Barriers to and Facilitators of Implementing DEPENAS Biopsychosocial Intervention in Primary Care: A Study Protocol

Abstract

Background: Our team has developed a biopsychosocial intervention called DEPENAS that has shown to be effective in primary health care in improving health and quality of life of patients with medically unexplained symptoms. We also found that general practitioners participating in the clinical trial do not use the intervention systematically because of barriers related to psychological determinants among professionals themselves. Based on the Theoretical Domains Framework (TDF) of Susan Michie, our study aims (1) to identify psychological determinants among professionals who are perceived to be facilitators of or barriers to the systematic and generalized use of the intervention in the consultation room and (2) to design an implementation strategy that considers these determinants and helps us to address them with a series of predesigned and validated techniques. Method: A qualitative exploratory study has been designed based on semistructured individual interviews conducted following a script based on the 14 TDF domains and analyzed in a deductive way. Participants will be doctors and nurses previously trained in the intervention that was put into practice under real-world conditions, from different health centers. Results of the analysis of the interviews will be used as the basis for designing the implementation strategy. Discussion: The implementation of the DEPENAS intervention in primary care to achieve its sustained and widespread use among primary care professionals involves changes in the model of patient care and the model of the health system, toward models that are more in tune with the needs of modern society. Investigating psychological determinants in professionals and addressing them with validated techniques, as part of the strategy for implementing a given intervention, is a novel approach that has the potential to help change the way in which we tackle change in healthcare organizations.