Measuring the Implementation of Behavioral Intervention Technologies: Recharacterization of Established Outcomes.

Behavioral intervention technologies (BITs) are websites, software, mobile apps, and sensors designed to help users address or change behaviors, cognitions, and emotional states. BITs have the potential to transform health care delivery, and early research has produced promising findings of efficacy. BITs also favor new models of health care delivery and provide novel data sources for measurement. However, there are few examples of successful BIT implementation and a lack of consensus on as well as inadequate descriptions of BIT implementation measurement. The aim of this viewpoint paper is to provide an overview and characterization of implementation outcomes for the study of BIT use in routine practice settings. Eight outcomes for the evaluation of implementation have been previously described: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. In a proposed recharacterization of these outcomes with respect to BIT implementation, definitions are clarified, expansions to the level of analysis are identified, and unique measurement characteristics are discussed. Differences between BIT development and implementation, an increased focus on consumer-level outcomes, the expansion of providers who support BIT use, and the blending of BITs with traditional health care services are specifically discussed. BITs have the potential to transform health care delivery. Realizing this potential, however, will hinge on high-quality research that consistently and accurately measures how well such technologies have been integrated into health services. This overview and characterization of implementation outcomes support BIT research by identifying and proposing solutions for key theoretical and practical measurement challenges.

Computer-based self-help therapy: A qualitative analysis of attrition.

The impact of computer-based cognitive-behavioral self-help therapy programs is limited by high attrition. This study explored reactions to computer-based cognitive-behavioral self-help therapy use among individuals not completing a full treatment course. Individuals receiving outpatient substance use disorder treatment at a Veterans Health Administration clinic who enrolled in a study implementing a computer-based cognitive-behavioral self-help therapy for insomnia, but subsequently dropped out prior to completion, were interviewed. Reactions to use and reasons for attrition were explored through thematic analysis of interviews. Among barriers to use, themes of competing demands, personal attributes, the computer-based format of computer-based cognitive-behavioral self-help therapies, and negative experiences with the specific program used were identified. Among facilitators of use, themes of personal support, the computer-based cognitive-behavioral self-help therapy format, and personal attributes were identified. Recommendations for future implementation efforts to include additional person-to-person contact during computer-based cognitive-behavioral self-help therapy participation were made. These themes may be employed to develop strategies for computer-based cognitive-behavioral self-help therapy implementation in order to maximize program engagement and completion.