Development of an Implementation Facilitation Strategy to Link Mental Health Screening and eHealth Intervention for Clients in Ryan White–Funded Clinics in Chicago. (1st July 2022)

• Record Type: Journal Article
• Authors: Stump, Tammy K.; Ethier, Kristen; Hirschhorn, Lisa R.; Dakin, Andrea; Bouacha, Nora; Freeman, Angela; Bannon, Jacqueline; Gómez, Walter; Moskowitz, Judith T.; Bouris, Alida
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 90(2022)Supplement 1
• Page Start: S197
• Page End: S205
• Publication Date: 2022-07-01
• Subjects: HIV -- positive affect -- depression -- screening -- implementation; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000002980
• Languages: English
• ISSNs: 1525-4135

Abstract

Abstract : Supplemental Digital Content is Available in the Text. Abstract : Background: To reduce the impact of depression on people living with HIV, we are implementing a clinic-based behavioral health screener and referral to Optimizing Resilience and Coping with HIV through Internet Delivery, an evidenced-based intervention. We used the Consolidated Framework for Implementation Research to identify contextual barriers and facilitators in advance of implementation. Setting: Sixteen Chicagoland area Ryan White Medical Case Management sites. Methods: We conducted a sequential mixed-methods study with medical case managers and supervisors. Participants completed an online survey assessing Consolidated Framework for Implementation Research domains, scored on a 1 (strongly disagree) to 5 (strongly agree) scale. Survey results informed a purposive sampling frame and interview protocol. Interviews were analyzed by rapid qualitative analysis. Results: On average, survey respondents (n = 58) slightly agreed with positive views of team culture, learning climate, and implementation readiness (mean = 3.80–3.87). Potential barriers included intervention complexity (mean = 3.47), needed human resources (mean = 2.71–3.33), and only slight agreement with relative advantage over existing screening/referral systems (mean = 3.09–3.71). Qualitative results (n = 15) identified low advantage for clinics with robust behavioral health systems but strong advantage in clinics without these services. Respondents identified system-wide training and monitoring strategies to facilitate implementation. Conclusions: Ryan White Medical Case Management sites are a generally favorable context for the implementation of the interventions. As illustrated in an implementation research logic model, barriers will be addressed through deploying strategies proposed to impact clinic- and individual-level outcomes, including electronic prompts (reduce complexity), training on Optimizing Resilience and Coping with HIV through Internet Delivery as a complement to other behavioral health services (increase relative advantage), and feedback during implementation (strengthen rewards/incentives).