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
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 o...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-03-01
|
| Series: | Internet Interventions |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214782923000982 |
| _version_ | 1797277359811854336 |
|---|---|
| author | Elisabet Gervind Mathilda Ben Salem Cecilia Svanborg Monica E. Nyström Josefine L. Lilja Viktor Kaldo Sandra Weineland |
| author_facet | Elisabet Gervind Mathilda Ben Salem Cecilia Svanborg Monica E. Nyström Josefine L. Lilja Viktor Kaldo Sandra Weineland |
| author_sort | Elisabet Gervind |
| collection | DOAJ |
| description | 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 internet-based 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. |
| first_indexed | 2024-03-07T15:46:32Z |
| format | Article |
| id | doaj.art-7728bd5013974a9dbeb59c174b6c8c9a |
| institution | Directory Open Access Journal |
| issn | 2214-7829 |
| language | English |
| last_indexed | 2024-03-07T15:46:32Z |
| publishDate | 2024-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Internet Interventions |
| spelling | doaj.art-7728bd5013974a9dbeb59c174b6c8c9a2024-03-05T04:29:47ZengElsevierInternet Interventions2214-78292024-03-0135100698The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM frameworkElisabet Gervind0Mathilda Ben Salem1Cecilia Svanborg2Monica E. Nyström3Josefine L. Lilja4Viktor Kaldo5Sandra Weineland6Research, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, SwedenNärhälsan, Region Västra Götaland, SwedenCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, SwedenDepartment of Learning, Informatics, Management and Ethics, Karolinska Institutet, Department of Epidemiology and Global Health, Umeå University, Umeå, SwedenDepartment of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenCentre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, SwedenResearch, Development, Education and Innovation, Primary Health Care, Region Västra Götaland, Sweden; Närhälsan, Region Västra Götaland, Sweden; General Practice/Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden; Corresponding author at: Department of Psychology, University of Gothenburg, Gothenburg, Sweden.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 internet-based 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.http://www.sciencedirect.com/science/article/pii/S2214782923000982Internet-based cognitive behavior therapyiCBTImplementation scienceComplex interventionPrimary careRE-AIM framework |
| spellingShingle | Elisabet Gervind Mathilda Ben Salem Cecilia Svanborg Monica E. Nyström Josefine L. Lilja Viktor Kaldo Sandra Weineland 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 Internet Interventions Internet-based cognitive behavior therapy iCBT Implementation science Complex intervention Primary care RE-AIM framework |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Internet-based cognitive behavior therapy iCBT Implementation science Complex intervention Primary care RE-AIM framework |
| url | http://www.sciencedirect.com/science/article/pii/S2214782923000982 |
| work_keys_str_mv | AT elisabetgervind theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT mathildabensalem theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT ceciliasvanborg theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT monicaenystrom theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT josefinellilja theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT viktorkaldo theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT sandraweineland theinfluenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT elisabetgervind influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT mathildabensalem influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT ceciliasvanborg influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT monicaenystrom influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT josefinellilja influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT viktorkaldo influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework AT sandraweineland influenceoforganizationalmodelsontheimplementationofinternetbasedcognitivebehaviortherapyinprimarycareamixedmethodsstudyusingthereaimframework |