Advertisement

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
Article

Abstract

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.

Keywords

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

Abbreviations

AVS

After visit summary

CFIR

Consolidated framework for implementation research

EBP

Evidence-based practice

EBPAS

Evidence-Based Practice Attitude Scale

EHR

Electronic health record

FG

Focus groups

IP

Internet protocol

PBS

Physician Belief Scale

PCP

Primary care physician

SOVA

Supporting our valued adolescents

T

Timepoint

UPMC

University of Pittsburgh Medical Center

UTAUT

Unified Theory of acceptance and use of technology

YRAB

Youth Research Advisory Board

Notes

Acknowledgements

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.

Funding

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)

References

  1. Aalto-Setälä, T., Marttunen, M., Tuulio-Henriksson, A., Poikolainen, K., & Lönnqvist, J. (2002). Depressive symptoms in adolescence as predictors of early adulthood depressive disorders and maladjustment. American Journal of Psychiatry, 159(7), 1235–1237.PubMedCrossRefGoogle Scholar
  2. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61–74.PubMedPubMedCentralCrossRefGoogle Scholar
  3. Benzer, J. K., Beehler, S., Miller, C., Burgess, J. F., Sullivan, J. L., Mohr, D. C., et al. (2012). Grounded theory of barriers and facilitators to mandated implementation of mental health care in the primary care setting. Depression Research Treatment, 2012(173), 597157.PubMedGoogle Scholar
  4. Berwick, D. M. (2003). Disseminating innovations in health care. JAMA, 289(15), 1969–1975.PubMedCrossRefGoogle Scholar
  5. Cheung, A. H., Zuckerbrot, R. A., Jensen, P. S., Laraque, D., Stein, R. E., & GROUP G-PS. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part II. Treatment and ongoing management. Pediatrics, 141(3), e20174082.PubMedCrossRefGoogle Scholar
  6. Cole, A. M., Esplin, A., & Baldwin, L.-M. (2015). Adaptation of an evidence-based colorectal cancer screening program using the consolidated framework for implementation research. Preventing Chronic Disease, 12, E213.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Consolidated Framework for Implementation Research. (2019). https://cfirguide.org/.
  8. Curran, G. M., Bauer, M., Mittman, B., Pyne, J. M., & Stetler, C. (2012). Effectiveness-implementation hybrid designs: Combining elements of clinical effectiveness and implementation research to enhance public health impact. Medical Care, 50(3), 217.PubMedPubMedCentralCrossRefGoogle Scholar
  9. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.PubMedCrossRefPubMedCentralGoogle Scholar
  10. Damschroder, L. J., & Lowery, J. C. (2013). Evaluation of a large-scale weight management program using the consolidated framework for implementation research (CFIR). Implementation Science, 8(1), 51.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Eccles, M. P., Hrisos, S., Francis, J., Kaner, E. F., Dickinson, H. O., Beyer, F., et al. (2006). Do self-reported intentions predict clinicians’ behaviour: A systematic review. Implementation Science, 1(1), 28.PubMedPubMedCentralCrossRefGoogle Scholar
  12. Fergusson, D. M., & Woodward, L. J. (2002). Mental health, educational, and social role outcomes of adolescents with depression. Archives of General Psychiatry, 59(3), 225–231.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Garbutt, J. M., Dodd, S., Walling, E., Lee, A. A., Kulka, K., & Lobb, R. (2018). Theory-based development of an implementation intervention to increase HPV vaccination in pediatric primary care practices. Implementation Science, 13(1), 45.PubMedCrossRefPubMedCentralGoogle Scholar
  14. Godin, G., & Kok, G. (1996). The theory of planned behavior: A review of its applications to health-related behaviors. American Journal of Health Promotion, 11(2), 87–98.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Grol, R. (2001). Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care, 39(8), 46–54.Google Scholar
  16. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, 113.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Hesse, B. W., Ahern, D. K., & Woods, S. S. (2011). Nudging best practice: The HITECH act and behavioral medicine. Translational Behavioral Medicine, 1(1), 175–181.PubMedCrossRefGoogle Scholar
  18. Holden, R. J. (2012). Social and personal normative influences on healthcare professionals to use information technology: Towards a more robust social ergonomics. Theoretical Issues in Ergonomics Science, 13(5), 546–569.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Lai, P. (2017). The literature review of technology adoption models and theories for the novelty technology. JISTEM-Journal of Information Systems Technology Management, 14(1), 21–38.Google Scholar
  20. Lau, R., Stevenson, F., Ong, B. N., Dziedzic, K., Treweek, S., Eldridge, S., et al. (2015). Achieving change in primary care–effectiveness of strategies for improving implementation of complex interventions: Systematic review of reviews. British Medical Journal Open, 5(12), e009993.Google Scholar
  21. Liang, S., Kegler, M. C., Cotter, M., Phillips, E., Beasley, D., Hermstad, A., et al. (2015). Integrating evidence-based practices for increasing cancer screenings in safety net health systems: A multiple case study using the Consolidated Framework for Implementation Research. Implementation Science, 11(1), 109.CrossRefGoogle Scholar
