Implementing a digital mental health intervention for individuals with psychosis - a multi-country qualitative study

• Published in: BMC psychiatry 2021-09, Vol.21 (1), p.1-468, Article 468
• Main Authors: Pemovska, Tamara, Arënliu, Aliriza, Konjufca, Jon, Uka, Fitim, Hunter, Jennifer, Bajraktarov, Stojan, Stevović, Lidija Injac, Jerotić, Stefan, Kulenović, Alma Džubur, Novotni, Antoni, Novotni, Ljubisa, Radojičić, Tamara, Repišti, Selman, Ribić, Emina, Ristić, Ivan, Mešević, Eldina Smajić, Zebić, Mirjana, Jovanović, Nikolina
• Format: Article
• Language: English
• Subjects: Care and treatment; Caregivers; Data collection; Developing countries; Digital intervention; Drug therapy; E-health; Ethics; Focus groups; Health aspects; Health care; Health care reform; Health services; Implementation science: psychosis; Informed consent; Intervention; Low- and middle-income setting; Medical personnel; Mental disorders; Mental health; Mental health care; Methods; Patients; Psychiatric services; Psychiatry; Psychoses; Psychosis; Psychosocial intervention; Qualitative research; Quality of life; Southeast Europe; Technology application
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-021-03466-x

Background Implementation of psychosocial interventions in mental health services has the potential to improve the treatment of psychosis spectrum disorders (PSD) in low- and middle-income countries (LMICs) where care is predominantly focused on pharmacotherapy. The first step is to understand the views of key stakeholders. We conducted a multi-language qualitative study to explore the contextual barriers and facilitators to implementation of a cost-effective, digital psychosocial intervention, called DIALOG+, for treating PSD. DIALOG+ builds on existing clinician-patient relationships without requiring development of new services, making it well-fitting for healthcare systems with scarce resources. Methods Thirty-two focus groups were conducted with 174 participants (patients, clinicians, policymakers and carers), who were familiarized with DIALOG+ through a presentation. The Southeast European LMICs included in this research were: Bosnia and Herzegovina, Kosovo, (Kosovo is referred throughout the text by United Nations resolution) North Macedonia, Montenegro and Serbia. Framework analysis was used to analyse the participants' accounts. Results Six major themes were identified. Three themes (Intervention characteristics; Carers' involvement; Patient and organisational benefits) were interpreted as perceived implementation facilitators. The theme Attitudes and perceived preparedness of potential adopters comprised of subthemes that were interpreted as both perceived implementation facilitators and barriers. Two other themes (Frequency of intervention delivery; Suggested changes to the intervention) were more broadly related to the intervention's implementation. Participants were exceedingly supportive of the implementation of a digital psychosocial intervention such as DIALOG+. Attractive intervention characteristics, efficient use of scarce resources for its implementation and potential to improve mental health services were seen as the main implementation facilitators. The major implementation barrier identified was psychiatrists' time constrains. Conclusions This study provided important insights regarding implementation of digital psychosocial interventions for people with PSD in low-resource settings by including perspectives from four stakeholder groups in five LMICs in Southeast Europe - a population and region rarely explored in the literature. The perceived limited availability of psychiatrists could be potentially resolved by increased inclusion