Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2020

Open Access 01-12-2020 | Care | Research article

Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review

Authors: Samuel D. Muir, Kathleen de Boer, Maja Nedeljkovic, Denny Meyer

Published in: BMC Health Services Research | Issue 1/2020

Login to get access

Abstract

Background

Whilst treatment for mental health issues has traditionally been conducted in-person, advances in technology has seen a recent growth in the use of online video therapy services to help overcome access-to-care barriers faced by those living in rural locations and those unable to travel. These barriers are particularly apparent in the case of veteran populations, which is the focus of this review. Whilst the research investigating the efficacy of online video therapy to treat mental health issues among veterans is promising, widespread adoption and utilisation of this modality remains low with efforts often failing to progress past the pilot phase to implementation. This review focuses on the implementation of online video therapy in veteran mental health care settings and aims to identify the potential barriers and facilitators relevant to implementing the modality in military organisations.

Methods

A systematic search of three databases (PsycInfo, PubMed, and Web of Science) was conducted. To be eligible for inclusion, studies had to investigate the challenges, lessons learnt, or factors operating as barriers and/or facilitators to the implementation of online video therapy in veteran health care systems.

Results

The initial search revealed a total of 202 articles. This was reduced to 133 when duplicates were removed. After screening the titles and abstracts a further 70 articles were excluded leaving 63 to be retrieved for full review. A total of 10 studies were included in this review. The most commonly reported barriers were related to clinician concerns, logistical problems, and technology. Other barriers included access to resources as well as challenges posed by collaborations, policy and recruitment. Facilitators included experience using the modality and having dedicated staff responsible for promoting and managing the new service (e.g., on-site champions and telehealth technicians).

