The Implementation of e-Health Interventions in Health Services

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The Implementation of e-Health Interventions in Health Services

FILIP DROZD, PhD

National Network for Infant Mental Health

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Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 2

Mamma Mia is developed by Changetech in collaboration with the National Network for Infant Mental Health, Regional Centre for Child and Adolscent Mental Health, for the Norwegian Women’s Public Health Assocation.

FUNDING & SUPPORT

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Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature.

Tampa, FL: National Implementation Research Network.

‘‘… a specified set of activities designed to put into practice an activity or program of known dimensions.’

– Fixsen et al., 2005

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WHAT IS IMPLEMENTATION?

DEFINITION

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1. Prevent postpartum depression

Provide instant help and support on indication

2. Promote subjective well-being Strengthen the couple relationship Promote parental sensitivity

Promote healthy parent-child interactions

Promote the development of a secure attachment

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MAMMA MIA

OVERALL GOALS

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INTERVENTION PROTOCOL

Drozd, F. et al., 2015. An Internet-based intervention (Mamma Mia) for postpartum depression: Mapping the development from theory to practice. JMIR Research Protocols, 4(4), e120.

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1. 2-armed trial

Mamma Mia+treatment-as-usual (n = 674) vs. treatment-as-usual (n = 668)

2. Inclusion criteria

18 years or older and able read and understand Norwegian

3. Outcomes

Depression, subjective well-being, parental satisfaction, relationship satisfaction, social support, parent-infant attachment during pregnancy and postpartum.

4. 6 measurement waves (n, %) Baseline: 1 342 (100%)

GW 37: 1 117 (83%) 6 weeks: 962 (72%) 3 months: 847 (63%) 6 months: 851 (63%)

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RANDOMIZED CONTROLLED TRIAL

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INTERVIEWS

Drozd, F., Andersen, C. E., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2017). User experiences and perceptions of internet interventions for depression. In S. Langrial & A. Sharieh (eds.), Web-based behavioral therapies for mental disorders. Hershey, PA: IGI Global.

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SYSTEMATIC REVIEW

Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016). The implementation of internet interventions for depression: A scoping review. Journal of Medical Internet Research, 18(9), e236.

https://doi.org/10.2196/jmir.5670

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Table 1. Number and percentage of references and units coded on the initial implementation components.

Implementation components K^a % k^b %

Selection 114 69,5 164 54,3

Training 28 17,1 44 14,6

Supervision 36 22,0 61 20,2

Performance 9 5,5 12 4,0

Decision-support 2 1,2 4 1,3

Administrative support 7 4,3 8 2,6

System intervention 8 4,9 9 3,0

Leadership 0 0,0 0 0,0

aK refers to unique references coded onto the various implementation components.

bk refers to number of analysis units extracted from the references.

SYSTEMATIC REVIEW

DIFFERENCES IN REPORTING ON IMPLEMENTATION COMPONENTS?

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SYSTEMATIC REVIEW

PUBLICATIONS IN REGULAR CARE SETTINGS, 2002-2014

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SYSTEMATIC REVIEW

WHAT CHARACTERIZES THE LITERATURE ON IMPLEMENTATION?

Table 4. The final template with meaningful themes, corresponding codes, definitions, and examples.

Level Theme K^a % Definition

1. User 152 50,3

1.1. Guided support 31 10,3

An internet-based self-help program including minimal, but regular human involvement and support.

1.2. User recruitment 121 40,1 Activities related to promoting and advertising the intervention to potential end-users.

2. Practitioner 99 32,8

2.1. Qualifications 38 12,6 Formal and informal background education and/or training among practitioners delivering internet interventions.

2.2. Training 32 10,6

Acquisition of new knowledge, skills, and abilities required to work with internet interventions.

2.3. Supervision 18 6,0

Coaching of practitioners working with users through observation, instruction, feedback, emotional support, debriefing, or some other form of on-the-job training.

aNumber of references coded on a theme or sub-theme.

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CLINICAL & IMPLEMENTATION GUIDELINES

Drozd, F., Haga, S. M., & Slinning, K. (2017). From science to practice: Implementation and clinical guidelines for an internet intervention for postpartum depression. In S. Langrial & A. Sharieh (eds.), Web-based behavioral therapies for mental disorders. Hershey, PA: IGI Global.

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1. What conditions at the well-baby clinics lead to a successful implementation of Mamma Mia?

2. How do participants rate the training and how does that influence the implementation of Mamma Mia?

3. What needs to improve to ensure a high-quality implementation of Mamma Mia?

Regional Centre for Child and Adolescent Mental Health | www.r-bup.no 13

IMPLEMENTATION PILOT

PURPOSE

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1. Training (2+2 days) 2. Implementation plan

3. Monthly coaching (clinical and implementation)

14 Drozd, F., Haga, S. M., & Slinning, K. (in preparation). Evaluation of the implementation of an internet

intervention in well-baby clinics: Factors associated with successful implementation. Translations in Behavioral Medicine.

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no

IMPLEMENTATION PILOT

IMPLEMENTATION PRACTICE

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1. 15 well-baby clinics

2. 23 midwives and public health nurses 3. 22 females; 1 male

4. Age: Mean = 52.6 yrs.; SD = 4.8 yrs.

5. Yrs. in current position: Mean = 10.43; SD = 7.20.

6. Edinburgh-method: 9 (39.1%) persons

7. Supplementary training in other methods: 16 (69.6%) persons

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 15

IMPLEMENTATION PILOT

PARTICIPANTS

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Large increase in knowledge about Mamma Mia pre-training (M = 4.67, SD = 2.61) compared to post-training (M = 8.38, SD = 1.12;

t(20) = -8.39, p < .001, Cohen’s d = 1.85).

On a scale from 1 to 10, where higher scores are better …

–Satisfaction with training: M = 8.36; SD = 0.95.

–Recommend training to others: M = 8.73; SD = 1.58.

–Recommend Mamma Mia to health personnel: M = 9.55; SD = 0.80.

–Recommend Mamma Mia to women: M = 9.73; SD = 0.55.

IMPLEMENTATION PILOT

TRAINING EVALUATION

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IMPLEMENTATION PILOT

IMPLEMENTATION OUTCOMES: NATIONAL & LOCAL GUIDELINES

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IMPLEMENTATION PILOT

IMPLEMENTATION OUTCOMES: INFLUENCE ON WORK & WORKFLOW

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1. Implementation plan

2. Organizational readiness

3. Leadership support (or lack thereof)

4. Implementation of Mamma Mia is feasible in well-baby clinics

19 Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no

IMPLEMENTATION PILOT

PRELIMINARY CONCLUSIONS

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EFFECTIVE INEFFECTIVE

INEFFECTIVE POTENTIALLY HARMFUL

TAKE-HOME MESSAGE

YES NO

YES

NO

EFFECTIVE INTERVENTIONS

EFFECTIVE IMPLEMENTATION

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The Implementation of e-Health Interventions in Health Services