Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

doi:10.2196/14255

. 2019 Sep 27;21(9):e14255.

doi: 10.2196/14255.

Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

Cecilie Varsi¹, Lise Solberg Nes^{1

2

3}, Olöf Birna Kristjansdottir^{1

4}, Saskia M Kelders^{5

6}, Una Stenberg⁴, Heidi Andersen Zangi^{7

8}, Elin Børøsund¹, Karen Elizabeth Weiss⁹, Audun Stubhaug^{2

10

11}, Rikke Aune Asbjørnsen^{1

5

12}, Marianne Westeng¹, Marte Ødegaard¹³, Hilde Eide^{1

14}

Affiliations

¹ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.
⁴ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
⁵ Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
⁶ Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa.
⁷ National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
⁸ Faculty of Health, VID Specialized University, Oslo, Norway.
⁹ Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States.
¹⁰ Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway.
¹¹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹² Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Norway.
¹³ University of Oslo Library, University of Oslo, Oslo, Norway.
¹⁴ Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway.

PMID: 31573934
PMCID: PMC6789428
DOI: 10.2196/14255

Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

Cecilie Varsi et al. J Med Internet Res. 2019.

. 2019 Sep 27;21(9):e14255.

doi: 10.2196/14255.

Authors

Affiliations

¹ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Oslo, Norway.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.
⁴ Norwegian National Advisory Unit on Learning and Mastery in Health, Oslo University Hospital, Oslo, Norway.
⁵ Center for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
⁶ Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa.
⁷ National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
⁸ Faculty of Health, VID Specialized University, Oslo, Norway.
⁹ Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States.
¹⁰ Regional Advisory Unit on Pain, Oslo University Hospital, Oslo, Norway.
¹¹ Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹² Department of Research and Innovation, Vestfold Hospital Trust, Tønsberg, Norway.
¹³ University of Oslo Library, University of Oslo, Oslo, Norway.
¹⁴ Science Centre Health and Technology, University of South-Eastern Norway, Drammen, Norway.

PMID: 31573934
PMCID: PMC6789428
DOI: 10.2196/14255

Abstract

Background: There is growing evidence of the positive effects of electronic health (eHealth) interventions for patients with chronic illness, but implementation of such interventions into practice is challenging. Implementation strategies that potentially impact implementation outcomes and implementation success have been identified. Which strategies are actually used in the implementation of eHealth interventions for patients with chronic illness and which ones are the most effective is unclear.

Objective: This systematic realist review aimed to summarize evidence from empirical studies regarding (1) which implementation strategies are used when implementing eHealth interventions for patients with chronic illnesses living at home, (2) implementation outcomes, and (3) the relationship between implementation strategies, implementation outcomes, and degree of implementation success.

Methods: A systematic literature search was performed in the electronic databases MEDLINE, Embase, PsycINFO, Scopus, Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Studies were included if they described implementation strategies used to support the integration of eHealth interventions into practice. Implementation strategies were categorized according to 9 categories defined by the Expert Recommendations for Implementing Change project: (1) engage consumers, (2) use evaluative and iterative strategies, (3) change infrastructure, (4) adapt and tailor to the context, (5) develop stakeholder interrelationships, (6) use financial strategies, (7) support clinicians, (8) provide interactive assistance, and (9) train and educate stakeholders. Implementation outcomes were extracted according to the implementation outcome framework by Proctor and colleagues: (1) acceptability, (2) adoption, (3) appropriateness, (4) cost, (5) feasibility, (6) fidelity, (7) penetration, and (8) sustainability. Implementation success was extracted according to the study authors' own evaluation of implementation success in relation to the used implementation strategies.

Results: The implementation strategies management support and engagement, internal and external facilitation, training, and audit and feedback were directly related to implementation success in several studies. No clear relationship was found between the number of implementation strategies used and implementation success.

Conclusions: This is the first review examining implementation strategies, implementation outcomes, and implementation success of studies reporting the implementation of eHealth programs for patients with chronic illnesses living at home. The review indicates that internal and external facilitation, audit and feedback, management support, and training of clinicians are of importance for eHealth implementation. The review also points to the lack of eHealth studies that report implementation strategies in a comprehensive way and highlights the need to design robust studies focusing on implementation strategies in the future.

Trial registration: PROSPERO CRD42018085539; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=85539.

Keywords: chronic illness; eHealth; implementation; implementation outcomes; implementation strategies; realist review.

