Table 2 Themes based on Consolidated Framework for Implementation Research (CFIR) domains (1–5), CFIR constructs, and perceived barriers and facilitators related to implementation of digital health care services
1. Digital health services: Increased flexibility for organization, midwives and youth. (The intervention characteristic domain) | ||
|---|---|---|
CFIR constructs | Facilitators | Barriers |
Relative Advantage | Improved flexibility for midwives and youth clinics. Timely youth-centered services. Simplifying patient-provider continuity* | Â |
Complexity | Easy-to-use software | Â |
Design Quality & Packaging | Useful digital tools and information in software | Insufficient documentation structure for digital meetings Short digital appointment timeframe* |
2. The health care system: Lowering the threshold for some youth, but efforts needed to ensure equitable access and utilization of services. (The outer setting domain) | ||
CFIR constructs | Facilitators | Barriers |
Patient Needs & Resources | Ability to meet diversity in needs. Improved access for hard-to-reach groups* | Inequities in digital access for youth* Lacking input and feedback of digital services from youth Exacerbating language and age-related barriers in digital meetings |
Peer-pressure | Competing services from private digital caregivers | Â |
External policy & Incentives | Accelerated digital availability due to Covid-19 pandemic response measures. | Â |
3. The organization at the youth clinics: Mixed experiences of organizational support and digital implications on quality of care. (The inner setting domain) | ||
CFIR constructs | Facilitators | Barriers |
Structural Characteristics | Region-wide collaboration and unity | Divided management undermines digital interprofessional collaboration. |
Networks & Communications | Open organizational communication climate | Â |
Tension for Change | Digitalization being ‘a sign of the times. |  |
Compatibility | Fits with workflows and tasks* Health examination appropriateness* | Privacy and safety concerns* Inadequate for a holistic health approach Loss of non-verbal cues and conversational depth |
Relative Priority | Â | Competing organizational priorities |
Goals & Feedback | Feedback opportunities and receptiveness* | Goals of digital services remain undefined. Concern over future directions |
Leadership Engagement | Â | Â |
Available Resources | Multilevel leadership support* | Â |
| Â | IT-support and digital infrastructure* | Â |
Access to Knowledge & Information | Available guidelines/instructions Introduction and training opportunities* | Â |
4.The health care providers: Midwives appreciate the digital option but prefer meeting youth face to face. (The characteristics of individuals domain) | ||
CFIR constructs | Facilitators | Barriers |
Knowledge & Beliefs about the intervention | Overall belief in the health benefits of digital service options | Midwives´ meeting preferences* Habit of clinic-based work Youths’ expectations on the digital meeting |
Self-efficacy | Increased digital confidence -practice makes perfect. Overcoming initial digital concern | Clinic setting offers more resources and higher confidence among midwives. |
Individual State of Change | An intent to suggest digital options for youths more often. | Â |
Other personal characteristics | Digital meetings require prior youth clinic experience of health care providers | Â |
5. Implementation strategies of the digital health services: The importance of knowledgeable and enthusiastic colleagues during the implementation process (The process domain) | ||
CFIR constructs | Facilitators | Barriers |
Champions | Value of engaged clinic co-workers to advance digital services | Â |