Table 4.
Frequency of positive and negative comments about implementation of internet-delivered cognitive behaviour therapy
| CFIR Constructs | Positive Comments | Negative Comments | All | Representative Comments | ||||
|---|---|---|---|---|---|---|---|---|
| Therapists | Managers | Total | Therapists | Managers | Total | Total | ||
| Intervention Characteristics | ||||||||
| Innovation | – | 0 | 0 | – | – | 0 | – | |
| Evidence strength & quality | 7 | 3 | 10 | 2 | 0 | 2 | “I work from the perspective that this is an evidenced based service.” (Manager) | |
| Relative advantage | 13 | 5 | 18 | 1 | 1 | 2 | “They are able to get all of the CBT approach and materials without having to come in for 5–6 weeks of face-to-face appointments. Most people can’t commit to that amount of time, so we often don’t get the opportunity to walk clients through an entire CBT program in the office.” (Therapist) | |
| Adaptability | 1 | 1 | 2 | 8 | 3 | 11 | “Some staff that offer the service have noted that the format is somewhat rigid and this does not fit well with their service delivery style.” (Manager) | |
| Trialability | – | 2 | 2 | – | – | 0 | – | |
| Complexity | – | – | 0 | 4 | 2 | 6 | “Therapeutic alliance is a little more difficult to establish when the non-verbal communication is not a part of the eq. I think it also depends on the age of the client and their communication style.” (Therapist) | |
| Design quality and packaging | 12 | 4 | 16 | 4 | 0 | 4 | “The course has excellent material that is well thought out and organized.” (Therapist) | |
| Cost | 1 | – | 1 | 1 | – | 1 | – | |
| Construct Total | 49 | 26 | 75 | |||||
| Outer Setting | ||||||||
| Needs & resources | 5 | 2 | 7 | 3 | 1 | 4 | “It’s great to have another program clients can access when as a health region there are such long wait times for clients to be seen.” (Therapist) | |
| Cosmopolitanism | – | 4 | 4 | – | – | 0 | “This is a great program. I really like the current model of delivery where U of R is the leader and the region provides counsellors to support.” (Manager) | |
| Peer pressure | – | – | 0 | – | – | 0 | – | |
| External policy & incentives | – | – | 0 | – | – | 0 | – | |
| Construct Total | 11 | 4 | 15 | |||||
| Inner Setting | ||||||||
| Structural characteristics | – | – | 0 | 2 | 2 | 4 | “Staff changing roles and positions has had an impact.” (Manager) | |
| Networks & communications | – | – | 0 | – | – | 0 | – | |
| Culture | 2 | 3 | 5 | – | 1 | 1 | “Our staff are invested in providing good services to the public” (Manager) | |
| Implementation climate | 3 | 4 | 7 | 18 | 4 | 22 | “The majority of in-person intakes would have a higher need based on the complexity of their cases or severity of their symptoms, therefore I have a hard time justifying the time spent on ICBT/client over in-person counselling.” (Therapist) | |
| Readiness for implementation | 8 | 6 | 14 | 35 | 13 | 48 | “I think that there is a negative view of ICBT at this time, as it is seen as another “demand” on therapists’ time without other responsibilities being modified.” (Therapist) | |
| Construct Total | 26 | 75 | 101 | |||||
| Individual Characteristics | ||||||||
| Knowledge & beliefs about the innovation | 8 | 4 | 12 | 9 | 5 | 14 | “There are several therapists who have a strong interest in ICBT and this positively influences the implementation of ICBT. ”(Therapist) “But for some reason ICBT is a bit boring as a therapist to deliver for me. And it’s exhausting. I don’t really like writing out my therapy.” (Therapist) | |
| Self-efficacy | – | – | 0 | – | 1 | 1 | – | |
| Individual stage of change | – | 1 | 1 | 1 | 3 | 4 | “Most of us struggle with change” (Manager) | |
| Individual identification with organization | – | – | 0 | – | – | 0 | – | |
| Other personal attributes | 1 | 2 | 3 | 0 | 2 | 2 | “Some are more comfortable both with computers and with the written communication methods of the program.” (Manager) | |
| Construct Total | 16 | 21 | 37 | |||||
| Implementation Processes | ||||||||
| Planning | 2 | 3 | 5 | – | – | 0 | “Very well planned and organized, all positive.” (Manager) | |
| Engaging | 14 | 8 | 22 | 11 | 9 | 20 | “A lot of patients in our region were quite aware of ICBT. It seemed that they had been hearing about it from both their personal networks and from professional caregivers that they were involved with.” (Therapist) “I just think more people could be involved in providing the service.” (Therapist) |
|
| Executing | 6 | 3 | 9 | 2 | – | 2 | “It seemed like ICBT was implemented fairly efficiently in our health region.” (Therapist) | |
| Reflecting & evaluating | 2 | 3 | 5 | 1 | 0 | 1 | “We communicated the patient outcomes to staff & senior leadership in very visual undisputable ways.” (Manager) | |
| Construct Total | 41 | 23 | 64 | |||||
| TOTAL COMMENTS | 143 | 149 | 292 | |||||
CFIR Consolidated Framework for Implementation Research, ICBT internet-delivered cognitive behavior therapy, U of R University of Regina, CBT cognitive behavior therapy