Where it really counts – Mental health implementation in LMICs

Thu. 02. May 2019 14:30

PlaceholderThere is a big difference between the mental healthcare systems in Low- and Middle-Income Countries (LMICs) compared to high-income countries. Therefore the IMA consortium finds it highly interesting to have two LMICs in our consortium and part of the trial. For this blog post, we wanted to find out if and how IMA has made an impact in these countries, so we asked our partners in Albania and Kosovo. In LMICs, the mental healthcare system often poses a bigger challenge than a help for those in need of its services. However, in Albania and Kosovo, reformations are put in motion and change is happening. In Albania, the mental healthcare system is moving from being highly centralised and providing symptom-focused, biological treatment to decentralisation and deinstitutionalisation, where the patients receive psychotherapy as well as support. In Kosovo, the mental healthcare system is also in the process of decentralisation and now counts one psychiatric clinic, four hospital wards, and seven community-based mental health centres across the country. However, none of these are located outside the larger cities. Despite the budget (based on GDP) in these countries being nearly half the size of that in other EU countries, the mental healthcare system receives great support from the policy makers. Our two partners from Albania and Kosovo were introduced to us by the London School of Hygiene and Tropical Medicine, who “joined IMA with the hope of introducing and implementing a new way of providing therapy for depression on the newly established mental health community teams in Albania and Kosova. We stepped in, knowing that we would be facing many challenges in terms of institutional resistance and mental health stigma, but also being prepared to encounter unknown difficulties, since information and evidence-based data from these countries is quite limited. We ultimately aimed to narrow the treatment gap for people suffering from depression in Albania and Kosova. If we could increase awareness about the condition, tackle stigma and treat just one more patient that would otherwise go untreated, we would have made a great achievement,” says Arlinda from the London School of Hygiene and Tropical Medicine.  Especially the notion of challenges in terms of mental health stigma is mentioned by the two partners, when asked why they decided to join our team in IMA. Gentiana from Tirana Community Centre for Health and Wellbeing says, “Mental health in Albania continues to be an important, but overlooked health issue. Albania joined the IMA project in order to contribute to the improvement of depression treatment, increased access, and lowering of stigma through the use of innovative methods,” and in Kosovo, Naim from the Mental Health Centre MCHPriz in Kosovo reasons that “The major problem with the stigma and other difficulties in providing mental health in Kosovo, such as staff shortages, especially psychologists and psychotherapists, makes it necessary to explore other options to increase people's access to depression in getting the most needed services for them.”  Even though it is still quite early to detect any influence IMA might have had on the national mental healthcare systems in the two countries, several factors are repeated when asking our partners this question. They include an attitude shift; awareness of the importance of psychologists; sparked curiosity within the field from clinicians, policy makers, and researchers; and an increase in the number of people who seek help within the mental healthcare system.  The project still has almost two years left before its conclusion, thus the impact of IMA in these two LMICs has potential to grow. In the future, Gentiana from Albania hopes “that the IMA project will have an impact on raising the issue of mental health at the attention of the public and policy makers. Demonstrating the use of innovative, effective, and evidence-based methods for treating depression will impose the necessity for scaling up these models throughout Albania,” and in Kosovo, Naim explains his hopes for the future, “IMA can manage to get into the list of services offered by the Mental Health Centres in Kosovo even after the completion of the project. Also, experience from implementation and its application can serve as a basis for the further development of eHealth approaches.” We in IMA hope that all of these hopes and predictions will come true and continue even after the project has run its course, but only time will tell. To find out more about the mental healthcare systems in Albania and Kosovo, check out their Prezi from our midterm workshop last year.  How do you think a project like IMA could affect the mental healthcare system in your country? Please write a comment below to let us know!