  22. McLennan, J. D., Jansen-McWilliams, L., Comer, D. M., Gardner, W. P., & Kelleher, K. J. (1999). The Physician Belief Scale and psychosocial problems in children: A report from the Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Journal of Developmental and Behavioral Pediatrics: JDBP, 20(1), 24–30.PubMedCrossRefGoogle Scholar
  23. Meredith, L. S., Stein, B. D., Paddock, S. M., Jaycox, L. H., Quinn, V. P., Chandra, A., et al. (2009). Perceived barriers to treatment for adolescent depression. Medical Care, 47(6), 677–685.PubMedCrossRefGoogle Scholar
  24. Millstein, S. G. (1996). Utility of the theories of reasoned action and planned behavior for predicting physician behavior: A prospective analysis. Health Psychology, 15(5), 398.PubMedCrossRefGoogle Scholar
  25. National Institute of Medical Health (NIMH). (2017). Treatment of major depressive episode among adolescents. Charlottesville: National Institute of Medical Health.Google Scholar
  26. Navratil, J., McCauley, H. L., Marmol, M., Barone, J., & Miller, E. (2015). Involving youth voices in research protocol reviews. The American Journal of Bioethics: AJOB, 15(11), 33–34.PubMedCrossRefGoogle Scholar
  27. Radovic, A., DeMand, A. L., Gmelin, T., Stein, B. D., & Miller, E. (2017a). SOVA: Design of a stakeholder informed social media website for depressed adolescents and their parents. Journal of Technology in Human Services, 35(3), 169–182.PubMedPubMedCentralCrossRefGoogle Scholar
  28. Radovic, A., Farris, C., Reynolds, K., Reis, E. C., Miller, E., & Stein, B. D. (2014). Primary care providers’ initial treatment decisions and antidepressant prescribing for adolescent depression. Journal of Developmental and Behavioral Pediatrics: JDBP, 35(1), 28–37.PubMedCrossRefGoogle Scholar
  29. Radovic, A., Gmelin, T., Hua, J., Long, C., Stein, B. D., & Miller, E. (2018). Supporting our valued adolescents (SOVA), a social media website for adolescents with depression and/or anxiety: technological feasibility, usability, and acceptability study. JMIR Mental Health, 5(1), e17.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Radovic, A., Gmelin, T., Stein, B. D., & Miller, E. (2017b). Depressed adolescents’ positive and negative use of social media. Journal of Adolescence, 55, 5–15.PubMedCrossRefGoogle Scholar
  31. Radovic, A., Li, Y., Landsittel, D., Stein, B. D., & Miller, E. (2019). A social media website (supporting our valued adolescents) to support treatment uptake for adolescents with depression and/or anxiety and their parents: Protocol for a pilot randomized controlled trial. JMIR Research Protocols, 8(1), e12117.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Radovic, A., Reynolds, K., McCauley, H., Sucato, G., Stein, B., & Miller, E. (2015). Parents’ role in adolescent depression care: Primary care provider perspectives. The Journal of Pediatrics, 167(4), 911–918.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Ramsey, A., Lord, S., Torrey, J., Marsch, L., & Lardiere, M. (2016). Paving the way to successful implementation: Identifying key barriers to use of technology-based therapeutic tools for behavioral health care. The Journal of Behavioral Health Services Research, 43(1), 54–70.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Richardson, J. E., Abramson, E. L., Pfoh, E. R., Kaushal, R., & HITEC Investigators (Eds.) (2012). Bridging informatics and implementation science: Evaluating a framework to assess electronic health record implementations in community settings. In AMIA annual symposium proceedings. Bethesda, MD: American Medical Informatics Association.Google Scholar
  35. Rogers, E. M. (2010). Diffusion of innovations. New York: Simon and Schuster.Google Scholar
  36. Sandelowski, M. (2000). Focus on research methods: Whatever happened to qualitative description? Research in Nursing & Health, 23, 334–340.CrossRefGoogle Scholar
  37. Stetler, C. B., Legro, M. W., Wallace, C. M., Bowman, C., Guihan, M., Hagedorn, H., et al. (2006). The role of formative evaluation in implementation research and the QUERI experience. Journal of General Internal Medicine, 21(2), S1.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Tanielian, T., Jaycox, L. H., Paddock, S. M., Chandra, A., Meredith, L. S., & Burnam, M. A. (2009). Improving treatment seeking among adolescents with depression: Understanding readiness for treatment. Journal of Adolescent Health, 45(5), 490–498.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Varsi, C., Ekstedt, M., Gammon, D., & Ruland, C. M. (2015). Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: A qualitative study. Journal of Medical Internet Research, 17(11), e262.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Venkatesh, V., Morris, M. G., Davis, G. B., & Davis, F. D. (2003). User acceptance of information technology: Toward a unified view. MIS Quarterly, 27(3), 425–478.CrossRefGoogle Scholar
  41. Venkatesh, V., Zhang, X., & Sykes, T. A. (2011). “Doctors do too little technology”: A longitudinal field study of an electronic healthcare system implementation. Information Systems Research, 22(3), 523–546.CrossRefGoogle Scholar
  42. Wisdom, J. P., Clarke, G. N., & Green, C. A. (2006). What teens want: Barriers to seeking care for depression. Administration and Policy in Mental Health and Mental Health Services Research, 33(2), 133.PubMedCrossRefPubMedCentralGoogle Scholar
  43. Zuckerbrot, R. A., Cheung, A., Jensen, P. S., Stein, R. E., Laraque, D., & GROUP G-PS. (2018). Guidelines for adolescent depression in primary care (GLAD-PC): Part I. Practice preparation, identification, assessment, and initial management. Pediatrics, 141(3), e20174081.PubMedCrossRefPubMedCentralGoogle Scholar

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

Personalised recommendations