Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial
BackgroundInternet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective....
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2023-02-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2023/1/e41532 |
| _version_ | 1797734431053578240 |
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| author | Christiaan Vis Josien Schuurmans Bruno Aouizerate Mette Atipei Craggs Philip Batterham Leah Bührmann Alison Calear Arlinda Cerga Pashoja Helen Christensen Els Dozeman Claus Duedal Pedersen David Daniel Ebert Anne Etzelmueller Naim Fanaj Tracy L Finch Denise Hanssen Ulrich Hegerl Adriaan Hoogendoorn Kim Mathiasen Carl May Andia Meksi Sevim Mustafa Bridianne O'Dea Caroline Oehler Jordi Piera-Jiménez Sebastian Potthoff Gentiana Qirjako Tim Rapley Judith Rosmalen Ylenia Sacco Ludovic Samalin Mette Maria Skjoth Kristine Tarp Ingrid Titzler Erik Van der Eycken Claire Rosalie van Genugten Alexis Whitton Enrico Zanalda Jan H Smit Heleen Riper |
| author_facet | Christiaan Vis Josien Schuurmans Bruno Aouizerate Mette Atipei Craggs Philip Batterham Leah Bührmann Alison Calear Arlinda Cerga Pashoja Helen Christensen Els Dozeman Claus Duedal Pedersen David Daniel Ebert Anne Etzelmueller Naim Fanaj Tracy L Finch Denise Hanssen Ulrich Hegerl Adriaan Hoogendoorn Kim Mathiasen Carl May Andia Meksi Sevim Mustafa Bridianne O'Dea Caroline Oehler Jordi Piera-Jiménez Sebastian Potthoff Gentiana Qirjako Tim Rapley Judith Rosmalen Ylenia Sacco Ludovic Samalin Mette Maria Skjoth Kristine Tarp Ingrid Titzler Erik Van der Eycken Claire Rosalie van Genugten Alexis Whitton Enrico Zanalda Jan H Smit Heleen Riper |
| author_sort | Christiaan Vis |
| collection | DOAJ |
| description |
BackgroundInternet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary.
ObjectiveThis study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia.
MethodsA stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit.
ResultsIn total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it.
ConclusionsThe ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice.
Trial RegistrationClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883
International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04686-4 |
| first_indexed | 2024-03-12T12:43:34Z |
| format | Article |
| id | doaj.art-8e5d0e47da0f4f42a9edbe8fd365b4f6 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:43:34Z |
| publishDate | 2023-02-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-8e5d0e47da0f4f42a9edbe8fd365b4f62023-08-28T23:35:14ZengJMIR PublicationsJournal of Medical Internet Research1438-88712023-02-0125e4153210.2196/41532Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized TrialChristiaan Vishttps://orcid.org/0000-0001-8783-8487Josien Schuurmanshttps://orcid.org/0000-0003-4029-1810Bruno Aouizeratehttps://orcid.org/0000-0002-7092-7747Mette Atipei Craggshttps://orcid.org/0000-0001-8102-4597Philip Batterhamhttps://orcid.org/0000-0002-4547-6876Leah Bührmannhttps://orcid.org/0000-0001-6957-4369Alison Calearhttps://orcid.org/0000-0002-7028-725XArlinda Cerga Pashojahttps://orcid.org/0000-0002-7029-947XHelen Christensenhttps://orcid.org/0000-0003-0435-2065Els Dozemanhttps://orcid.org/0000-0002-3550-4298Claus Duedal Pedersenhttps://orcid.org/0000-0002-6637-0392David Daniel Eberthttps://orcid.org/0000-0001-6820-0146Anne Etzelmuellerhttps://orcid.org/0000-0001-8833-6067Naim Fanajhttps://orcid.org/0000-0001-7375-643XTracy L Finchhttps://orcid.org/0000-0001-8647-735XDenise Hanssenhttps://orcid.org/0000-0003-0119-9608Ulrich Hegerlhttps://orcid.org/0000-0003-2031-0594Adriaan Hoogendoornhttps://orcid.org/0000-0003-4784-0712Kim Mathiasenhttps://orcid.org/0000-0001-6067-8866Carl Mayhttps://orcid.org/0000-0002-0451-2690Andia Meksihttps://orcid.org/0000-0003-1769-1488Sevim Mustafahttps://orcid.org/0000-0003-1105-6475Bridianne O'Deahttps://orcid.org/0000-0003-1731-210XCaroline Oehlerhttps://orcid.org/0000-0001-8329-147XJordi Piera-Jiménezhttps://orcid.org/0000-0001-6471-9979Sebastian Potthoffhttps://orcid.org/0000-0003-4580-8532Gentiana Qirjakohttps://orcid.org/0000-0003-3179-9006Tim Rapleyhttps://orcid.org/0000-0003-4836-4279Judith Rosmalenhttps://orcid.org/0000-0002-6393-0032Ylenia Saccohttps://orcid.org/0000-0002-2312-5231Ludovic Samalinhttps://orcid.org/0000-0003-0740-4019Mette Maria Skjothhttps://orcid.org/0000-0002-3528-4619Kristine Tarphttps://orcid.org/0000-0003-0901-855XIngrid Titzlerhttps://orcid.org/0000-0002-8963-2324Erik Van der Eyckenhttps://orcid.org/0000-0001-5807-3366Claire Rosalie van Genugtenhttps://orcid.org/0000-0003-3209-4673Alexis Whittonhttps://orcid.org/0000-0002-7944-2172Enrico Zanaldahttps://orcid.org/0000-0003-4449-8384Jan H Smithttps://orcid.org/0000-0002-2062-8378Heleen Riperhttps://orcid.org/0000-0002-8144-8901 BackgroundInternet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. ObjectiveThis study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. MethodsA stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. ResultsIn total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. ConclusionsThe ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. Trial RegistrationClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-020-04686-4https://www.jmir.org/2023/1/e41532 |
| spellingShingle | Christiaan Vis Josien Schuurmans Bruno Aouizerate Mette Atipei Craggs Philip Batterham Leah Bührmann Alison Calear Arlinda Cerga Pashoja Helen Christensen Els Dozeman Claus Duedal Pedersen David Daniel Ebert Anne Etzelmueller Naim Fanaj Tracy L Finch Denise Hanssen Ulrich Hegerl Adriaan Hoogendoorn Kim Mathiasen Carl May Andia Meksi Sevim Mustafa Bridianne O'Dea Caroline Oehler Jordi Piera-Jiménez Sebastian Potthoff Gentiana Qirjako Tim Rapley Judith Rosmalen Ylenia Sacco Ludovic Samalin Mette Maria Skjoth Kristine Tarp Ingrid Titzler Erik Van der Eycken Claire Rosalie van Genugten Alexis Whitton Enrico Zanalda Jan H Smit Heleen Riper Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial Journal of Medical Internet Research |
| title | Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial |
| title_full | Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial |
| title_fullStr | Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial |
| title_full_unstemmed | Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial |
| title_short | Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial |
| title_sort | effectiveness of self guided tailored implementation strategies in integrating and embedding internet based cognitive behavioral therapy in routine mental health care results of a multicenter stepped wedge cluster randomized trial |
| url | https://www.jmir.org/2023/1/e41532 |
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