Kia Ora – ImpleMentAll goes down under

Mon. 11. Mar 2019 10:39

PlaceholderISRII 2019 Conference, 12-15 February, Auckland This year’s conference of the International Society for Research on Internet Interventions (ISRII) took place in Auckland, New Zealand on 12-15 February 2019. Despite the long travel distance to be taken by most of its consortium members, ImpleMentAll was pleased to have organised two symposia. First things first. When arriving at the venue on Wednesday morning, the conference participants walked over to the Waipapa Marae, a sacred meeting ground located at the University of Auckland campus. To introduce the participants to the culture, we were greeted with a heartfelt Pōwhiri, a welcome ceremony traditionally celebrated by New Zealand’s indigenous population, the Māori. Afterwards, a group of students from the Hoani Waititi school performed an impressive Kapa Haka, a ritual Māori dance. After an official opening address by (former) president Frances Kay-Lambkin and conference co-conveners Karolina Stasiak and Terry Fleming, the ISRII 2019 conference started with two keynotes. The first was given by Lance O’Sullivan, who demonstrated the discrepancies in healthcare between indigenous and non-indigenous populations in New Zealand. The second was speaker was Ricardo Muñoz, who granted insight into his own origins, pointing to the fact that probably all of us have some traces of indigeneity in our history. Delighted by Ricardo Muñoz’ motivational words that the ISRII community could contribute to make healthcare a universal human right and Lance O’Sullivan’s appeal to disrupt old habits to make innovations work, everyone was good to go to dive into the exciting world of Internet Interventions.          A variety of high-ranked researchers from 24 countries came together to present on their work, to exchange knowledge, and to become inspired. During the three conference days, the following themes were covered: (1) Indigeneity, diversity & equity in Internet Interventions, (2) Development, evaluation & testing, (3) Implementation, engagement & scaling out, (4) Big data, data mining, analytics, (5) Methods & meta science, (6) Human Computer Interaction & design thinking, (7) Persuasive technology & behaviour change, (8) Next generation interventions & technology. ImpleMentAll’s two-part symposium named “Next Generation Internet Interventions in Routine Practice” chaired by Christiaan Vis and Anne Etzelmüller focused on the implementation science perspective of eHealth interventions on the one hand, and on the implementation practice perspective on the other hand. A variety of ImpleMentAll related topics were addressed by ten speakers from the consortium. The first part covered the effectiveness of iCBT services in routine healthcare and the reporting of implementation outcomes under routine care conditions (Anne Etzelmüller), ImpleMentAll’s study protocol (Christiaan Vis), an evaluation concept for the implementation of internet- and tele-based prevention services (Ingrid Titzler), a cross-cultural confirmatory factor analysis of the NoMAD instrument in a healthcare context (Leah Bührmann), and major challenges in large-scale EU-funded projects in terms of obtaining valuable and reliable data in multi-centre, multi-continental trials (Claire van Genugten). The second part included contributions on the implementation of iCBT as part of a digital stepped mental healthcare service in general practice (Isabel Zbukvic), insights to an international, online self-management program and its implementation in Germany (Pia Drießen), Albania and Kosovo (Arlinda Cerga-Pashoja), the development of iCBT implementation in Denmark (Kim Mathiasen), and tailored implementation and a preview of the ImpleMentAll ItFits-toolkit (Jordi Piera, Christiaan Vis). Next to the shared efforts of the ImpleMentAll consortium, Christiaan Vis organised a panel discussion, also titled “Next Generation Internet Interventions in Routine Practice”. The active discussion was fed by a questionnaire issued amongst the conference participants. Results of the survey and opinions of the panel – Heleen Riper, David Ebert, David Mohr, Heather Hadjistavropoulos, Nick Titov, and Kim Mathiasen – were discussed, complemented by enthusiastic contributions coming from the audience. The discussion round was concluded with the statement “We all want innovation, but we don’t want change”, highlighting the big challenge of implementation science and practice in the field. The ImpleMentAll group was not the only ones to focus on the topic of implementation, many other speakers also emphasised translation-to-practice processes as inevitable components of their study designs. Internet Intervention developers were talking about co-design, stakeholder involvement, or design for implementation, which lead a conference participant to pose a crucial question during the panel session: “Might we all talk about the same processes, but in different languages?” Probably, and another challenge for the ImpleMentAll project and the world of implementation will be to come to a common terminology to work more effectively towards more successful implementation of Internet Interventions. The conference ended with some closing remarks by Frances Kay-Lambkin and the appointment of ISRII’s new president, David Ebert as well as the announcement of the new president elect, Pepijn van de Ven. Coming back to “next generations” and taking a look at a crowd of researchers all being at different points in their academic career, Ricardo Muñoz formulated his striking take-home message:  “There will always be new knowledge coming with new generations, but the values will stay the same.” Taking the perspective of ImpleMentAll, we all traveled home with a new valuable experience in our researcher-suitcases – paired with the promising notion that Implementation Science is going places in the field of Internet Interventions. Interested in more work presented at the ISRII? Check out #ISRII10 on Twitter or www.isrii2019.nz Are you working with implementation, but “in a different language”? Please comment below, we would love to hear from you!

