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Table 5 Recommendations for implementing digital health interventions

From: IMPlementation of An online Relatives’ Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use

Understanding context is key
Clarify exactly how DHI fits into the broader clinical service including care pathways and auditing targets
Understand, acknowledge, and where possible address important wider contextual barriers to uptake and use of DHI
Clarify the organisational structure and identify relevant decision-makers across different levels of the organisation, and understand how decision making around adoption of new practices happens within each organisation
Consider which elements of DHI require local adaptation (e.g. resource directories of other available services), and which require national integration (e.g. online forums)
Design DHI to be compatible with the range of hardware and software currently used across the healthcare teams
Identify other organisational changes that are occurring simultaneously and consider how these may affect implementation of DHI. Simultaneous implementation of other DHIs may be particularly challenging for staff
Maximise initial buy-in and continued use
Clearly identify originators/developers of DHI, and seek endorsement from credible parent organisations, and end users
Ensure DHI is clearly identified as a clinical initiative and not identified as primarily research
Explicitly identify and label DHI with the key value(s) for each stakeholder group in the organisation
All relevant user groups (including staff) should have full access to the DHI, pilot the DHI, consider the pros and cons, and be part of the service decision to adopt
All staff fears and concerns about DHI should be identified and addressed in organisational written policy and staff training prior to adoption
Promote DHI as part of a multichannel service to avoid “out of sight out of mind”
Ensure ongoing training and support for all staff
Consider appointing one or more champions to coordinate organisational activity and be a point of contact for DHI providers
Train staff in all relevant skills including generic IT skills, using multi-channel, flexible training that can accommodate constant turnover of staff.
Provide relevant feedback and manage expectations
Audit reports around DHI use need to be easily available to stakeholders in user friendly form, with clear mechanism established for addressing feedback involving DHI providers
Specific short and long term targets should be set regarding uptake and use of DHI to manage staff expectations and evaluate progress