the implementation of e-health interventions in health

The Implementation of e-Health

Interventions in Health Services

FILIP DROZD, PhD

National Network for Infant Mental Health

Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 2

Mamma Mia is developed by Changetech in collaboration with the National Network for Infant Mental Health, Regional Centre for

Child and Adolscent Mental Health, for the Norwegian Women’s Public Health Assocation.

FUNDING & SUPPORT

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature.

Tampa, FL: National Implementation Research Network.

‘‘… a specified set of activities designed to put into

practice an activity or program of known dimensions.’

– Fixsen et al., 2005

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WHAT IS IMPLEMENTATION?DEFINITION

1. Prevent postpartum depression

Provide instant help and support on indication

2. Promote subjective well-being

Strengthen the couple relationship

Promote parental sensitivity

Promote healthy parent-child interactions

Promote the development of a secure attachment

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MAMMA MIAOVERALL GOALS

INTERVENTION PROTOCOL

Drozd, F. et al., 2015. An Internet-based intervention (Mamma Mia) for postpartum depression: Mapping the

development from theory to practice. JMIR Research Protocols, 4(4), e120.

1. 2-armed trial

Mamma Mia+treatment-as-usual (n = 674) vs. treatment-as-usual (n = 668)

2. Inclusion criteria

18 years or older and able read and understand Norwegian

3. Outcomes

Depression, subjective well-being, parental satisfaction, relationship satisfaction,

social support, parent-infant attachment during pregnancy and postpartum.

4. 6 measurement waves (n, %)

Baseline: 1 342 (100%)

GW 37: 1 117 (83%)

6 weeks: 962 (72%)

3 months: 847 (63%)

6 months: 851 (63%)

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RANDOMIZED CONTROLLED TRIAL

INTERVIEWS

Drozd, F., Andersen, C. E., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2017). User experiences and perceptions of

internet interventions for depression. In S. Langrial & A. Sharieh (eds.), Web-based behavioral therapies

for mental disorders. Hershey, PA: IGI Global.

SYSTEMATIC REVIEW

Drozd, F., Vaskinn, L., Bergsund, H. B., Haga, S. M., Slinning, K., & Bjørkli, C. A. (2016). The implementation of

internet interventions for depression: A scoping review. Journal of Medical Internet Research, 18(9), e236.

https://doi.org/10.2196/jmir.5670

Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 9

Table 1. Number and percentage of references and units coded on the initial implementation components.

Implementation components Ka % kb %

Selection 114 69,5 164 54,3

Training 28 17,1 44 14,6

Supervision 36 22,0 61 20,2

Performance 9 5,5 12 4,0

Decision-support 2 1,2 4 1,3

Administrative support 7 4,3 8 2,6

System intervention 8 4,9 9 3,0

Leadership 0 0,0 0 0,0

aK refers to unique references coded onto the various implementation components.

bk refers to number of analysis units extracted from the references.

SYSTEMATIC REVIEWDIFFERENCES IN REPORTING ON IMPLEMENTATION COMPONENTS?

Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 10

SYSTEMATIC REVIEWPUBLICATIONS IN REGULAR CARE SETTINGS, 2002-2014

Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway | www.r-bup.no 11

SYSTEMATIC REVIEWWHAT CHARACTERIZES THE LITERATURE ON IMPLEMENTATION?

Table 4. The final template with meaningful themes, corresponding codes, definitions, and examples.

Level Theme Ka % Definition

1. User 152 50,3

1.1. Guided support 31 10,3

An internet-based self-help program including minimal, but

regular human involvement and support.

1.2. User recruitment 121 40,1

Activities related to promoting and advertising the

intervention to potential end-users.

2. Practitioner 99 32,8

2.1. Qualifications 38 12,6

Formal and informal background education and/or training

among practitioners delivering internet interventions.

2.2. Training 32 10,6

Acquisition of new knowledge, skills, and abilities required to

work with internet interventions.

2.3. Supervision 18 6,0

Coaching of practitioners working with users through

observation, instruction, feedback, emotional support,

debriefing, or some other form of on-the-job training.

aNumber of references coded on a theme or sub-theme.

CLINICAL & IMPLEMENTATION GUIDELINES

Drozd, F., Haga, S. M., & Slinning, K. (2017). From science to practice: Implementation and clinical guidelines

for an internet intervention for postpartum depression. In S. Langrial & A. Sharieh (eds.), Web-based

behavioral therapies for mental disorders. Hershey, PA: IGI Global.

1. What conditions at the well-baby clinics lead to a successful

implementation of Mamma Mia?

2. How do participants rate the training and how does that

influence the implementation of Mamma Mia?

3. What needs to improve to ensure a high-quality

implementation of Mamma Mia?

Regional Centre for Child and Adolescent Mental Health | www.r-bup.no 13

IMPLEMENTATION PILOTPURPOSE

1. Training (2+2 days)

2. Implementation plan

3. Monthly coaching (clinical and implementation)

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Drozd, F., Haga, S. M., & Slinning, K. (in preparation). Evaluation of the implementation of an internet

intervention in well-baby clinics: Factors associated with successful implementation. Translations in

Behavioral Medicine.

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no

IMPLEMENTATION PILOTIMPLEMENTATION PRACTICE

1. 15 well-baby clinics

2. 23 midwives and public health nurses

3. 22 females; 1 male

4. Age: Mean = 52.6 yrs.; SD = 4.8 yrs.

5. Yrs. in current position: Mean = 10.43; SD = 7.20.

6. Edinburgh-method: 9 (39.1%) persons

7. Supplementary training in other methods: 16 (69.6%) persons

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 15

IMPLEMENTATION PILOTPARTICIPANTS

Large increase in knowledge about Mamma Mia pre-training (M =

4.67, SD = 2.61) compared to post-training (M = 8.38, SD = 1.12;

t(20) = -8.39, p < .001, Cohen’s d = 1.85).

On a scale from 1 to 10, where higher scores are better …

– Satisfaction with training: M = 8.36; SD = 0.95.

–Recommend training to others: M = 8.73; SD = 1.58.

–Recommend Mamma Mia to health personnel: M = 9.55; SD =

0.80.

–Recommend Mamma Mia to women: M = 9.73; SD = 0.55.

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 16

IMPLEMENTATION PILOTTRAINING EVALUATION

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 17

IMPLEMENTATION PILOTIMPLEMENTATION OUTCOMES: NATIONAL & LOCAL GUIDELINES

Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no 18

IMPLEMENTATION PILOTIMPLEMENTATION OUTCOMES: INFLUENCE ON WORK & WORKFLOW

1. Implementation plan

2. Organizational readiness

3. Leadership support (or lack thereof)

4. Implementation of Mamma Mia is feasible in well-baby clinics

19Regionsenter for barn og unges psykiske helse, Helseregion Øst og Sør | www.r-bup.no

IMPLEMENTATION PILOTPRELIMINARY CONCLUSIONS

EFFECTIVE INEFFECTIVE

INEFFECTIVEPOTENTIALLY

HARMFUL

TAKE-HOME MESSAGE

YES NO

YES

NO

EFFEC

TIV

E IN

TER

VEN

TIO

NS

EFFECTIVE IMPLEMENTATION

THANK YOU!

FILIP DROZD

E-mail: filip.drozd@r-bup.no