Abstract
BackgroundDepression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system. Internet-delivered cognitive behavior therapy (ICBT) improves patient access to treatment by providing therapeutic information via the Internet, presented in sequential lessons, accompanied by brief weekly therapist support. While there is growing research supporting ICBT, use of ICBT within community mental health clinics is limited. In a recent trial, an external unit specializing in ICBT facilitated use of ICBT in community mental health clinics in one Canadian province (ISRCTN42729166; registered November 5, 2013). Patient outcomes were very promising and uptake was encouraging. This paper reports on a parallel process evaluation designed to understand facilitators and barriers impacting the uptake and implementation of ICBT.MethodsTherapists (n = 22) and managers (n = 11) from seven community mental health clinics dispersed across one Canadian province who were involved in implementing ICBT over ~2 years completed an online survey (including open and closed-ended questions) about ICBT experiences. The questions were based on the Consolidated Framework for Implementation Research (CFIR), which outlines diverse constructs that have the potential to impact program implementation.ResultsAnalyses suggested ICBT implementation was perceived to be most prominently facilitated by intervention characteristics (namely the relative advantages of ICBT compared to face-to-face therapy, the quality of the ICBT program that was delivered, and evidence supporting ICBT) and implementation processes (namely the use of an external facilitation unit that aided with engaging patients, therapists, and managers and ICBT implementation). The inner setting was identified as the most significant barrier to implementation as a result of limited resources for ICBT combined with greater priority given to face-to-face care.ConclusionsThe results contribute to understanding facilitators and barriers to using ICBT within community mental health clinics and serve to identify recommendations for improving uptake and implementation of ICBT in clinic settings.
Highlights
Depression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system
Internet-delivered cognitive behavior therapy (ICBT) for depression and anxiety has the potential to address many of these barriers and improve patient access to evidence-based treatment [3]
Perceptions of ICBT There was strong indication that both therapists and managers had positive perceptions of ICBT. Both agreed strongly that Saskatchewan residents should have access to ICBT (M = 4.61/5, SD = .50), that health regions should be committed to ensuring access to ICBT (M = 4.12/5; SD = 1.05), that health regions should identify barriers and facilitators associated with ICBT (M = 4.12/ 5; SD = 1.05), that health regions should continuously monitor and evaluate ICBT (M = 4.06; SD = 1.25) and, that it was worth their time to be involved in ICBT (M = 4.39; SD = .79)
Summary
Depression and anxiety are prevalent and under treated conditions that create enormous burden for the patient and the health system. Internet-delivered cognitive behavior therapy (ICBT) for depression and anxiety has the potential to address many of these barriers and improve patient access to evidence-based treatment [3]. Randomized controlled trials provide strong support for ICBT with large treatment effects identified for those receiving ICBT [4]; these promising findings extend to when ICBT is delivered in routine practice settings [5]. This latter research primarily has been conducted in specialized ICBT clinics, where there are limited competing demands on therapists’ time [5]
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