Managing ImpleMentAll

Thu. 28. Feb 2019 00:00

PlaceholderAs most of our readers will know, ImpleMentAll is a fairly large and complex project with aims tapping into implementation science as well as psychology and the provision of mental health care. The many processes going on at once further complicate the project, which leads us to the theme of this blog; the management of IMA and what it takes to keep a complex project successful. First of all, successful management of a project like IMA requires a global and in-depth view of the processes of the project work plan, including ongoing and coming activities. The experienced and skilled coordination team, consisting of Claus Duedal Pedersen, Christiaan Vis, Mette Atipei Craggs, and Carmen Ceinos, is managing the plan and  providing  support to  the consortium in all the aspects that may have an impact: from the specific financial or scientific perspectives, to the operational activities. The coordination team has produced a project handbook, which is essentially a condensed version of Annex 1 to the Grant Agreement. The handbook provides a short and concise version of the project plan, including a general overview of the project, the management and coordination structure, communication tools and procedures, quality control and assurance, and, last but not least, reporting. The handbook also functions as a management tool, keeping the whole consortium up to date on what their tasks are and what is expected of them. As a reference work, the consortium partners can use the handbook to look up work plans, timelines, and the structures of the various work packages. Along with pens, leaflets, and other merchandise, the project handbook is part of IMA’s communication material collection, contributing to the dissemination of our project. It provides a clear and well-structured presentation of the project and serves as a source of deep insight into the project, when we attend conferences and congresses to share the knowledge of IMA and implementation science in general. IMA Project and Communication Manager, Mette Atipei Craggs: “The project handbook as a concept has evolved over a couple of EU-funded projects that this coordination team has been leading. We now find it an essential tool in steering the project towards its ambitious goals and making sure that no activity is overlooked and that we make every deadline on time.”  The handbook is a living document that must reflect the changes the project is facing during its lifetime of 51 months. We are already in the second version incorporating the changes produced in the first 18 months, where the first major amendment was pushed through. Do you want to know more about management of IMA or maybe even receive a copy of the project handbook, then please feel free to write us either directly or in the comments below!

Working with the NoMAD and ORIC translations

Mon. 28. Jan 2019 11:28

PlaceholderThe translations of the NoMAD and ORIC questionnaires are two of ImpleMentAll’s most significant outcomes so far. They were published here on the website a few months ago, but have you wondered how and why these translations were made? Well, you are about to learn! First of all, the NoMAD and ORIC questionnaires are the primary outcome measures for the IMA study, and it is important that the staff working at the IMA sites in the different countries is able to complete them. As some of the staff may not be sufficiently fluent in English to accurately answer the questions in the surveys, the two questionnaires were translated into the seven languages that the IMA trial sites speak besides English.  If taking on a broader perspective, surveys are tools for producing knowledge and NoMAD and ORIC are merely examples of this. By making a questionnaire available in various languages, the researchers greatly extend the scope of utility for the questionnaire as not all participants in a study speak the original language that a survey was developed in. Furthermore, translating the questionnaire enables comparative research across several countries, as the utility of the questionnaire is no longer limited to native or fluent speakers of the original language. In regards to NoMAD, the researchers behind the Normalisation Process Theory website (NPT) have received enquiries from other researchers from around the world about gaining access to the questionnaire in their native language. Now, through IMA, these enquiries can be answered positively and the researchers can be provided with a translated version. Actually, the researchers have already shared the French and Dutch translations upon requests. Turning to the process of translating the NoMAD and ORIC questionnaires, a small team consisting of Leah Buhrmann and Christiaan Vis, with input from Tracy Finch, worked with partners in each trial site using a standard translation process. From each trial site, two native speakers with high proficiencies in English translated the survey items into the native language of that site. Next, a third translator, who was an English native speaker and had a high proficiency in the language of the trial site, created a ‘back-translation’ where s/he translated the questionnaire back to English. Then, the two English versions were compared and any variations were analysed to make sure that the translation kept the intended meaning of the items. Sometimes, the process was repeated until a satisfactory result was reached. Thus, the seven translations made within the framework of IMA are expected to bring great value to the project as well as to the implementation society in general. If you have any questions about the translation process, please write them below!

