Implementing guided ICBT for chronic pain and fatigue: A qualitative evaluation among therapists and managers, 2019, Knoop et al

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Free full text: https://www.sciencedirect.com/science/article/pii/S2214782919300910

Internet Interventions
Available online 31 October 2019, 100290
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Implementing guided ICBT for chronic pain and fatigue: A qualitative evaluation among therapists and managers
Rosalievan der Vaarta
1
MargreetWorm-Smeitinkb1
YvonneBosa
MichelWensingcd
AndreaEversa1
HansKnoopb1

https://doi.org/10.1016/j.invent.2019.100290Get rights and content

Under a Creative Commons license
open access

Highlights


•
ICBT for chronic somatic conditions such as pain and fatigue can overcome current barriers to provide patients with evidence-based psychological care

•
Implementing ICBT in mental health care has been found to be challenging on many levels

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This study uses the Consolidated Framework for Implementation Research to evaluate an implementation project on ICBT for chronic pain and fatigue

•
Therapists and managers were interviewed and provided an extensive overview of key facilitating and hindering factors to adopt ICBT in daily clinical practice

•
Some key factors are “find support from all stakeholders”, “Align goals, expectations and skills”, and “create a feeling of ownership”.



Abstract
Introduction
Internet-based cognitive behavioural therapy (ICBT) for chronic pain and chronic fatigue syndrome (CFS) has a high potential to increase the number of patients who can receive an evidence based treatment aimed to reduce symptoms and/or disability and to lower burden on (mental) health care. However, implementing a new behaviour-change intervention, and especially an online intervention, has shown to be a challenge. This study aimed to identify factors influencing the implementation process of ICBT for chronic pain and CFS in mental health care.

Methods
A qualitative study using semi-structured interviews with therapists and managers from twelve mental health care clinics was conducted. Questions and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), covering five domains: (1) the implemented intervention, (2) individual characteristics of the users, (3) the inner setting of implementation, (4) the outer setting, and (5) the implementation process.

Results
In all five domains important facilitators and barriers were found. Key themes were: (1) the quality of the content, its perceived effectiveness and usability, (2) the attitude, self-efficacy and ability to learn new skills among therapists, and motivation to start online treatment among patients, (3) internal communication within a team, existing workload, and top-down support from the management, (4) availability of reimbursement options and marketing strategies, and (5) involvement of all key stakeholders, steering towards independence of the implementation sites during the process and adequate training of therapists.

Conclusions
This study provides insight in the challenge of implementing ICBT for chronic pain and CFS in daily clinical practice. Several lessons can be learned from the interviews with therapists and managers which can also be more broadly applied to (ICBT) implementation projects in general. Development of practical tools to support the implementation process would be a valuable next step to overcome certain challenges at forehand and to properly prepare for those expected to come along.

Keywords
Internet-based cognitive behavioural therapy
Implementation
Pain
Chronic fatigue syndrome
Qualitative evaluation

 

[Trish]

''... availability of reimbursement options and marketing strategies''

So that's what it's about.

 

[rvallee]

But I keep hearing how it's a subjective illness experience so how can people who don't experience the thing provide any insight? Might as well ask chefs to rate what they think their clients rate their food for all that this is relevant.

ICBT for chronic somatic conditions such as pain and fatigue can overcome current barriers to provide patients with evidence-based psychological care

No, it can't. That's aspirational, not a statement of fact and it doesn't even make sense. Ironically, this garbage IS the main barrier to any form evidence-based care.

Some key factors are “find support from all stakeholders”, “Align goals, expectations and skills”, and “create a feeling of ownership”.

A qualitative study using semi-structured interviews with therapists and managers

There you have it, patients are not stakeholders. Neither are caregivers who have the best second-hand experience, very different from the tiny slice snapshot perception therapists, clinicians and researchers have. Rarely admitted. Ironically, I have no idea what stakes therapists and managers might have beyond current employment. So it's basically asking them whether their employment is justified, that is the only stake they have. Which is both biased and conflicted.

BPS in a nutshell: asking from "all" stakeholders, doesn't ask patients. Brilliant. Next stop: clinical trials where they only ask the maker of the drug whether they feel it works. There, all stakeholders involved. So "holistic" and thinking about the patient as a person, by literally not considering them stakeholders. Which is a change from asking and then discarding what they don't like. Not asking at all is some kind of innovation, I guess.

 

[alktipping]

online therapy why bother paying therapist when you can point your mus patients to all the bs books and papers there fore saving the nhs and other healthcare bodies significant sums of money . also after the benefits agencies around the world have impoverished all of us undeserving sick and disabled how are we going to get online to receive these words of wisdom from the delusional cretins/authors of this bullshit.