Implementing Internet-Based Cognitive Behavioral Therapy in Routine Care: Healthcare Practitioners\u2019 Attitude and Perceived Level of Normalization After a Single Information Event

Anna-Lena Netter,Eva-Lotta Brakemeier,Tim Rapley,Tilo Kircher,David Daniel Ebert,Anne Etzelmueller

doi:10.1007/s41347-021-00237-z

Abstract

Understanding implementation-related factors and processes is key to ensuring that Internet-based interventions are embedded in practice and provide added value to the delivery of evidence-based care. The aim of this study was to evaluate the attitudes towards an Internet-based cognitive behavioural therapy (iCBT) intervention for the treatment of depression as well as its level of normalization and early implementation success (operationalized as intention to use the intervention) among German health care professionals (HCP). Data were collected following onetime information sessions on an iCBT tool using the Evidence-Based Practice Attitude Scale (EBPAS) and the Normalization Process Theory Measure (NoMAD). Influences of attitudes on normalization as well as influences of attitude and normalization on intention to use were analysed. Most participants (n = 78; 86.3% clinical psychologists, 9.6% general practitioners) intended to use the intervention in the future (82.1%) and had a moderately positive attitude towards iCBT interventions. The perceived level of normalization (i.e., the level of how well iCBT is integrated in practice) was moderate in the overall sample. High appeal, openness towards iCBT, low requirement to use it, and low perceived divergence (perceived difference between current and new practices) had a significant positive effect on normalization. This study indicates that iCBT can be implemented in German routine mental healthcare. However, implementation processes might benefit from tailored information campaigns that clearly highlight the effectiveness and benefits of iCBT interventions to foster openness towards iCBT interventions among HCPs.

Highlights

Anne Etzelmueller and Anna-Lena Netter share the first authorship.Addressing the demand for treatment of common mental health problems, such as major depressive disorder (MDD), is a severe public challenge
We evaluated the prediction of the “intention to use” the Internet-based cognitive behavioural therapy (iCBT) tool from Evidence-Based Practice Attitude Scale (EBPAS) and NoMAD constructs
The subscales Appeal (M = 2.84 vs. M = 2.91), Openness (M = 2.73 vs. 2.76), and Divergence (M = 2.87 vs. M = 2.75) were close to the established norms. These results indicate an openmindedness of the health care professionals (HCP) in this study about iCBT which they found to be intuitively appealing

Summary

Introduction

Addressing the demand for treatment of common mental health problems, such as major depressive disorder (MDD), is a severe public challenge. Long waiting periods for therapy due to the lack or uneven distribution of trained providers, dependency on location and time, or the complexity and chronicity of patient’s symptomatology are frequent barriers to treatment access (Mack et al, 2014; Wittchen et al, 2011). Attitudinal barriers such as low perceived need, low mental health literacy, financial factors, and fear of stigmatization towards mental illness prevent people from seeking help and receiving treatment (Schnyder et al, 2017)

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