JMIR Publications

ABSTRACT

Background:

Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation.

Objective:

This study has two main objectives: (1) to identify and describe the primary care organizations providing ICBT in Sweden; and (2) to compare decision makers’ (i.e., directors of primary care organizations) views on barriers and facilitators for implementation of ICBT in organizations that have implemented ICBT (implementers) and in organizations that have not implemented ICBT (non-implementers).

Methods:

An online survey, based on a checklist for identifying barriers and facilitators, was developed and made accessible to all primary care organizations in Sweden. The survey consisted of background questions, e.g., the use of ICBT and the number of persons working with ICBT, and barriers and facilitators relating to the following categories: patients, CBT therapists, ICBT programs, organizations, and wider society.

Results:

The participation rate was 35.7% (404/1130). The majority of participants were healthcare center directors with a background in nursing (61.8%; 250/404). 89.9% (363/404) of the participating organizations provided CBT. A minority of these organizations, 20.5% (83/404) offered ICBT and thus were implementers. In general, psychologists (80.7%; 67/83) and social workers (37.3%; 31/83) delivered ICBT to patients. The majority, 73.4% (61/83), of organizations had 1-2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1-10 in 65% (54/83) of the organizations. Regarding implementers and non-implementers there were 13 significant (P< .05) relationships out of 37 possible. For example, implementers perceive very few technical problems compared to non-implementers, who expect a certain amount of technical difficulties, and implementers consider to a higher extent than non-implementers that it is easy for organizations to access ICBT programs.

Conclusions:

Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its utilization, implementation within primary care in Sweden is low. Several interesting differences between implementers and non-implementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT.