JMIR Publications

ABSTRACT

Background:

Routine Outcome Monitoring (ROM) is an evidence-based methodology that supports continuous assessment and improvement of therapeutic processes through systematic collection of clinical data. Despite its demonstrated benefits in improving clinical outcomes and patient engagement, ROM implementation remains limited in many countries, including Italy, due to structural fragmentation, lack of digital infrastructure, and cultural resistance among professionals. The Italian psychotherapy landscape is characterized by high professional autonomy, heterogeneous clinical approaches, and limited institutional coordination, creating unique challenges for implementing standardized monitoring practices.

Objective:

The objective of our study was to investigate the implementation of a digital platform designed to support routine outcome monitoring in Italian psychotherapy, focusing on individual, organizational, and contextual factors that influence its integration into daily clinical practice using the Consolidated Framework for Implementation Research.

Methods:

Psychotherapists will be recruited from diverse settings across Italy, including private practice, public sector, and freelance arrangements. This longitudinal, mixed-methods implementation study will combine qualitative semi-structured interviews and quantitative surveys using the Evidence-Based Practice Attitude Scale-36. Data collection will occur over 18 months across three timepoints: before, during, and after implementation of the digital platform "Mindy." Interview guides will be developed based on CFIR constructs selected through a structured expert consensus process involving nine contributors. Thematic analysis following Braun and Clarke methodology will be applied to interview transcripts, with CFIR framework guiding the coding process.

Results:

A total of approximately 30 psychotherapists will participate in the study, selected to reflect diversity in employment setting, therapeutic orientation, and geographical location. A subset of at least three psychotherapists will be interviewed longitudinally across all three implementation phases. Pilot testing with three psychotherapists confirmed protocol feasibility and revealed preliminary themes regarding platform usability, workflow integration challenges, and the importance of technical reliability and legal clarity for successful adoption.

Conclusions:

This study will provide comprehensive insights into the mechanisms that support or hinder implementation of digital tools for routine outcome monitoring in psychotherapy. The findings may inform the development of scalable, context-sensitive strategies for integrating ROM into everyday psychotherapeutic work, with implications extending beyond the Italian context to other health systems facing similar structural and cultural barriers to innovation adoption. Clinical Trial: Not applicable.