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Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care

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Abstract

This study aimed to identify barriers to use of technology for behavioral health care from the perspective of care decision makers at community behavioral health organizations. As part of a larger survey of technology readiness, 260 care decision makers completed an open-ended question about perceived barriers to use of technology. Using the Consolidated Framework for Implementation Research (CFIR), qualitative analyses yielded barrier themes related to characteristics of technology (e.g., cost and privacy), potential end users (e.g., technology literacy and attitudes about technology), organization structure and climate (e.g., budget and infrastructure), and factors external to organizations (e.g., broadband accessibility and reimbursement policies). Number of reported barriers was higher among respondents representing agencies with lower annual budgets and smaller client bases relative to higher budget, larger clientele organizations. Individual barriers were differentially associated with budget, size of client base, and geographic location. Results are discussed in light of implementation science frameworks and proactive strategies to address perceived obstacles to adoption and use of technology-based behavioral health tools.

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References

  1. Chiauzzi E, Green TC, Lord S, et al. My Student Body: A high-risk drinking prevention web site for college students. Journal of American College Health 2005;53:263–274.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Lord S, D’Amante D, Meyers S, et al. Connecting to prevention: Efficacy of an online alcohol and other drug prevention program for early adolescents. Paper presentation, Society for Adolescent Health, 2007.

  3. Marsch L, Bickel W, Badger G. Applying computer technology to substance abuse prevention science: Results of a preliminary examination. Journal of Child & Adolescent Substance Abuse 2006; 16(2): 69–94.

    Article  Google Scholar 

  4. Ben-Zeev D. Mobile technologies in the study, assessment, and treatment of schizophrenia. Schizophrenia Bulletin 2012; 38(3): 384–385. doi: 10.1093/schbul/sbr179

    Article  PubMed  PubMed Central  Google Scholar 

  5. Lord SE, Trudeau KJ, Black RA, et al. CHAT: development and validation of a computer-delivered, self-report, substance use assessment for adolescents. Substance Use & Misuse 2011;46(6):781–794.

    Article  Google Scholar 

  6. Brunette MF, Ferron JC, McHugo GJ, et al. An electronic decision support system to motivate people with severe mental illnesses to quit smoking. Psychiatric Services 2011;62(4):360–366.

    Article  PubMed  Google Scholar 

  7. Carroll KM, Ball SA, Martino S, et al. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Drug and Alcohol Dependence 2009;100(1–2):178–181.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dallery J, Raiff BR. Contingency management in the 21st century: Technological innovations to promote smoking cessation. Substance Use & Misuse 2011;46(1):10–22.

    Article  Google Scholar 

  9. Marsch LA, Grabinski MJ, Bickel WK, et al. Computer-assisted HIV prevention for youth with substance use disorders. Substance Use & Misuse 2011; 46(1): 46–56.

    Article  Google Scholar 

  10. Proudfoot J, Goldberg D, Mann A, et al. Computerized, interactive, multimedia cognitive-behavioural program for anxiety and depression in general practice. Psychological Medicine 2003; 33(2): 217–227.

    Article  PubMed  CAS  Google Scholar 

  11. van der Krieke L, Wunderink L, Emerencia AC, et al. E-mental health self-management for psychotic disorders: State of the art and future perspectives. Psychiatric Services 2014; 65(1): 33–49.

    Article  PubMed  Google Scholar 

  12. Gustafson DH, Boyle MG, Shaw BR, et al. An e-Health solution for people with alcohol problems. Alcohol Research & Health 2011; 33(4): 327–337.

    Google Scholar 

  13. Newman MG, Szkodny LE, Llera SJ, et al. A review of technology-assisted self-help and minimal contact therapies for anxiety and depression: is human contact necessary for therapeutic efficacy? Clinical Psychology Review 2011;31(1):89–103.

    Article  PubMed  Google Scholar 

  14. Preziosa A, Grassi A, Gaggioli A, et al. Therapeutic Applications of the mobile phone. British Journal of Guidance & Counselling 2009; 37(3): 313–324.

    Article  Google Scholar 

  15. Marsch LA. Leveraging technology to enhance addiction treatment and recovery. Journal of Addictive Diseases 2012; 31(3): 313–318.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Barak A, Hen L, Boniel-Nissim M, et al. A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. Journal of Technology in Human Services 2008; 26(2–4): 109–160.

    Article  Google Scholar 

  17. Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis AIDS. 2009; 23(1): 107–115.

    Article  PubMed  Google Scholar 

  18. Pating DR, Miller MM, Goplerud E, et al. New systems of care for substance use disorders: treatment, finance, and technology under health care reform. Psychiatric Clinics of North America 2012; 35(2): 327–356.

    Article  PubMed  Google Scholar 

  19. Harris Interactive. Patient Choice an Increasingly Important Factor in the Age of the “Healthcare Consumer”. Available at http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/mid/1508/articleId/1074/ctl/ReadCustom%20Default/Default.aspx. Accessed March 10, 2013.

