Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals’ Perspectives
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Abstract
BACKGROUND: Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. OBJECTIVE: Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. METHODS: We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. RESULTS: We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. CONCLUSIONS: Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. TRIAL REGISTRATION: PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk.
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Acceptance of DMHIs by mental health professionals is an important factor influencing their inclusion in routine clinical care, as health professional endorsement can impact whether a client is willing to use a DMHI and if DMHIs are considered a suitable option for referral.
“Acceptance of DMHIs by mental health professionals is another important factor influencing their inclusion in routine clinical care, as health professional endorsement can impact whether a client is willing to use a DMHI [20] and if DMHIs are considered a suitable option for referral [22].”
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- Authors
- Davies, F., Shepherd, H. L., Beatty, L., Clark, B., Butow, P., & Shaw, J.
- Affiliations
- The University of Sydney (AU)
- Flinders University (AU)
- Corresponding author
- Shepherd, Heather L
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2020-07-23
- Volume
- 22
- Issue
- 7
- Pages
- e17362
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC7413287
- OpenAlex
- W3044951923
- Cited by
- 110
- References
- 62
- Citations by year
- 2026: 18 · 2025: 23 · 2024: 24 · 2023: 13 · 2022: 16 · 2021: 15 · 2020: 1
- FWCI
- 1.77
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Cancer Institute NSW (14/TPG/1‐02)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Keywords
- online therapy, implementation barriers and facilitators, health professionals' perspectives, routine mental health care, blended therapy, therapeutic relationship, health professions education, organizational support, computer literacy, models of care
- MeSH terms
- Adult, Health Personnel, Humans, Mental Health, Telemedicine, Internet
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