Domain & complexity level | Theme | Facilitator | Barrier | Facilitator & barrier |
---|---|---|---|---|
1. The condition complicated | A demand for treatment options | Psychological treatment missing | ||
Facilitating other treatments | ||||
Insomnia suitable for online treatment | ||||
2. The technology complicated | Technical functionality and reliability | Intuitive and satisfactory functionality | Insufficient functionality | |
Stable platform | Technical problems | |||
Connected to the national e-health service | ||||
Technology features | Providing variation in everyday work | Automatic suicide question | ||
Standardisation guarantees quality | ||||
Clarity and structure | ||||
3. The value proposition simple | Desirability | Time and cost effective | ||
Not time or place bound | ||||
Reaching new groups of patients | ||||
Feasibility for patients in psychiatry | Perceived as effective | Too complicated for patients | ||
Secondary benefits | Generally improved mental health | |||
Improved treatment competence | ||||
Improved sleep among therapists | ||||
Facilitating other digitalisation projects | ||||
4. The adopters complex | Identifying ICBT-i therapists | Low interest in ICBT-i | ||
Low availability of therapists | ||||
Colleagues’ attitudes to ICBT-i | Initial positive attitudes | Ideological differences | ||
Attitudes gradually more positive | Scepticism and distancing | |||
Recruitment of patients | High demand for ICBT-i | Few patients identified as suitable | Low commitment | |
Patients not reached by information | ||||
New skills and routines | Less stressful | Communication by text difficult | ||
Advantages in communication by text | Non-response to messages stressful | |||
High quality treatment | Disadvantages in online contact | |||
5. The organisation complicated | Managerial engagement | Support from senior managers | Concern about negative reactions | |
Engagement in implementation | ||||
Prioritising ICBT-i | Top-down implementation | |||
Priority issues | ||||
Organisational challenges | ICBT-i a solution for organisational challenges | Unclear directives | ||
Insufficient digitalisation knowledge | ||||
Organisational responsibility for insomnia | ||||
Experiences from implementation activities | Solid and structured | Comprehensive process | ||
Hi quality training, supervision and support | ||||
6. The wider system simple | Societal development | General societal development | ||
Patients’ expectations | ||||
Pressure from patient organisations | ||||
Regional support | Regional strategic goal | |||
7. Embedding and adaptation over time complicated | Challenge to scale up | Fear about long run implications | ||
Challenges for future implementation |