  20. Ben-Zeev D, Davis KE, Kaiser S, et al. Mobile technologies among people with serious mental illness: opportunities for future services. Administration and Policy in Mental Health and Mental Health Services Research 2013; 40(4): 340–3.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Pew Internet & American Life Project. Pew Internet: Health. Available at http://www.pewinternet.org/Commentary/2011/November/Pew-Internet-Health.aspx. Accessed June 19, 2013.

  22. Ennis L, Rose D, Callard F, et al. Rapid progress or lengthy process? Electronic personal health records in mental health. BMC Psychiatry 2011; 11: 117.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Goldzweig CL, Towfigh A, Maglione M, et al. Costs and benefits of health information technology: new trends from the literature. Health Affairs 2009; 28(2): 282–293.

    Article  Google Scholar 

  24. Takian A, Sheikh A, Barber N. We are bitter, but we are better off: case study of the implementation of an electronic health record system into a mental health hospital in England. BMC Health Services Research 2012; 12: 484.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Buti AL, Eakins D, Fussell H, et al. Clinician attitudes, social norms and intentions to use a computer-assisted intervention. Journal of Substance Abuse Treatment 2013; 44(4): 433–437.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Mohr DC, Burns MN, Schueller SM, et al. Behavioral intervention technologies: Evidence review and recommendations for future research in mental health. General Hospital Psychiatry 2013.

  27. Damschroder LJ, Aron DC, Keith RE, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implementation Science 2009; 4(1): 50.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rogers E. Diffusion of Innovations, 5th Edition. New York, NY: Free Press; 2003.

    Google Scholar 

  29. Greenhalgh T, Robert G, Macfarlane F, et al. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 2004; 82(4): 581–629.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Molfenter T, Capoccia VA, Boyle MG, et al. The readiness of addiction treatment agencies for health care reform. Substance Abuse Treatment Prevention and Policy 2012; 7:16.

  31. California State Rural Health Association. Rural Providers and eHealth: The Future is Now. Sacramento, CA, 2010.

  32. Lehman WE, Greener JM, Simpson DD. Assessing organizational readiness for change. Journal of Substance Abuse Treatment 2002; 22(4): 197–209.

    Article  PubMed  Google Scholar 

  33. Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. Journal of Biomedical Informatics 2010; 43(1): 159–172.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Andrews M. ‘Who is being heard? Response bias in open-ended responses in a large government employee survey.’ Public Opinion Quarterly 2004; 69: 3760–3766.

    Google Scholar 

  35. Olson DE. Agency theory in the not-for-profit sector: Its role at independent colleges. Nonprofit and Voluntary Sector Quarterly 2000; 29(2): 280–296.

    Article  Google Scholar 

  36. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research 2005; 15: 1277–1288.

    Article  PubMed  Google Scholar 

  37. Charmaz K. Constructing Grounded Theory: A Practical Guide through Qualitative Analysis. Thousand Oaks: Sage Publications, 2006.

    Google Scholar 

  38. McAlearney AS, Schweikhart SB, Medow MA. Organizational and physician perspectives about facilitating handheld computer use in clinical practice: results of a cross-site qualitative study. Journal of the American Medical Informatics Association 2005; 12(5): 568–575.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Miles MB, Huberman AM. Qualitative data analysis: An expanded sourcebook, 2nd Edition. Thousand Oaks: Sage Publications; 1994.

    Google Scholar 

  40. Blaya JA, Fraser HS, Holt B. E-health technologies show promise in developing countries. Health Affairs 2010; 29(2): 244–251.

    Article  PubMed  Google Scholar 

  41. Burns LR, Pauly MV. Accountable care organizations may have difficulty avoiding the failures of integrated delivery networks of the 1990s. Health Affairs 2012; 31(11): 2407–2416.

    Article  PubMed  Google Scholar 

  42. Aarons GA, Glisson C, Green PD, et al. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study. Implementation Science 2012; 7: 56.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health 2011; 38(2): 65–76.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

This research study was supported by NIDA 1P30DA029926-01. The preparation of this manuscript was partially supported by NIMH T32 MH019960.

Conflict of Interest

The authors have no conflicts of interest to report.

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Authors and Affiliations

  1. Center for Mental Health Services Research, Brown School of Social Work, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA

    Alex Ramsey PhD

  2. Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA

    Sarah Lord PhD & Lisa Marsch PhD

  3. Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA

    John Torrey BA

  4. National Council for Behavioral Health, 1701 K St, NW Ste # 400, Washington, DC, 20006, USA

    Michael Lardiere LCSW

Authors
  1. Alex Ramsey PhD
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  2. Sarah Lord PhD
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  3. John Torrey BA
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  4. Lisa Marsch PhD
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  5. Michael Lardiere LCSW
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Corresponding author

Correspondence to Sarah Lord PhD.

Additional information

Alex Ramsey was a Research Associate at the Center for Technology and Behavioral Health, Dartmouth Psychiatric Research Center, at the time of this study.

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Ramsey, A., Lord, S., Torrey, J. et al. Paving the Way to Successful Implementation: Identifying Key Barriers to Use of Technology-Based Therapeutic Tools for Behavioral Health Care. J Behav Health Serv Res 43, 54–70 (2016). https://doi.org/10.1007/s11414-014-9436-5

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  • DOI: https://doi.org/10.1007/s11414-014-9436-5

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