Barriers and facilitators to implement e-mental health for depression and anxiety in patients with macular oedema: a qualitative interview study among stakeholders

Abstract

Purpose: Mental health problems are common in patients with macular oedema, who receive repeated intravitreal injections with anti-vascular endothelial growth factor. A guided internet-based self-help intervention, called E-PsEYE, was developed to reduce these problems. Patients were referred by their ophthalmologist to follow E-PsEYE individually at home, guided by a social worker from low vision services. Since e-mental health is new in this setting and professionals were collaborating in a novel way, barriers and facilitators during implementation and for future scale-up were evaluated. Methods: Semi-structured interviews were performed with patients (n=8), ophthalmologists (n=4), heads of ophthalmology departments (n=2), doctor’s assistants (n=3), social workers (n=6) and managers from low vision services (n=2), and representatives from a health insurer (n=2). Data were analyzed using a thematic approach. Results: Both patients and professionals were satisfied with the potential efficiency and added value of the intervention. They indicated that sufficient digital skills in patients and social workers, information technology (IT) support and adding personalized face-to-face contacts, could facilitate implementation. However, a high workload within the different settings (i.e., hospital and low vision services) and the reluctance of both patients and professionals in focusing on mental health problems could hinder implementation. Moreover, evidence on cost-effectiveness and incorporation in current guidelines were expected to be important for reimbursement and scale-up. Conclusions: Both on the individual level and in the interaction between stakeholders and their context, different important barriers and facilitators were expressed. To facilitate the use of E-PsEYE in practice, strategies that focus on these aspects could be implemented, e.g. healthcare providers could discuss and normalize mental health complaints and their digital skills could be supported.