Prescribing Technology to Increase Uptake of Depression Treatment in Primary Care: A Pre-implementation Focus Group Study of SOVA (Supporting Our Valued Adolescents)

  • Ana RadovicEmail author
  • Kayla Odenthal
  • Ana T. Flores
  • Elizabeth Miller
  • Bradley D. Stein


Supporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices. A baseline survey was administered using Evidence-Based Practice Attitude Scale (EBPAS) and Physician Belief Scale (PBS). Subsequently, during each focus group, PCPs listened to a relevant presentation after which a facilitated discussion was audio recorded and transcribed. After timepoint 1, a codebook based on Consolidated Framework for Intervention Research (CFIR) and qualitative description were used to summarize findings and inform implementation strategies that were then adapted based on PCP feedback from timepoint 2. PCPs were provided with resources to implement SOVA over 5 months and then a third focus group was conducted to gather their feedback. Based on EBPAS and PBS, PCPs are willing to try new evidence-based practices and have positive feelings about taking care of psychosocial problems with some concerns about increased burden. During focus groups, PCPs expressed SOVA has a relative advantage and intuitive appeal, especially due to its potential to overcome stigma and reach adolescents and parents who may not want to talk about mental health concerns with their PCP. PCPs informed various implementation strategies (e.g., advertising to reach a wider audience than the target population; physical patient reminders). During timepoint 3, however, they shared they had a difficult time utilizing these despite their intention. PCPs requested use of champions and others to nudge them and priming of families with advertising, so that the PCP would not be required to initiate recommendation of the intervention, but only offer their strong endorsement when prompted. The process of conducting a pre-implementation study in primary care settings may assist with piloting potential implementation strategies and understanding barriers to their use.

Trial registration NCT03318666.


Adolescent Depression Anxiety Technology Health services Implementation science Primary health care Pediatrics 



After visit summary


Consolidated framework for implementation research


Evidence-based practice


Evidence-Based Practice Attitude Scale


Electronic health record


Focus groups


Internet protocol


Physician Belief Scale


Primary care physician


Supporting our valued adolescents




University of Pittsburgh Medical Center


Unified Theory of acceptance and use of technology


Youth Research Advisory Board



We thank Cassandra Long for assistance with research recruitment and interview transcription. We thank Sharanya Bandla for technical assistance. We thank the University of Pittsburgh Clinical and Translational Science Institute’s (UL1TR001857) Pediatric PittNet practice-based research network for enhancing our recruitment efforts in their affiliated pediatric offices in the greater Pittsburgh area. We thank and acknowledge the pediatric practices and primary care providers, practice managers, and insurance representatives for informing this study and making it possible.

Author contributions

The authors are fully responsible for the reported research, have all met requirements for authorship, and have read and approved the final document. AR wrote the first draft of this manuscript for which no payment was received.


Dr. Radovic was supported on an institutional career development award during this study (AHRQ PCOR K12 HS 22989-1) and is currently on a second career development award (NIMH 1K23MH111922-01A1). This research was also supported in part by UPMC Children’s Hospital of Pittsburgh and the University of Pittsburgh School of Medicine. The project described was also supported by the National Institutes of Health through Grant Number UL1TR001857.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical Approval

The original study protocol was approved by the University of Pittsburgh Institutional Review Board. All individuals provided verbal consent to participate.

Supplementary material

10880_2019_9669_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMCUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.RAND CorporationPittsburghUSA
  3. 3.Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghUSA

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