Implementation of internet-delivered cognitive behavior therapy within community mental health clinics: a process evaluation using the consolidated framework for implementation research
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BACKGROUND: 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) 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. METHODS: Therapists (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. RESULTS: Analyses 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. CONCLUSIONS: The 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.
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Lack of human support and contact has also affected user engagement and may account for the low adaptability and acceptability of CCBT.
“This has also affected user engagement (Batterham et al ., 2018) and may account for the low adaptability and acceptability of CCBT (Hadjistavropoulos et al ., 2017; Knowles et al ., 2015).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Hadjistavropoulos et al., 2017
The Discussion’s “Facilitators and barriers” section says that low adaptability in the amount of support and length of treatment was perceived as a barrier to ICBT implementation. It does not say that a lack of human contact caused low adaptability or acceptability; the program described in Methods included therapist support. The user-engagement portion of the citing sentence is attached to Batterham et al., not this source. No page number is available in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPast research on the Wellbeing Course has shown outcomes are strong whether delivered by therapists who specialise in iCBT or by therapists who primarily deliver face-to-face treatment.
“Past research on the Wellbeing Course has shown outcomes are strong whether delivered by therapists who specialise in iCBT or by therapists who primarily deliver face-to-face treatment. 15,16”
Recent studies have demonstrated that a successful implementation model for delivering CCBT in clinics has involved therapist support.
“Furthermore, recent studies have demonstrated that a successful implementation model for delivering CCBT in clinics has involved therapist support (Hadjistavropoulos et al ., 2017; Titov et al ., 2018).”
From A qualitative study of patients’ experiences and acceptance of computerised cognitive behavioural therapy in primary care, Scotland (2021) · cites this paper as Hadjistavropoulos et al., 2017
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- Authors
- Hadjistavropoulos, H. D., Nugent, M. M., Dirkse, D., & Pugh, N.
- Affiliations
- University of Regina (CA)
- Corresponding author
- Hadjistavropoulos, H.D.
- Venue
- BMC Psychiatry
- Published
- 2017-09-12
- Volume
- 17
- Issue
- 1
- Pages
- 331-331
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC5596488
- OpenAlex
- W2755320000
- Cited by
- 94
- References
- 20
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 8 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 15 · 2019: 14 · 2018: 5
- FWCI
- 10.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Canadian Institutes of Health Research (293379)
- Health Research Foundation
- Saskatchewan Health Research Foundation
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- internet-based cognitive behavioral therapy, community mental health centers, implementation barriers and facilitators, depression, anxiety, therapist perspectives, inner setting, Consolidated Framework for Implementation Research, face-to-face therapy, mental health service delivery
- MeSH terms
- Anxiety Disorders, Canada, Depressive Disorder, Female, Health Services Accessibility, Humans, Male, Mental Health, Patient Participation, Cognitive Behavioral Therapy, Treatment Outcome, Telemedicine, Internet
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