MAST – an evaluative framework for telemedicine innovations

Mon. 10. Dec 2018 12:36

PlaceholderIn ImpleMentAll, our ultimate goal is to develop a toolkit for tailored eHealth implementation, the ItFits-toolkit. Our assessment of the ItFits-toolkit as a potentially valuable innovation will be based on several frameworks. The “Model for Assessment of Telemedicine” (MAST) is one of them.   MAST is a framework for assessment and evaluation of telemedicine innovations in the healthcare sector. The model was developed to provide a basis for the decision of whether a telemedicine innovation is beneficial to the patients and the healthcare system or not. Many digital innovations do not give value for money the first times they are implemented, this is just how innovations work; they are implemented, assessed, and then altered before being implemented again. MAST provides a structure to help decision makers gather the knowledge necessary to form a foundation for the right decision.   When developing MAST, the researchers asked 50 different European healthcare decision makers what they would like to know before deciding whether an innovation should be implemented. Based on these answers, they detected 7 domains that are crucial to explore when making this decision: The first domain concerns which health problem the innovation will deal with and the innovative technology that is used to solve the problem. The second domain concerns the patient’s safety in relation to the innovation, including clinical and technical safety. The third domain is clinical effectiveness, that is, which effect the innovation has on the life and health of the patient. The fourth domain is patient perspectives; this concerns the patient’s experience of the innovation. The fifth domain concerns the economic aspects: how much the innovation costs to buy and implement and what are the economic consequences. The sixth domain is the organisational aspects, including how the staff experiences the innovation when working with it. The seventh and last domain concerns the socio-cultural and legal aspects such as law and ethics. The information used to describe the outcomes of telemedicine within each domain must be based on science and scientific methods. In some cases, e.g. when the telemedicine service involves moving hospital treatment of patients with serious illnesses to their own home, a randomised trial with a significant number of participants is needed. In other cases, interviews with a small cohort of patients with experience with the telemedicine service may be sufficient.   ”The seven domains of MAST are based on what European healthcare decision makers need when making decisions on whether to buy new telemedicine services or not. Therefore, MAST can help companies and innovators in identifying the most relevant information about their new technology and avoid unnecessary data collection,” says Kristian Kidholm, one of the developers of MAST.   The assessment must start with preceding considerations to determine whether it is relevant for an organisation to carry out the assessment and whether the technology and the organisation are sufficiently matured and prepared. After the preceding considerations, the multidisciplinary assessment is carried out to describe and assess the different outcomes of the innovation. The outcomes and description of patients and the innovation can be divided into the seven domains described above. Finally, in relation to the description of the outcomes, an assessment should also be made of the transferability of the results.   Commenting on the value and effectivity of MAST, Kristian Kidholm says, ”Our delphi study from 2017 showed that MAST is valid and does provide the information about telemedicine that decision makers need.”   To match the project's complexity, the evaluation carried out in IMA will be based on and inspired by several frameworks, including MAST. If you have any questions or comments on MAST, please make sure to write them below, we would love to hear your inputs!

The DNA of a strong consortium

Wed. 07. Nov 2018 11:44

PlaceholderHave you ever wondered how to make a strong consortium? It must be able to complete the tasks given and thereby ensure that ambitious goals are obtained as well as achieving the expected impact. This blog post will account for some of the thoughts we had when establishing the ImpleMentAll consortium making sure that the necessary knowledge, expertise, and resources were present in the project. The ImpleMentAll consortium consists of 15 partners covering four elements that we found to be crucial to the project. For one, it was important to ensure skilled research competences, thus the IMA research team comprises world leading institutions in implementation science, clinical psychology, and eMental Health. These partners contribute to reaching IMA’s goal of streamlining the implementation process and scaling up eHealth interventions. Secondly, we work with real life implementation, which means that we need partners who can provide test beds for the tailored implementation strategies, ItFits-toolkit, and take ambitious steps towards large-scale implementation and normalisation of iCBT in routine practice. The IMA test sites were chosen to constitute different types of healthcare sectors in countries with varying levels of income addressing diverse groups of patients. Thirdly, experienced project management and collaboration is ensured by comprising the management team of organisations and individuals with extensive knowledge as well as successful track records of project management at a European level for several years. Furthermore, significant parts of the consortium had collaborated previously on other projects ensuring efficient team work. Fourth and finally, inclusion of partners with extensive competences in communication and dissemination ensures high visibility and scaling of the project in order to make the results available to the wider European society. “Creating the consortium for an EU project the size of IMA is always one of the most important parts of the proposal process. With the IMA consortium, we managed to include the highest level of scientific knowledge, along with organisations that were not only ready to be test sites for the research and had a need for implementation of new iCBT services, but had also showed in other projects that they were able to carry out large scale implementation. For us, it was also very important to include representatives for patients and healthcare professionals to take into consideration the perspectives of these groups and the public,” says Claus Duedal Pedersen on why the consortium is composed the way it is. The 15 partners in the IMA consortium are spread across Europe and in Australia to ensure representativeness. Our Australian partners not only contribute with their great experience of telemedicine and how to implement this, but also with different challenges than those faced by the European partners. For instance, the geography and general logistics can prevent colleagues from seeing each other face-to-face every day – or healthcare professionals from seeing their patients in person. Additionally, our partners in low/middle income countries bring interesting challenges by operating in healthcare systems at different stages. An important outcome of IMA will be to find out if we, by supporting their implementation process, help them develop their healthcare system further for the benefit of their citizens. The ImpleMentAll consortium unites leading experts in various areas, such as clinical practice, health innovation, clinical research, patients’ interests, and implementation science. The areas not covered in the consortium are to a large extent covered in the External Advisory Board, ensuring that the ImpleMentAll project has the know-how needed to reach our goals and have substantial impact on the future of healthcare sectors. If you have any questions, comments, or brilliant ideas about how to establish a strong consortium for a great project at EU-level, please comment below. We would love to hear your insights!

