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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