the implementation of e-health interventions in health
TRANSCRIPT
The Implementation of e-Health
Interventions in Health Services
FILIP DROZD, PhD
National Network for Infant Mental Health
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
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
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 MIAOVERALL GOALS
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.
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
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.
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
Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 9
Table 1. Number and percentage of references and units coded on the initial implementation components.
Implementation components Ka % kb %
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 REVIEWDIFFERENCES IN REPORTING ON IMPLEMENTATION COMPONENTS?
Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 10
SYSTEMATIC REVIEWPUBLICATIONS IN REGULAR CARE SETTINGS, 2002-2014
Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 11
SYSTEMATIC REVIEWWHAT CHARACTERIZES THE LITERATURE ON IMPLEMENTATION?
Table 4. The final template with meaningful themes, corresponding codes, definitions, and examples.
Level Theme Ka % 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.
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.
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 PILOTPURPOSE
1. Training (2+2 days)
2. Implementation plan
3. Monthly coaching (clinical and implementation)
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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 PILOTIMPLEMENTATION PRACTICE
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 PILOTPARTICIPANTS
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.
Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 16
IMPLEMENTATION PILOTTRAINING EVALUATION
Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 17
IMPLEMENTATION PILOTIMPLEMENTATION OUTCOMES: NATIONAL & LOCAL GUIDELINES
Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 18
IMPLEMENTATION PILOTIMPLEMENTATION OUTCOMES: INFLUENCE ON WORK & WORKFLOW
1. Implementation plan
2. Organizational readiness
3. Leadership support (or lack thereof)
4. Implementation of Mamma Mia is feasible in well-baby clinics
19Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no
IMPLEMENTATION PILOTPRELIMINARY CONCLUSIONS
EFFECTIVE INEFFECTIVE
INEFFECTIVEPOTENTIALLY
HARMFUL
TAKE-HOME MESSAGE
YES NO
YES
NO
EFFEC
TIV
E IN
TER
VEN
TIO
NS
EFFECTIVE IMPLEMENTATION