JMIR Publications

ABSTRACT

Background:

While eMental health interventions, especially when delivered in a blended way, have much potential to improve the quality and efficiency of mental healthcare, their use in practice is lagging behind on expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental healthcare since it is too broad and generic.

Objective:

The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting - forensic mental healthcare - by means of participatory development with therapists.

Methods:

The participatory process was divided into four phases and was executed by a project team consisting of one manager, three to five therapists and one researcher. In Phase 1, general requirements for the adaptation of the existing instrument were discussed in two focus groups with the project team. In Phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited by means of semi-structured interviews with all 18 therapists working at an outpatient clinic. In Phase 3, multiple focus groups with the project teams were held to create a first version of the adapted FfBC instrument. In Phase 4, a digital prototype of the instrument was used with eight patients, and the experiences of four therapists were discussed in a focus group.

Results:

In Phase 1, it became clear that the therapists’ main requirement was to develop a much shorter instrument with a few items, of which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which five were used adapted: (1) motivation for blended treatment, (2) writing about thoughts, feelings and behavior, (3) conscientiousness, (4) psychosocial problems, and (5) social support. Additionally, a part focused on the practical necessary preconditions that patients should fill out by themselves before treatment was developed. The use of the online prototype of the instrument in treatment resulted in overall positive experiences with the content, but therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors.

Conclusions:

The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared-decision making. In general, adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization and eHealth intervention. In order to adapt the instrument for other contexts, the guidelines that were described in this paper can be followed.