JMIR Publications

ABSTRACT

Background:

E-mental health represents a way to increase access to evidence-based psychological support. However, implementation of e-mental health in routine healthcare practice is limited, with few studies focusing on implementation. Accordingly, there is a need to better understand barriers and facilitators to implementing e-mental health. Existing research has mainly focused on the viewpoints of patients and health professionals. Currently there is a lack of knowledge concerning barriers and facilitators from the perspective of primary care decision makers that is, the person(s), responsible for deciding if a given e-mental health intervention should be implemented or not in a primary care organization.

Objective:

The three objectives were: (1) to identify and describe barriers and facilitators to implementation of e-mental health as perceived by primary care decision makers, (2) to evaluate the relative importance of the different barriers and facilitators, and (3) compare the barriers and facilitators between primary care decision makers, those who have implemented versus have not implemented e-mental health.

Methods:

An online self-report survey was conducted with primary care decision makers responsible for the implementation of e-mental health in primary care organizations in Sweden. Two open-ended questions on barriers and facilitators were analyzed through summative and deductive content analysis.

Results:

Fifty-seven primary care decision makers representing implementers (i.e., organizations that offered e-mental health) identified facilitators to implementation whereas 53 identified barriers. 222 primary care decision makers representing non-implementers (i.e., organizations that did not offer e-mental health) identified barriers to implementation whereas 210 identified facilitators. Altogether 30 barriers and 21 facilitators to implementation were identified related to (1) innovation, (2) patients, (3) health professionals, (4) incentives and resources, (5) capacity for organizational change, and (6) social, political and legal aspects. The most prevalent barriers related to incentives and resources whereas the most prevalent facilitators concern capacity for organizational change.

Conclusions:

A number of barriers and facilitators were identified that could influence implementation of e-mental health from the perspective of primary care decision makers. Implementers and non-implementers identify many common barriers and facilitators but also differ in terms of certain important barriers and facilitators. Common and differing barriers and facilitators identified by implementers and non-implementers may be important to reflect on and address when planning for the implementation of e-mental health.