Normalisation in a nutshell

Fri. 05. Oct 2018 09:00

PlaceholderImpleMentAll’s aim is to make the normalisation process easier and more effective for healthcare innovations in the future. Thus, normalisation is a key part of our work with this project, and therefore crucial to understand in order to understand ImpleMentAll.   Normalisation is easier said than done. The following definitions might seem quite straight forward, but the elaboration makes it clear that there is a lot more to the term and the process than the definition leads one to think. With this blog post, we will try to break down the normalisation process and make it easier to understand in order to provide insight into the core of ImpleMentAll. Normalisation refers to the things people do to embed and integrate an innovation in routine practice. Thus, normalisation is the process of creating new routines based on an innovation. In ImpleMentAll, we realise that most health innovations, regardless of how good or beneficial they might be, rarely find their way to routine practice simply because the normalisation process is too complex. Therefore, we work with the Normalisation Process Theory (NPT). NPT explains the work of implementation, embedding, and integration with a focus on the contribution of individuals and groups. It is an action theory, meaning that it explains actions rather than attitudes. NPT features four constructs explaining the work that people might do when implementing an innovation; coherence, cognitive participation, collective action, and reflexive monitoring. Coherence is the sense-making work done in order to operationalise the innovation. People must distinguish how the innovation differs from the current routine practice. Furthermore, they must work together to agree on the aims, objectives, and expected benefits of the innovation, while working individually to detect the tasks and responsibilities they themselves have in relation to the innovation. Finally, they must understand the benefits and values of the innovation. Cognitive participation is the relational work done to build and sustain new practices related to the innovation. First, the new set of practices must be initiated in order to be driven forward, then the participants may need to organise or reorganise themselves to collectively contribute to the work involved in new practices. It must be ensured that other participants believe that it is important to be involved in the integration, and lastly, the actions and procedures to sustain the innovation must be collectively defined. Collective action is the operational work done in order to adopt the innovation. The participants should work with artefacts and symbols related to the innovation. Moreover, they must do knowledge work in order to build accountability and maintain confidence in the innovation. The work done in relation to the innovation must be divided between the participants, making it clear who does what. Finally, the resources must be allocated. Reflexive monitoring is the appraisal work done in order for the participants to assess and understand how the innovation affects them and others. The participants must determine how effective or useful the innovation is, as well as what it is worth in order to detect whether redefinitions and modifications of practices are needed. Thus, in order to successfully turn an innovation into routine practice it is important for the participants to fully understand the innovation at various levels, as well as prepare themselves for the innovation and actively ensure to drive forward the new set of practices. Moreover, the participants must collectively define and carry out work with the innovation, and lastly, evaluate and perhaps adjust the innovation. The ImpleMentAll trial is using a 23-item self-report questionnaire that taps into the four core constructs of the NPT to measure organisational readiness for implementing change. The Normalisation MeAsure Development questionnaire (NoMAD) is an instrument designed for measuring implementation processes and predicting their outcomes. NoMAD comprises three sections; Part A assesses respondent background information, Part B assesses global normalisation (3 items), and Part C assesses the four central implementation processes of NPT discussed in the above (20 items). As has been made clear, normalisation is an extremely complex process, and changing it, or optimising it, is a very difficult task to take on. Nonetheless, that’s exactly what we have done in ImpleMentAll. If you would like to dig deeper into normalisation and learn more about it, please comment any question you may have below and we will have our experts answer it, or follow the links to read more about NoMAD and NPT.

