Table 4 Barriers and facilitators to implementing ICTs

Capability

Knowledge

An awareness of the existence of something

7

• Educating staff about the reasons for universal screening prior to implementation (Facilitator)

• No manual or guidelines as to how the mobile app should be introduced and used throughout treatment (Barrier)

Skills

An ability or proficiency acquired through practice

5

• No access to appropriate training to ensure that nurses feel able to use innovative technology (Barrier)

• Training health care professionals for assessing and caring for patients from a distance using mobile telehealth iPad interactions (Facilitator)

Memory, attention and decision processes

The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives

2

• Clinical decision support tool to provide a definitive recommendation about whether to hospitalize or release a patient, decreasing cognitive burden (Facilitators)

Motivation

Social/professional role and identity

A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting

6

• Concerned for who [which clinician] would be responsible for monitoring the devices (Barrier)

• Task can be reasonably done by existing hospital staff and the minimal requirement to manage replies from participants who were in crisis (Facilitator)

Optimism

The confidence that things will happen for the best or that desired goals will be attained

2

• Clinicians and managers agreed that the new ICT made sense and was immediately appealing (Facilitator)

Beliefs about Consequences

Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation

5

• Uncertainty about how well the mobile app was incorporated in the face-to-face treatment, and whether this led to a positive or negative effect (Barrier)

• Concerns about giving service users iPhones and Fitbits for the duration of the study, suggesting that the equipment would either be stolen or damaged (Barrier)

• Perceived value or benefit of the tool to help patients (Facilitator)

Goals

Mental representations of outcomes or end states that an individual wants to achieve

1

• Perception that the intervention may have better fit with schools and universal youth services (Barrier)

Emotion

A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event

3

• Perceived burdensomeness and technophobia (Barrier)

Opportunity

Environmental context and resources (Physical)

Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence and adaptive behaviour

12

• Occasional dropped or slow connections, pixel blurring, and the need for online security (Barrier)

• Taking extra time away from the usual therapy (Barrier)

• Using the smartphone application was more time consuming (Barrier)

• No access to the research team available in participating wards to troubleshoot technological issues in a timely manner (Barrier)

• Patients' lack of access to the technology (e.g., smart phones) (Barrier)

• Inexpensive ICT (Facilitator)

Social influences

Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours

10

• Having a hospital staff member in the role of principal investigator at each site (Facilitator)

• Positive working collaborations between clinicians and the research team, including data scientists and technicians, to ensure a continuous flow of data (Facilitator)

• Waiting to download the app until the moment of discharge limits the opportunity for staff to facilitate the adoption of a smartphone app (Barrier)

• Limited buy-in at management levels (Barrier)