Søren Lange Nielsen’s research while affiliated with Region of Southern Denmark and other places

UNSTRUCTURED Digital mental health solutions have great potential to enhance mental healthcare. However, barriers at the level of users, interventions and context hinder engagement and uptake. Involving users in the design, adaptation and implementation process has been put forward as a potential solution, yet instructions and examples on how to do so are limited. One potential framework is design thinking. Although design thinking is a common approach in the business community, its use for guiding development and adaptation processes is not yet common practice in the context of digital mental health. Unsurprisingly, it is difficult to find concrete instructions on how to do this, even more so in an international context. Therefore, the Successful User Participation Examples and Recommendations (SUPER) project aimed to develop guidelines for entrepreneurs and mental health organizations on how to involve end-users and mental health professionals in the transnational development, implementation and adaptation of mental health technology. This paper describes the steps of design thinking and how these can be undertaken by researchers, practitioners or developers in the context of digital mental health. The process is illustrated with two adaptations of digital mental health solutions following this approach, executed by the SUPER consortium in the Netherlands and in Denmark. The learnings from these two pilots are provided in the form of key considerations and highlights of issues that were experienced during both design thinking processes. The overall aim is to guide practitioners, developers and researchers towards better development and international adaptation of digital mental health.

Increased user participation in developing and adapting digital mental health solutions helps to tackle barriers and enhance facilitators for uptake of and engagement with digital mental health solutions. These guideline aims to aid this process of involving and empowering the intended users and provide a practical step-by-step guide to better understand and include them in a meaningful way. To do so, we will elaborate on the importance and concept of this participation. Then, we will present Design Thinking as a process framework, referring to methods you can use for user participation throughout the process. To provide depth, the guidelines incorporate insights from transnational adaptations of two digital mental health solutions: the Stress Autism Mate (SAM) app and the SAFE app. These real-world examples highlight the challenges and successes encountered when scaling solutions across cultural contexts. Finally, we summarise our recommendations in concrete topics you should be aware of when working with user participation for digital mental health innovation in an international context.

Background The process of tailored implementation is ill-defined and under-explored. The ItFits-toolkit was developed and subsequently tested as a self-guided online platform to facilitate implementation of tailored strategies for internet-based cognitive behavioural therapy (iCBT) services. In ImpleMentAll, ItFits-toolkit had a small but positive effect on the primary outcome of iCBT normalisation. This paper investigates, from a qualitative perspective, how implementation teams developed and undertook tailored implementation using the toolkit within the trial. Methods Implementation teams in thirteen sites from nine countries (Europe and Australia) used the ItFits-toolkit for six months minimum, consistent with the trial protocol. A qualitative process evaluation was conducted. Descriptive data regarding goals, barriers, strategies, and implementation plans collected within the toolkit informed qualitative data collection in real time. Qualitative data included remote longitudinal interviews ( n = 55) with implementation team members ( n = 30) and observations of support calls ( n = 19) with study sites. Qualitative data were analysed thematically, using a team-based approach. Results Implementation teams developed and executed tailored implementation projects across all steps in the toolkit process. Working in a structured way but with room for flexibility, decisions were shaped by team members’ ideas and goals, iterative stakeholder engagement, internal and external influences, and the context of the ImpleMentAll project. Although teams reported some positive impacts of their projects, ‘time’, both for undertaking the work, and for seeing project impacts, was described as a key factor in decisions about implementation strategies and assessments of success. Conclusion This study responds directly to McHugh et al.’s (2022) call for empirical description of what implementation tailoring looks like in action, in service settings. Self-guided facilitation of tailored implementation enables implementers in service settings to undertake tailoring within their organisations. Implementation tailoring takes considerable time and involves detailed work but can be supported through the provision of implementation science informed guidance and materials, iterative and ongoing stakeholder engagement, and working reflectively in response to external influencing factors. Directions for advancement of tailored implementation are suggested.

Introduction This study investigates the implementation of a new, more automated screening procedure using the ItFits-toolkit in the online clinic, Internet Psychiatry (iPsych) (www.internetpsykiatrien.dk), delivering guided iCBT for mild to moderate anxiety and depressive disorders. The study focuses on how the therapists experienced the process. Methods Qualitative data were collected from semi-structured individual interviews with seven therapists from iPsych. The interviews were conducted using an interview guide with questions based on the Consolidated Framework for Implementation Research (CFIR). Quantitative data on the perceived level of normalization were collected from iPsych therapists, administrative staff, and off-site professionals in contact with the target demographic at 10-time points throughout the implementation. Results The therapists experienced an improvement in the intake procedure. They reported having more relevant information about the patients to be used during the assessment and the treatment; they liked the new design better; there was a better alignment of expectations between patients and therapists; the patient group was generally a better fit for treatment after implementation; and more of the assessed patients were included in the program. The quantitative data support the interview data and describe a process of normalization that increases over time. Discussion The ItFits-toolkit appears to have been an effective mediator of the implementation process. The therapists were aided in the process of change, resulting in an enhanced ability to target the patients who can benefit from the treatment program, less expenditure of time on the wrong population, and more satisfied therapists.