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[Summary] A Solution-Focused Research Approach to Achieve an Implementable Revolution in Digital Mental Health (Mohr, Riper, Schueller 2017)
TLDR; Digital mental health tools are not working in the real-world mostly due to adherence. We need to rethink our approach and design tools patients will actually use in practice.
TLDR; Real-world implementation of digital mental health tools is failing. To bridge the ‘research to practice gap’ we need to rethink how we approach research and design tools that people will use in real life.
Although we have promising research, real-world implementations have mostly failed and are not being used by patients or therapists. We need a paradigm shift in our approach to close the “research to practice gap.”
“Numerous health care systems have attempted to implement DMH interventions to address the large burden of mental health. However, these real-world implementation efforts have failed, often because they are not used by patients or therapists. This large research to practice gap suggests failures at many points, including DMH intervention design, research methods, and implementation approaches. The promised revolution in mental health will require a paradigm shift that addresses all 3 components to overcome the design, research, and routine care chasms.”
A “solution-focused approach” prioritizes practical solutions that work in real-world settings over efficacy in the lab by improving on 3 stages: create, trial, and sustain.
“A solution-focused approach differs from an efficacy approach by prioritizing the development of a solution to a practical problem over the production of generalizable efficacy knowledge that might be correct in abstract but does not represent or trans- late to any specific real-world setting. We will more likely be successful if we produce a sustainable solution in a real-world setting and then adapt to other contexts. We suggest that solution-focused research can achieve its goals more rapidly by progressing through the 3 stages of create, trial, and sustain rather than the traditional phases of discovery, pilot, efficacy, and effectiveness that are more familiar to clinical scientists.”
Current interventions lack adherence and engagement, with patients failing to complete more than 1 or 2 sessions.
“Adherence and sustained engagement with DMH interventions is a long-standing, recognized problem.”
“Lack of engagement suggests fundamental problems in the design of DMH interventions, which commonly rely on psychoeducational self-help materials and worksheets delivered via digital media that require significant time and effort on the part of patients. Patients’ enthusiasm for these designs can be gauged by the failure of many to complete more than 1 or 2 sessions.”
We must be willing to let go of old paradigms (eg internet-based CBT) and be willing to find tools that are designed to fit into the lives of end-users and genuinely address their needs and preferences.
“Although our first-generation DMH interventions, translating evidence-based treatments into web-based treatments, have provided useful insights, in creating our next generation of DMH interventions, we must be willing to let go of old paradigms, such as internet-based cognitive behavioral therapy. We must be willing to design new digital experiences that leverage unique affordances of technologies and novel insights they can help deliver. Digital tools need to fit into the fabric of patients’ lives and accommodate practitioners’ workflows. Design approaches have started to be used in DMH interventions, but our goal should not be to design the best internet-based cognitive behavior treatment; instead, we must understand the lives and workflows that these tools are intended to support and address stakeholders’ needs, preferences, and goals.”
We can use technology to design and create tools that are more efficient and engaging.
“Technologies will enable new forms of services that can be efficient yet engaging. To achieve this, we must design these new services and the supporting technologies and interfaces.”
We have to think about how DMH tools will be implemented in the real world as we’re making and researching them.
“The failure to bridge DMH research and real-world implementation in care settings indicates that implementation cannot be left as a post hoc procedure. Sustainable DMH interventions will require that implementation plans addressing multilevel organizational issues, reimbursement, and business models be defined from the start, along with the design of the services and technologies.”
New trial methods must allow for product iteration and evolution.
“Digital technologies are continuously evolving, requiring rapid evaluation to prevent obsolescence. Thus, DMH trial methods cannot lock down intervention elements; rather, trial methods must allow for learning, iteration, and redesign, which can be achieved by integrating continuous quality improvement methods and principles of iterative design into trial methods.”
We argue that the end goal of research should be sustainable implementation. Solution-focused research can support sustainment by slowly withdrawing research support and transferring critical knowledge and skills to the organization in which the DMH has been designed and evaluated and has demonstrated effectiveness.
“To truly revolutionize mental health services, we must let go of preconceptions and explore new ways of developing, providing, and evaluating DMH interventions that result in sustainable implementation in the real world.”