Enhancing the implementation of evidence-based treatment interventions. A comprehensive evaluation of a real-world implementation programme

Abstract

Background

Ostrobothnia Depression Programme (ODP) was conducted in South Ostrobothnia Hospital District in Finland 2009–2014. It was targeted to tackle heterogeneous treatment practices and congested patient flow with a marked increase in depressed patients, and deficit in the integrative treatment of comorbid substance abuse. The ODP included an implementation programme for two evidence-based treatments (EBTs): motivational interviewing and behavioural activation. The implementation plan included two multi-faceted workshop days (mandatory), subsequent (voluntary) regular case consultations and other more general strategies, e.g. training videos available.

Methods

We performed a comprehensive evaluation of the ODP implementation programme: mixed-methods surveys for the therapists and focus group interviews with the leaders and programme executives, and analysis of the implementation plan against Normalization Process Theory.

Results

About a third of the 84 ODP trained therapists were considered as active adopters still after closing the programme. The only therapist related factor predicting the adoption was a positive experience of using the EBTs. Support from the leadership and the influence of peers both facilitated the adoption. Attending the case consultations and watching the videos were under-utilized. Staff turnover undermined the sustainability of the outcomes. No specific sustainment strategies were included in the implementation plan.

Conclusions

Brief but multi-faceted training workshops are viable means to start implementing EBTs in a real-world setting. Scaling up and sustaining their adoption rate entails specific amendments in the implementation plan, e.g. policies to reinforce the leaders’ role as facilitators, making the case consultations mandatory and establishing a post-programme recurring training policy for newcomers.