Tackling Societal Challenges

Thu. 06. Sep 2018 13:12

PlaceholderOne of the great aims of the Horizon 2020 programme and any project funded by it, is to tackle the current challenges faced by society. We wouldn’t have started ImpleMentAll if we didn’t believe in our own contribution to this mission. This means that the project was born out of challenges in the healthcare sector that need solving in order to better the treatment of (mental) health issues, especially internet-based and innovative treatments.   One of the primary challenges in eMental health treatment is that while recent research has shown the effectiveness of iCBT for treatment of depression, the implementation of these services is lagging greatly because of inefficient and costly implementation efforts. There also seems to be a lack of problem analysis and awareness of barriers and facilitators for successful implementation in addition to the uptake of well-researched and proven interventions addressing current challenges still being slow. In IMA, we believe that this is at least partly due to implementation sites lacking a tailored strategy for the implementation of the iCBT services.   Our consortium counts some of the leading experts from both the scientific and practical sides of eHealth and eMental health implementation - and based on their combined experiences, we know that there is a need for effective implementation strategies and especially tailored implementation strategies fitting the local clinical context and service implemented.   ImpleMentAll will be one of the first large-scale attempts to address implementation barriers through tailoring evidence-informed strategies. Tailoring is a systematic process that includes identifying the “determinants of practice” (factors hindering or facilitating implementation), designing implementation interventions appropriate to those determinants, and the actual application and evaluation of those implementation interventions.   Despite our good intensions, extensive experience, and innovative thinking, tackling this societal challenge is not an easy task. Christiaan Vis, our Scientific Coordinator, explains: “Developing effective and efficient treatments is a major challenge. And when effective treatments are found, embedding them in routine practice to have real impact in patients is another challenge. Applying and embedding new treatments in existing care practices is difficult and takes place in complex care settings in which many people with different expertise, roles, and responsibilities in varying organisational structures are working together to achieve the common goal of improving a person’s health. These processes of normalisation do not occur overnight, but can be assessed, modelled, and, as we aim for, improved.”   Thereby, we in ImpleMentAll are facing some tremendous challenges in our work to improve implementation of clinical innovations across the globe, but even though we have our work cut out for us, we rise to the challenge and firmly believe that what we plan to do will help us reach our goal.   If you have any questions for our consortium about tailored implementation or how to tackle the challenge of poor implementation in general, please comment below!

A sneak peek into our study protocol

Mon. 02. Jul 2018 11:28

PlaceholderIMA’s study protocol is confidential, thus it cannot be shared, but for those of you interested in the project and our methods, this blog post gives a glimpse of the research methods we use in our work with IMA. The study protocol’s purpose is fourfold. First of all, it defines the purpose and scope of the project, which is to study the effects of tailored implementation by carrying out a controlled implementation intervention in complex real-life implementations of iCBT. Secondly, it creates consensus and agreement on the study amongst the IMA consortium by establishing the two research questions; 1. Does the ItFits-toolkit lead to a higher uptake and normalisation of iCBT in routine mental healthcare than IAU (Implementation-As-Usual)? 2. Does the ItFits-toolkit lead to faster increase of uptake and normalisation of iCBT in routine mental healthcare than IAU? Thirdly, it provides the basis for scientific and ethical approvals, and finally, it sets out the next steps in preparing for the study. The study protocol also defines the difference between the method that the ItFits-toolkit will provide for implementation, and Implementation-As-Usual. This is a vital distinction because it lays the foundation for why the work of IMA is necessary and what makes the ItFits-toolkit a relevant tool. Christiaan Vis, Scientific Coordinator in ImpleMentAll, explains why the study protocol is a crucial part of ImpleMentAll, “the generic protocol serves as an evaluation framework specifying a set of minimal requirements for answering one question: does the ItFits-toolkit work? It specifies the rationales, the design, end-points, methods and instruments of the study, as well as the experiment itself, i.e. comparing tailored implementation as operationalised by the ItFits-toolkit with usual implementation. All twelve implementation sites apply and adhere to this generic evaluation framework so we are able to analyse the effectiveness of the ItFits-toolkit within and across various healthcare settings.” Thus, the development and testing of the toolkit is the main focal point in this protocol. The stepped-wedge trial design has been chosen for the IMA trial. This is a type of randomised controlled trial, which is structured to reduce bias when testing various hypotheses. In the project, the point in time that each implementation site receives the ItFits-toolkit is randomised. By the end of the trial, all implementation sites have received the ItFits-toolkit, thus acting sequentially as control and intervention condition. There are two types of study participants; implementers who are directly involved in the development, coordination, and execution of implementation; and service delivery staff who are the ‘receivers’ of the implementation activities and are subject to changes in their daily work to implement iCBT. The study protocol ends with defining the next steps, which are related to the agreement that has now been made with the trial sites about how to carry out the trials as well as the rest of the project. Establishing a trial protocol for a study as complex as IMA is no easy feat, and many important decisions have been made in the process. Although it is now fixed, we are always open to discussing our choice of methods for the sake of learning from others’ experience.   So, if you have input for/questions about our trial – or have experience with conducting complex scientific studies that you want to share – please comment below!

