Prescribing Technology to Increase Uptake of Depression Treatment in Primary Care: A Pre-implementation Focus Group Study of SOVA (Supporting Our Valued Adolescents)
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.
KeywordsAdolescent Depression Anxiety Technology Health services Implementation science Primary health care Pediatrics
After visit summary
Consolidated framework for implementation research
Evidence-Based Practice Attitude Scale
Electronic health record
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.
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.
The original study protocol was approved by the University of Pittsburgh Institutional Review Board. All individuals provided verbal consent to participate.
- Consolidated Framework for Implementation Research. (2019). https://cfirguide.org/.
- 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
- Grol, R. (2001). Successes and failures in the implementation of evidence-based guidelines for clinical practice. Medical Care, 39(8), 46–54.Google Scholar
- 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
- 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
- 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
- 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
- National Institute of Medical Health (NIMH). (2017). Treatment of major depressive episode among adolescents. Charlottesville: National Institute of Medical Health.Google Scholar
- 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
- 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
- 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
- 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
- Rogers, E. M. (2010). Diffusion of innovations. New York: Simon and Schuster.Google Scholar
- 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
- 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