Communication strategies to facilitate the implementation of new clinical practices: a qualitative study of community mental health therapists

Lay Summary There has been a great deal of attention recently to the study of implementation, or how something (e.g., a new clinical practice or initiative) is actually put into effect. Many studies have found a number of barriers to and facilitators of the implementation process. But despite this increased attention, the field of implementation science may not have paid enough attention to the role of communication. Although communication is generally acknowledged as important, precisely how it impacts implementation—and, importantly, the ways it might be improved—is typically unexplored. This study conducted focus groups with mental health therapists in 12 clinics which were about to implement a new clinical practice: measurement-based care for depressed adults receiving psychotherapy. What these therapists shared about their perspectives and experiences suggest that there are at least five ways to facilitate effective communication when introducing a new clinical practice: communicating a clear rationale for the new practice, providing necessary procedural knowledge, using multiple methods to communicate about the change, giving sufficient lead time to prepare for the change, and providing the opportunity for bidirectional engagement.

Characterizing Social Media and Digital Data Use in Mental Health Therapy from Therapist and Patient Perspectives (Preprint)

BACKGROUND Incorporating insights from social media into the patient provider encounter is increasingly being explored in healthcare settings. Less is known about the utility of this data in mental health therapy. OBJECTIVE This study aimed to prospectively investigate and characterize how social media and digital data is used in mental health therapy from both the patient and mental health therapist perspective. METHODS Patients enrolled in mental health therapy and mental health therapists were interviewed using a semi-structured interview. All interviews were transcribed and coded using a deductive framework analysis. Themes and sub-themes were identified. Participants completed a socio-demographic survey while mental health therapists also completed a behavioral norms and elicitation survey. RESULTS Seventeen participants: mental health therapists (48%, 8) and patients (52%, 9), were interviewed. Overall, participants identified four themes and nine sub-themes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most sub-themes were related to advantages of and disadvantages of incorporating digital data in mental health therapy. Advantage sub-themes included convenience objective, builds rapport, and user-friendly while disadvantage sub-themes were digital data/social media is non-reflective, ethically ambiguous, and non-generalizable. Injunctive and descriptive normative beliefs mapped onto two advantage sub-themes: convenience and objectivity. CONCLUSIONS This qualitative pilot study established advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and comfortable to use and discuss social media and digital data in mental health therapy.

Investigating Race-related Stress, Burnout, and Secondary Traumatic Stress for Black Mental Health Therapists

The present study examines the relationships among burnout, secondary traumatic stress (STS), and race-related stress among a national sample of 250 Black mental health therapists (counselors, social workers, psychologists, and marriage and family therapists). We investigated the predictive nature of the three subscales (Individual Racism, Cultural Racism, and Institutional Racism) of the Index of Race-Related Stress–Brief Version (IRRS-B) and selected demographic variables on therapists’ reports of burnout and STS assessed on the Professional Quality of Life Scale–Version 5 (ProQOL-5). All three forms of race-related stress significantly predicted both burnout and STS for Black mental health therapists. Of the demographic variables, hours worked per week significantly predicted burnout and STS. Additionally, highest degree obtained significantly predicted STS for Black mental health therapists. The utility of these findings in understanding the connections among race-related stress, burnout, and STS are discussed as well as directions for future research.

Using Narrative Practices in Diverse Indian Contexts

The use of narrative practice within mental health contexts in India is relatively new. This qualitative thematic study reports on how narrative practices are being used by mental health practitioners within and outside of the therapy setting in Mumbai, India. Eleven mental health therapists were interviewed regarding their use of narrative ideas in practice. Data were analyzed using thematic analysis and revealed three themes: (1) “Doing It Together” reflected the need to work in partnership, (2) “Quest for Possibility” revealed ways in which therapists were positioned and used narrative ideas to advocate for change within and beyond the therapy room, and (3) “An Evolving Journey” highlighted the personal and professional growth of therapists. Findings reveal that narrative practices have positively impacted the lives of therapists, clients, and the wider community, making it a valuable modality for promoting well-being and mental health in India.

Sustainability of a biobehavioral intervention implemented by therapists and sustainment in community settings

The ultimate aim of dissemination and implementation of empirically supported treatments (ESTs) in behavioral medicine is (a) sustainability of the therapist/provider’s EST usage and (b) sustainment of EST delivery in the setting. Thus far, sustainability has been understudied, and the therapist and setting variables that may be influential are unclear. The purpose of the study was to test the therapists’ sustainability of a cancer-specific EST using a prospective longitudinal design and examine its predictors. Oncology mental health therapists (N = 134) from diverse settings (N = 110) completed training in the biobehavioral intervention (BBI) and were provided with 6 months of support for implementation, with no support thereafter. BBI usage (percent of patients treated) was reported at 2, 4, 6, and 12 months. Using a generalized estimating equation with a logistic link function, 12-month sustainability (a nonsignificant change in usage from 6 to 12 months) was studied along with therapist, supervisor, and setting variables as predictors. BBI usage increased through 6 months and, importantly, usage was sustained from 6 (68.4% [95% CI = 62.2%–73.9%]) to 12 months (70.9% [95% CI = 63.6%–77.3%]), with sustainment in 66 settings (60.0%). Predictors of implementation-to-sustainability usage were therapists’ early intentions to use the BBI (p < .001) and from the setting, supervisors’ positive attitudes toward ESTs (p = .016). Adding to the DI literature, a health psychology intervention was disseminated, implemented, and found sustainable across diverse therapists and settings. Therapists and setting predictors of usage, if modified, might facilitate future sustainability/sustainment of ESTs.

Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

Background The shortage and disproportionate distribution of health care workers worldwide is further aggravated by the inadequacy of training programs, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment. Offline digital education has the potential to improve the quality of health professions education. Objective The primary objective of this systematic review was to evaluate the effectiveness of offline digital education compared with various controls in improving learners’ knowledge, skills, attitudes, satisfaction, and patient-related outcomes. The secondary objectives were (1) to assess the cost-effectiveness of the interventions and (2) to assess adverse effects of the interventions on patients and learners. Methods We searched 7 electronic databases and 2 trial registries for randomized controlled trials published between January 1990 and August 2017. We used Cochrane systematic review methods. Results A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (standardized mean difference [SMD]=1.88; 95% CI 1.14 to 2.62; participants=300; studies=3; I2=80%; low certainty evidence). A meta-analysis of 2 studies found that compared with no intervention, the effects of offline digital education (computer-assisted training [CAT]) on nurses and physical therapists’ knowledge were uncertain (SMD 0.55; 95% CI –0.39 to 1.50; participants=64; I2=71%; very low certainty evidence). A meta-analysis of 2 studies found that compared with traditional learning, a PowerPoint presentation may improve the knowledge of patient care personnel and pharmacists (SMD 0.76; 95% CI 0.29 to 1.23; participants=167; I2=54%; low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, the effects of computer-assisted training on skills in community (mental health) therapists, nurses, and pharmacists were uncertain (SMD 0.45; 95% CI –0.35 to 1.25; participants=229; I2=88%; very low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses and mental health therapists (SMD –0.07; 95% CI –0.42 to 0.28, participants=232; I2=41%; low certainty evidence). A total of 2 studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes, the results were mixed and inconclusive. None of the studies reported adverse or unintended effects of the interventions. Only 1 study reported costs of interventions. The risk of bias was predominantly unclear and the certainty of the evidence ranged from low to very low. Conclusions There is some evidence to support the effectiveness of offline digital education in improving learners’ knowledge and insufficient quality and quantity evidence for the other outcomes. Future high-quality studies are needed to increase generalizability and inform use of this modality of education.

Offline Digital Education for Postregistration Health Professions: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration (Preprint)

BACKGROUND The shortage and disproportionate distribution of health care workers worldwide is further aggravated by the inadequacy of training programs, difficulties in implementing conventional curricula, deficiencies in learning infrastructure, or a lack of essential equipment. Offline digital education has the potential to improve the quality of health professions education. OBJECTIVE The primary objective of this systematic review was to evaluate the effectiveness of offline digital education compared with various controls in improving learners’ knowledge, skills, attitudes, satisfaction, and patient-related outcomes. The secondary objectives were (1) to assess the cost-effectiveness of the interventions and (2) to assess adverse effects of the interventions on patients and learners. METHODS We searched 7 electronic databases and 2 trial registries for randomized controlled trials published between January 1990 and August 2017. We used Cochrane systematic review methods. RESULTS A total of 27 trials involving 4618 individuals were included in this systematic review. Meta-analyses found that compared with no intervention, offline digital education (CD-ROM) may increase knowledge in nurses (standardized mean difference [SMD]=1.88; 95% CI 1.14 to 2.62; participants=300; studies=3; I2=80%; low certainty evidence). A meta-analysis of 2 studies found that compared with no intervention, the effects of offline digital education (computer-assisted training [CAT]) on nurses and physical therapists’ knowledge were uncertain (SMD 0.55; 95% CI –0.39 to 1.50; participants=64; I2=71%; very low certainty evidence). A meta-analysis of 2 studies found that compared with traditional learning, a PowerPoint presentation may improve the knowledge of patient care personnel and pharmacists (SMD 0.76; 95% CI 0.29 to 1.23; participants=167; I2=54%; low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, the effects of computer-assisted training on skills in community (mental health) therapists, nurses, and pharmacists were uncertain (SMD 0.45; 95% CI –0.35 to 1.25; participants=229; I2=88%; very low certainty evidence). A meta-analysis of 4 studies found that compared with traditional training, offline digital education may have little effect or no difference on satisfaction scores in nurses and mental health therapists (SMD –0.07; 95% CI –0.42 to 0.28, participants=232; I2=41%; low certainty evidence). A total of 2 studies found that offline digital education may have little or no effect on patient-centered outcomes when compared with blended learning. For skills and attitudes, the results were mixed and inconclusive. None of the studies reported adverse or unintended effects of the interventions. Only 1 study reported costs of interventions. The risk of bias was predominantly unclear and the certainty of the evidence ranged from low to very low. CONCLUSIONS There is some evidence to support the effectiveness of offline digital education in improving learners’ knowledge and insufficient quality and quantity evidence for the other outcomes. Future high-quality studies are needed to increase generalizability and inform use of this modality of education.