. 2023 Jan 25;23(1):78.

doi: 10.1186/s12913-022-08993-1.

Implementation strategies for telemental health: a systematic review

Rebecca Appleton^#¹, Phoebe Barnett^#^{2

3}, Norha Vera San Juan⁴, Elizabeth Tuudah⁵, Natasha Lyons², Jennie Parker⁶, Emily Roxburgh⁷, Spyros Spyridonidis⁸, Millie Tamworth⁸, Minnie Worden⁸, Melisa Yilmaz⁸, Nick Sevdalis⁹, Brynmor Lloyd-Evans², Justin J Needle^#¹⁰, Sonia Johnson^#^{2

11}

Affiliations

¹ NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK. r.appleton@ucl.ac.uk.
² NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
³ Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁴ NIHR Mental Health Policy Research Unit, King's College London, London, UK.
⁵ Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
⁶ Lived Experience Researcher, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
⁷ Kingston iCope, Camden & Islington NHS Trust, London, UK.
⁸ Division of Psychiatry, UCL, London, UK.
⁹ Centre for Implementation Science, King's College London, London, UK.
¹⁰ Centre for Health Services Research, City, University of London, London, UK.
¹¹ Camden and Islington NHS Foundation Trust, London, UK.

^# Contributed equally.

PMID: 36694164
PMCID: PMC9873395
DOI: 10.1186/s12913-022-08993-1

Implementation strategies for telemental health: a systematic review

Rebecca Appleton et al. BMC Health Serv Res. 2023.

. 2023 Jan 25;23(1):78.

doi: 10.1186/s12913-022-08993-1.

Authors

Affiliations

¹ NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK. r.appleton@ucl.ac.uk.
² NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
³ Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁴ NIHR Mental Health Policy Research Unit, King's College London, London, UK.
⁵ Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK.
⁶ Lived Experience Researcher, NIHR Mental Health Policy Research Unit, Division of Psychiatry, UCL, London, UK.
⁷ Kingston iCope, Camden & Islington NHS Trust, London, UK.
⁸ Division of Psychiatry, UCL, London, UK.
⁹ Centre for Implementation Science, King's College London, London, UK.
¹⁰ Centre for Health Services Research, City, University of London, London, UK.
¹¹ Camden and Islington NHS Foundation Trust, London, UK.

^# Contributed equally.

PMID: 36694164
PMCID: PMC9873395
DOI: 10.1186/s12913-022-08993-1

Abstract

Background: The COVID-19 pandemic resulted in a rapid shift from traditional face-to-face care provision towards delivering mental health care remotely through telecommunications, often referred to as telemental health care. However, the manner and extent of telemental health implementation have varied considerably across settings and areas, and substantial barriers are encountered. There is, therefore, a need to identify what works best for service users and staff and establish the key mechanisms for efficient integration into routine care.

Objective: We aimed to identify investigations of pre-planned strategies reported in the literature intended to achieve or improve effective and sustained implementation of telemental health approaches (including video calls, telephone calls, text messaging platforms or a combination of any of these approaches with face-to-face care), and to evaluate how different strategies influence implementation outcomes.

Methods: A systematic review was conducted, with five databases searched for any relevant literature published between January 2010 and July 2021. Studies were eligible if they took place in specialist mental health services and focused on pre-planned strategies to achieve or improve the delivery of mental health care through remote communication between mental health professionals or between mental health professionals and service users, family members, unpaid carers, or peer supporters. All included studies were quality-assessed. Data were synthesised using the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies and the taxonomy of implementation outcomes.

Results: A total of 14 studies were identified as meeting the inclusion criteria from a total of 14,294 records of which 338 were assessed at full text. All ERIC implementation strategies were used by at least one study, the most commonly reported being 'Train and educate stakeholders'. All studies reported using a combination of several implementation strategies, with the mean number of strategies used per study of 3.5 (range 2-6), many of which were reported to result in an improvement in implementation over time. Few studies specifically investigated a single implementation strategy and its associated outcomes, making conclusions regarding the most beneficial strategy difficult to draw.

Conclusions: Using a combination of implementation strategies appears to be a helpful method of supporting the implementation of telemental health. Further research is needed to test the impact of specific implementation strategies on implementation outcomes.

Keywords: Implementation; Mental health; Remote care; Systematic review; Telemedicine; Telemental health; Telepsychiatry.

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Conflict of interest statement

NS is the director of the London Safety and Training Solutions Ltd, which offers training in patient safety, implementation solutions and human factors to healthcare organisations and the pharmaceutical industry. The other authors have no conflicts of interest to declare.

Figures

**Fig. 1**
PRIMSA flow chart showing the study selection and screening process

See this image and copyright information in PMC

References

1. AHRQ. Telemental Health 2021. Available from: https://digital.ahrq.gov/telehealth-0.
1. Appleton R, Williams J, San Juan NV, Needle JJ, Schlief M, Jordan H, et al. Implementation, adoption, and perceptions of telemental health during the COVID-19 pandemic: systematic review. J Med Internet Res. 2021;23(12):e31746. doi: 10.2196/31746. - DOI - PMC - PubMed
1. Wyler H, Liebrenz M, Ajdacic-Gross V, Seifritz E, Young S, Burger P, et al. Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs telepsychiatric sessions. BMC Psychiatry. 2021;21(1):237. doi: 10.1186/s12888-021-03236-9. - DOI - PMC - PubMed
1. Severe J, Tang R, Horbatch F, Onishchenko R, Naini V, Blazek MC. Factors influencing patients’ initial decisions regarding telepsychiatry participation during the COVID-19 pandemic: telephone-based survey. JMIR Form Res. 2020;4(12):e25469. doi: 10.2196/25469. - DOI - PMC - PubMed
1. Vera San Juan N, Shah P, Schlief M, Appleton R, Nyikavaranda P, Birken M, et al. Service user experiences and views regarding telemental health during the COVID-19 pandemic: a co-produced framework analysis. PLoS ONE. 2021;16(9):e0257270. doi: 10.1371/journal.pone.0257270. - DOI - PMC - PubMed

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Implementation strategies for telemental health: a systematic review

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Implementation strategies for telemental health: a systematic review

Authors

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Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

Medical