JMIR Publications

ABSTRACT

Background:

To address the anticipated rise in mental health symptoms experienced at the population level during the COVID-19 pandemic, the Ontario government provided two therapist-assisted internet-delivered cognitive behavioral therapy (iCBT) programs to adults free of charge at the point of service.

Objective:

Exploration of the facilitators of and barriers to implementing iCBT at the population level in Ontario, Canada from the perspective of patients and therapists to better understand how therapist-assisted iCBT programs can be effectively implemented at the population level and inform strategies for enhancing service delivery and integration into the healthcare system.

Methods:

Using a convenience sampling methodology, semi-structured interviews were conducted with ten therapists who delivered iCBT and twenty patients who received iCBT through either of the publicly funded programs to explore their perspectives of the program. Interview data were analyzed using inductive thematic analysis to generate themes.

Results:

Six salient themes were identified. Facilitators included the therapist-assisted nature of the program, the ease of registration, the lack of cost, and the feasibility of completing the psychoeducational modules given the online and self-paced nature of the program. Barriers included challenges with the online remote modality for developing the therapeutic alliance, the program's generalized nature, which limited customization to individual needs, and a lack of formal integration between the iCBT program and the healthcare system.

Conclusions:

Although the program was generally well-received by patients and therapists due to its accessibility and feasibility, the digital format of the program presented both benefits and unique challenges. Strategies for improving the quality of service delivery include opportunities for synchronous communication between therapists and patients, options for increased customization, and the formal integration of iCBT into a broader stepped-care model that centralizes patient referrals between care providers and promotes continuity of care.