The creation of an external advisory board

Wed. 13. Jun 2018 13:51

PlaceholderTo create the best possible External Advisory Board (EAB) for the ImpleMentAll project, all of the consortium members were included in the decision process. We did this by carrying out a stakeholder survey where all partners in ImpleMentAll were asked to participate and give their input.   Mette Maria Skjøth, leader of WP6, says; “the EAB has been established based on a thorough stakeholder analysis including a survey among the project members to ensure the right selection of stakeholders. The stakeholders in the EAB represent a wide range of different skills and expertise in areas such as patient groups, psychiatry, implementation, management, and policy. Including all of these areas has the purpose of infusing the project with knowledge from many angles.”   We wanted to ensure that the EAB represents experts from all relevant fields and from a wide range of backgrounds, therefore we applied a systematic approach. The systematic gathering and analysis of information involved all consortium members to ensure that the entire range of stakeholder groups would be represented in the EAB. Based on the stakeholder mapping and analysis, we created a stakeholder database. The main categories of stakeholder groups (e.g. researchers, eHealth experts, implementation experts) were defined and the corresponding representatives were recruited to take part in the ImpleMentAll EAB.   “The purpose of having an external advisory board in ImpleMentAll is to seek external advice on relevant issues in the project, to engage with experienced stakeholders, and to disseminate results,” says Mette Maria Skjøth, while emphasising that the purpose of the EAB is to give regular external advice on relevant issues.   The EAB will:  Provide independent, expert advice to ensure that the project will develop in accordance to the appropriate legal, ethical and social issues, and general philosophy and direction of the project. Advise on corrective measures in the content of the work. Advise on the dissemination and exploitation of the project’s results.   “I am delighted to be an advisor to the IMA project. Implementing digital healthcare solutions requires focussed attention to maximise the benefits for patients, whilst also allowing room for flexibility and innovation. The IMA project will provide vital evidence and guidance to health systems in how to move from pilot projects to implementation at scale,” says Bruce Witear about being a member of the EAB.    The first meeting with the External Advisory Board (EAB) was held on October 31st. It was an overwhelming success with interesting discussions and a lot of engagement from the members of the board. A presentation of the EAB members can be found here.   The second meeting with the EAB took place on March 20th and covered topics such as the midterm workshop, the scientific content of the project, and general discussions. Like the first meeting it was quite successful, which is why we are very excited for the upcoming meeting with the EAB. It will be held on 9 October 2018 in connection with the project’s 5th consortium meeting and the midterm workshop in Odense.   If you have any questions for or about the EAB, or if you are a member and want to share your experience, please comment below!

Webinar on past experiences that can further ImpleMentAll

Fri. 04. May 2018 14:18

PlaceholderSome of you might be familiar with the MasterMind project. It is a finished project, but because it focused on implementing eMental health initiatives across Europe, its themes and findings are closely tied to the ImpleMentAll project. On March 16, a webinar was conducted. By using MasterMind as a starting point for discussion, the webinar touched upon strategies for effectively implementing health initiatives and possible complications during the process based on past experiences. This approach resulted in a highly relevant webinar for everyone interested in ImpleMentAll. After a short presentation of MasterMind by Claus Duedal Pedersen, coordinator of MasterMind as well as ImpleMentAll, Chris Wright covered their experiences and learning points in relation to where MasterMind took them in terms of their implementation, then Modesto Sierra Callau from Spain explained how the project was conducted, and in conclusion, Christiaan Vis discussed how the experiences with implementation during the MasterMind project, can be used in the future, in particular when working with ImpleMentAll. “As a direct consequence of MasterMind, our new mental health strategy in Scotland stipulates that cCBT should exist in all health board areas and be offered to all adults across Scotland,” says Chris Wright from Scotland making it clear that the MasterMind project has largely improved the mental health care sector in Scotland. Other than becoming a part of national healthcare services around Europe, the MasterMind project also added a successful alternative to traditional treatment of mental health issues, Modesto Sierra Callau from Spain states; “There are more than 40% of the patients who are considered as successful patients because they have reached end of the program, or they do not show symptoms of depression after the last control for those patients who have made at least half of the program.” Throughout the webinar, it was nicely tied together how MasterMind can be interpreted as a preceding step to ImpleMentAll. By discussing the details of MasterMind and afterwards applying them to ImpleMentAll, the presenters of the webinar effectively led the way for this interpretation in an easy and convincing manner. During his part of the presentation, Christiaan Vis referred to Winston Churchill when stating;
“If you want to be perfect, or if you want to be able to improve stuff, then you need to change, and that is actually what we are doing with implementation.” With this statement, Christiaan Vis effectively demonstrates how important the work on ImpleMentAll is and how big an impact the project will have on the healthcare sectors throughout the world, suggesting that, as a result, they will improve and maybe even be perfected. If you are interested in listening to the webinar, it can be found here. If you have any experiences or anecdotes about working with implementation in the healthcare sector or elsewhere, please post it in the comment section and let’s get a debate going!

