictly evidence-based CBT. The development of Internet-delivered CBT (ICBT) has been intensive in the past decade and results show that guided ICBT can be as effective as face-to-face CBT but also indicate a need to integrate the two forms of CBT delivery. less thanbrgreater than less thanbrgreater thanObjective: In this study, we developed and tested a new treatment format in which ICBT and face-to-face therapy were blended. We designed a support system accessible via the Internet (using a computer or an Apple iPad) for patients and therapists delivering CBT face-to-face. The support system included basic CBT components and a library of interventions gathered from existing ICBT manuals. less thanbrgreater than less thanbrgreater thanMethods: The study involved 15 patients with mild to moderate anxiety or depression (or both). Eight therapists conducted the treatments. All participants were interviewed after the nine-week intervention. Further, patients provided self-reports on clinical measures pre- and post-trial, as well as at a 12-month follow-up. less thanbrgreater than less thanbrgreater thanResults: A reduction was found in symptom scores across all measures. The reliable change index ranged from 60% to 87% for depression and anxiety. Large effect sizes (Cohens d) ranging from 1.62 (CI 95% 0.59-2.66) to 2.43 (CI 95% 1.12-3.74) were found. There were no missing data and no treatment dropouts. In addition, the results had been maintained at the 12-month follow-up. Qualitative interviews revealed that the users perceived the support system as beneficial. less thanbrgreater than less thanbrgreater thanConclusions: The results suggest that modern information technology can effectively blend with face-to-face treatments and be used to facilitate communication and structure in therapy, thus reducing therapist drift.
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