©Cecilie Varsi, Lise Solberg Nes, Olöf Birna Kristjansdottir, Saskia M Kelders, Una Stenberg, Heidi Andersen Zangi, Elin Børøsund, Karen Elizabeth Weiss, Audun Stubhaug, Rikke Aune Asbjørnsen, Marianne Westeng, Marte Ødegaard, Hilde Eide. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 27.09.2019.

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Conflict of interest statement

Conflicts of Interest: None declared.

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References

1. Eysenbach G. What is eHealth? J Med Internet Res. 2001 Jun;3(2):E20. doi: 10.2196/jmir.3.2.e20. - DOI - PMC - PubMed
1. Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017 Apr;100(4):616–635. doi: 10.1016/j.pec.2016.10.019. http://linkinghub.elsevier.com/retrieve/pii/S0738-3991(16)30489-X S0738-3991(16)30489-X - DOI - PMC - PubMed
1. Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med. 2018 Nov 01;42(2):169–187. doi: 10.1007/s10865-018-9984-x.10.1007/s10865-018-9984-x - DOI - PubMed
1. Varsi C, Ekstedt M, Gammon D, Ruland CM. 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. J Med Internet Res. 2015 Nov 18;17(11):e262. doi: 10.2196/jmir.5091. http://www.jmir.org/2015/11/e262/ v17i11e262 - DOI - PMC - PubMed
1. Borosund E, Varsi C, Clark M, Ehlers S, Andrykowski M, Sleveland H. Pilot testing an app-based stress management intervention for cancer survivors [in press] Translat Behav Med. 2019:1. doi: 10.1093/tbm/ibz062. - DOI - PMC - PubMed

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[1] Eysenbach G. What is eHealth? J Med Internet Res. 2001 Jun;3(2):E20. doi: 10.2196/jmir.3.2.e20. - DOI - PMC - PubMed

[2] Eysenbach G. What is eHealth? J Med Internet Res. 2001 Jun;3(2):E20. doi: 10.2196/jmir.3.2.e20. - DOI - PMC - PubMed

[3] Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017 Apr;100(4):616–635. doi: 10.1016/j.pec.2016.10.019. http://linkinghub.elsevier.com/retrieve/pii/S0738-3991(16)30489-X S0738-3991(16)30489-X - DOI - PMC - PubMed

[4] Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: a meta-ethnography review of published studies. Patient Educ Couns. 2017 Apr;100(4):616–635. doi: 10.1016/j.pec.2016.10.019. http://linkinghub.elsevier.com/retrieve/pii/S0738-3991(16)30489-X S0738-3991(16)30489-X - DOI - PMC - PubMed

[5] Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med. 2018 Nov 01;42(2):169–187. doi: 10.1007/s10865-018-9984-x.10.1007/s10865-018-9984-x - DOI - PubMed

[6] Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med. 2018 Nov 01;42(2):169–187. doi: 10.1007/s10865-018-9984-x.10.1007/s10865-018-9984-x - DOI - PubMed

[7] Varsi C, Ekstedt M, Gammon D, Ruland CM. 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. J Med Internet Res. 2015 Nov 18;17(11):e262. doi: 10.2196/jmir.5091. http://www.jmir.org/2015/11/e262/ v17i11e262 - DOI - PMC - PubMed

[8] Varsi C, Ekstedt M, Gammon D, Ruland CM. 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. J Med Internet Res. 2015 Nov 18;17(11):e262. doi: 10.2196/jmir.5091. http://www.jmir.org/2015/11/e262/ v17i11e262 - DOI - PMC - PubMed

[9] Borosund E, Varsi C, Clark M, Ehlers S, Andrykowski M, Sleveland H. Pilot testing an app-based stress management intervention for cancer survivors [in press] Translat Behav Med. 2019:1. doi: 10.1093/tbm/ibz062. - DOI - PMC - PubMed

[10] Borosund E, Varsi C, Clark M, Ehlers S, Andrykowski M, Sleveland H. Pilot testing an app-based stress management intervention for cancer survivors [in press] Translat Behav Med. 2019:1. doi: 10.1093/tbm/ibz062. - DOI - PMC - PubMed

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Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

Affiliations

Implementation Strategies to Enhance the Implementation of eHealth Programs for Patients With Chronic Illnesses: Realist Systematic Review

Authors

Affiliations

Abstract

Conflict of interest statement

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