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Table 1 Summary of themes, facilitators, barriers, and complexity level, sorted under the NASSS domains

From: Experiences from implementation of internet-delivered cognitive behaviour therapy for insomnia in psychiatric health care: a qualitative study applying the NASSS framework

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

 
  1. ICBT-i Internet-delivered cognitive behaviour therapy for insomnia
  2. Key facilitators and barriers are marked in italics