We build too many walls and not enough bridges

Mon. 09. Apr 2018 13:20

Placeholder"We build too many walls and not enough bridges". These words by Isaac Newton formed the opening of the seminar titled “Breaking walls, building bridges”, which presented the IMA project and provided a much needed insight on mental healthcare in Central and Eastern Europe - an area of the world that has largely been overlooked in global mental health, despite the scarcity of resources in the region.  The seminar, featuring distinguished experts, incl. the Deputy Minister of Health in Albania and consortium members London School of Hygiene and Tropical Medicine, the Mental Health Centre in Prizren, and the EAAD, was hosted by the Centre for Global Mental Health and is now available as a webinar ( http://www.mhinnovation.net/breaking-walls-building-bridges-mental-health-reforms-central-and-eastern-europe).  In short, the seminar covered a highly interesting discussion of mental healthcare in Albania and Kosovo from both historic and current perspectives and the presentation of IMA as an international cooperation contributing to the improvement of mental health in the two countries. IMA is described as a chance for these countries to develop and implement much needed services for mental health.  With its thorough and relevant focus on these topics, the webinar is a must-see for anyone interested in the improvement of mental health care in any setting, including Low and Middle Income Countries, the use of technology for this purpose, and the contribution that implementation science can make to this field. A few quotes from partners behind the webinar: European Alliance Against Depression: "Working in an international team within ImpleMentAll gives us the unique opportunity to look into implementation strategies in different countries and health care settings. We are looking forward to learn from these differences.” Naim Fanaj, Mental Health Center, Prizren, Kosovo: "IMA is building bridges and developing mental healthcare in Kosovo in light of implementing new advanced services - iCBT"  To IMA, building bridges between research and routine care is everything, as we want to help useful clinical innovations reach the citizens and patients who need them. If you have any  eHealth or eMental health implementation issues that you'd like to discuss with the speakers from the webinar, just post a comment below and we'll make sure that it reaches them. 

Why do we need ImpleMentAll?

Tue. 20. Mar 2018 10:58

PlaceholderNo matter where you look in the world, the experience with eHealth implementation is that it is a time-demanding and difficult process that often fails. eHealth solutions, no matter how brilliant, simply don’t make it into routine care before they become obsolete. This applies to large roll-out projects such as implementation of national infrastructures or EMRs as well as smaller, more specialised initiatives, e.g. implementing apps or video conference for specific purposes. For example, a great number of EU-funded projects have tried to implement eHealth solutions into routine care, with varying degrees of success, and IMA builds on good and bad experiences from these. One of the project’s main tasks is to translate the experiences into a scientific and structured way to manage implementation.
This is a general problem, which is why we address it with a broad focus on eHealth in any shape or form. Still, our research aims demand comparability and therefore we have chosen one intervention for the study: internet-based Cognitive Behavioural Therapy (iCBT). This particular intervention was deemed the most suitable because of its comprehensive evidence base, the general need for it in many parts of the world, and the widespread experience with implementation of this type of intervention.
The average time from when evidence has been established for a given new treatment method till it is considered generally implemented and normalised is 18 years. In RSD, we have been developing, testing, and implementing eHealth solutions – learning the hard way that it takes 8-9 years for a technically ready solution to reach normalisation in a hospital, region, or municipality. In the light of the general technological development, which is characterised by a much greater speed, there is a major discrepancy between the time for normalisation and the technological development, which means that we end up implementing obsolete solutions. Therefore, we need tools for implementing in a knowledge-based way, fast, and right. The purpose of IMA is to develop and validate these tools and we have high hopes for their effect.
Claus Duedal Pedersen, Project Coordinator: “IMA transforms past European experience on eHealth implementation into practical tools, which can make a real difference for efficient implementation processes.”
Do you have any concrete experiences with eHealth or eMental health implementation, that you think we should know about?

Welcome to our blog!

Thu. 01. Mar 2018 14:58

PlaceholderWelcome to our blog and to our very first post! The first of many and one that we have looked forward to releasing into the world. To get a good start, we will begin our blogging endeavours with an introduction to this format in an IMA context, including our thoughts on what the blog should bring of value to you as a reader and us as a project. So, the overarching purpose of this blog is to dive into the many interesting and complex subjects that form the basis of the IMA project. The blog will aim to display who we are as a project, what we do, and why. Also, the blog will be interactive and provide a direct channel for consortium partners and external stakeholders alike to communicate and share their extensive knowledge on implementation, eHealth, eMental health, etc. Our reason for choosing the blogging format is a hope that this will foster a more personal and quirky representation of what lies behind our work and what comes out of it than the usual project reports and news updates. The blog is planned and produced by the Project Coordination Team, but all content is directly derived from the work carried out by the project partners and depends heavily on their most valuable contribution.
We will blog about the topics that the project has been born with, e.g. implementation science, Normalization Process Theory, eHealth, and eMental health, but also the themes, issues, challenges, and successes that we will meet on our journey towards completion in 2021. We hope that you will give our blog a good reception and follow it as it unfolds over the next couple of years.
This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733025.
This content reflects only the author's view and the European Commission is not responsible for any use that may be made of the information it contains.

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