JMIR Publications

ABSTRACT

Background:

Digital mental health interventions (DHMIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) can be useful to examine multilevel factors related to DMHI implementation efforts.

Objective:

The aim of this paper is to identify barriers, facilitators, and best practice recommendations for implementing DMHIs across similar organization settings, according to the EPIS outer context, inner context, innovation, and bridging factors domains.

Methods:

This paper stems from a large state-funded project, which includes six city and county behavioral health departments in California to explore the use of DMHIs as part of county mental health services. As part of a formative evaluation, our team conducted interviews with clinical staff, peer support specialists, and county/city/clinic leaders using a semi-structured interview guide. We followed a recursive six-step process to conduct qualitative analyses including inductive and conductive components guided by the EPIS framework.

Results:

Based on 69 interviews, we identified three main themes that aligned with the EPIS framework related to the readiness of individuals, innovations, and organizations/systems. Individual-level readiness includes the extent to which clients have the necessary technological tools (e.g., smartphones) and knowledge (digital literacy). Innovation-level readiness pertains to the accessibility, usefulness, safety, and fit of the innovation. Organization/system-level readiness includes the extent to which providers and leadership collectively hold positive views about DMHIs, as well as the extent to which infrastructure (e.g., staffing, payment model) is appropriate.

Conclusions:

Successful implementation requires readiness at the individual, innovation, and organization/system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, safe, and adapted to fit into existing client needs and clinical workflow. To improve organization/system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformation (e.g., the integrated care model). Clinical Trial: N/A