Conclusions

This review suggests that numerous barriers must be identified and addressed before attempting to implement an online video therapy service in veteran organisations. Further research is needed to establish best practice for implementation, particularly across geographically dispersed sites. It is hoped that the findings of this review will be used to help inform future implementation efforts and research initiatives in this space.
Appendix
Available only for authorised users
Literature
1.
2.
Darkins A. The growth of telehealth services in the veterans health administration between 1994 and 2014: a study in the diffusion of innovation. Telemed e-Health. 2014;20(9):761–8.CrossRef
3.
Mehrotra A, Huskamp HA, Souza J, Uscher-Pines L, Rose S, Landon BE, et al. Rapid growth in mental health telemedicine use among rural Medicare beneficiaries, wide variation across states. Health Aff. 2017;36(5):909–17.CrossRef
4.
5.
Jerome LW, Zaylor C. Cyberspace: creating a therapeutic environment for telehealth applications. Prof Psychol Res Pract. 2000;31(5):478.CrossRef
6.
Bouchard S, Paquin B, Payeur R, Allard M, Rivard V, Fournier T, et al. Delivering cognitive-behavior therapy for panic disorder with agoraphobia in videoconference. Telemed J E Health. 2004;10(1):13–25.CrossRefPubMed
7.
Ben-Zeev D, Corrigan PW, Britt TW, Langford L. Stigma of mental illness and service use in the military. J Ment Health. 2012;21(3):264–73.CrossRefPubMed
8.
Greene-Shortridge TM, Britt TW, Castro CA. The stigma of mental health problems in the military. Mil Med. 2007;172(2):157–61.CrossRefPubMed
9.
Burnam MA, Meredith LS, Tanielian T, Jaycox LH. Mental health care for Iraq and Afghanistan war veterans. Health Aff. 2009;28(3):771–82.CrossRef
10.
McFarlane A, Hodson S. Mental health in the Australian Defence force: 2010 ADF mental health prevalence and wellbeing study: full reportDepartment of Defence; 2011.
11.
Stecker T, Fortney JC, Hamilton F, Ajzen I. An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatr Serv. 2007;58(10):1358–61.CrossRefPubMed
12.
Warner CH, Appenzeller GN, Mullen K, Warner CM, Grieger T. Soldier attitudes toward mental health screening and seeking care upon return from combat. Mil Med. 2008;173(6):563–9.CrossRefPubMed
13.
Egede LE, Acierno R, Knapp RG, Lejuez C, Hernandez-Tejada M, Payne EH, et al. Psychotherapy for depression in older veterans via telemedicine: a randomised, open-label, non-inferiority trial. Lancet Psychiatry. 2015;2(8):693–701.CrossRefPubMed
14.
Ruskin PE, Silver-Aylaian M, Kling MA, Reed SA, Bradham DD, Hebel JR, et al. Treatment outcomes in depression: comparison of remote treatment through telepsychiatry to in-person treatment. Am J Psychiatry. 2004;161(8):1471–6.CrossRefPubMed
15.
Morland LA, Greene CJ, Rosen CS, Foy D, Reilly P, Shore J, et al. Telemedicine for anger management therapy in a rural population of combat veterans with posttraumatic stress disorder: a randomized noninferiority trial. J Clin Psychiatry. 2010;71(7):855–63.CrossRefPubMed
16.
Strachan M, Gros DF, Ruggiero KJ, Lejuez CW, Acierno R. An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings. Behav Ther. 2012;43(3):560–9.CrossRefPubMed
17.
Adler G, Pritchett LR, Kauth MR, Nadorff D. A pilot project to improve access to telepsychotherapy at rural clinics. Telemed e-Health. 2014;20(1):83–5.CrossRef
18.
Bauer MS, Krawczyk L, Tuozzo K, Frigand C, Holmes S, Miller CJ, et al. Implementing and sustaining team-based telecare for bipolar disorder: lessons learned from a model-guided, mixed methods analysis. Telemed e-Health. 2018;24(1):45–53.CrossRef
19.
Brooks E, Manson SM, Bair B, Dailey N, Shore JH. The diffusion of telehealth in rural American Indian communities: a retrospective survey of key stakeholders. Telemed e-Health. 2012;18(1):60–6.CrossRef
20.
Brooks E, Turvey C, Augusterfer EF. Provider barriers to telemental health: obstacles overcome, obstacles remaining. Telemed e-Health. 2013;19(6):433–7.CrossRef
21.
Hill RD, Luptak MK, Rupper RW, Bair B, Peterson C, Dailey N, et al. Review of veterans health administration telemedicine interventions. Am J Manag Care. 2010;16(12):302–10.
22.
Interian A, King AR, St. Hill LM, Robinson CH, Damschroder LJ. Evaluating the implementation of home-based videoconferencing for providing mental health services. Psychiatr Serv. 2017;69(1):69–75.CrossRefPubMed
23.
Lindsay JA, Kauth MR, Hudson S, Martin LA, Ramsey DJ, Daily L, et al. Implementation of video telehealth to improve access to evidence-based psychotherapy for posttraumatic stress disorder. Telemed e-Health. 2015;21(6):467–72.CrossRef
24.
Moreau JL, Cordasco KM, Young AS, Oishi SM, Rose DE, Canelo I, et al. The use of Telemental health to meet the mental health needs of women using Department of Veterans Affairs Services. Womens Health Issues. 2018;28(2):181–7.CrossRefPubMed
25.
Shore JH, Manson SM. A developmental model for rural telepsychiatry. Psychiatr Serv. 2005;56(8):976–80.CrossRefPubMed
26.
Darkins A. Program management of telemental health care services. J Geriatr Psychiatry Neurol. 2001;14(2):80–7.CrossRefPubMed
27.
Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3–4):327.CrossRefPubMed
28.
Fixsen DL, Naoom SF, Blase KA, Friedman RM, Wallace F, Burns B, et al. Implementation research: a synthesis of the literature. Tampa: Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network; 2005.
29.
Trautmann S, Goodwin L, Höfler M, Jacobi F, Strehle J, Zimmermann P, et al. Prevalence and severity of mental disorders in military personnel: a standardised comparison with civilians. Epidemiol Psychiatr Sci. 2017;26(2):199–208.CrossRefPubMed
30.
Karlin BE, Cross G. From the laboratory to the therapy room: national dissemination and implementation of evidence-based psychotherapies in the US Department of veterans affairs health care system. Am Psychol. 2014;69(1):19.CrossRefPubMed
31.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.CrossRefPubMed
32.
Brown RA, Marshall GN, Breslau J, Farris C, Osilla KC, Pincus HA, et al. Access to behavioral health care for geographically remote service members and dependents in the US. Rand Health Quart. 2015;5(1):21. eCollection 2015 Jul 15.
33.
Naylor PJ, Nettlefold L, Race D, Hoy C, Ashe MC, Higgins JW, et al. Implementation of school based physical activity interventions: a systematic review. Prev Med. 2015;72:95–115.CrossRefPubMed
34.
Wierenga D, Engbers LH, Van Empelen P, Duijts S, Hildebrandt VH, Van Mechelen W. What is actually measured in process evaluations for worksite health promotion programs: a systematic review. BMC Public Health. 2013;13(1):1190.CrossRefPubMedPubMedCentral
35.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
36.
Palyo SA, Schopmeyer KA, McQuaid JR. Tele-pain management: use of videoconferencing technology in the delivery of an integrated cognitive–behavioral and physical therapy group intervention. Psychol Serv. 2012;9(2):200.CrossRefPubMed
37.
Azevedo KJ, Weiss BJ, Webb K, Gimeno J, Cloitre M. Piloting specialized mental health care for rural women veterans using STAIR delivered via telehealth: implications for reducing health disparities. J Health Care Poor Underserved. 2016;27(4):1–7.CrossRefPubMed
38.
Shore J, Kaufmann LJ, Brooks E, Bair B, Dailey N, Richardson WB Jr, et al. Review of American Indian veteran telemental health. Telemed e-Health. 2012;18(2):87–94.CrossRef
39.
Luxton DD, Sirotin AP, Mishkind MC. Safety of telemental healthcare delivered to clinically unsupervised settings: a systematic review. Telemed e-Health. 2010 Jul 1;16(6):705–11.CrossRef
40.
Bruno R, Abbott JA. Australian health professionals’ attitudes toward and frequency of use of internet supported psychological interventions. Int J Forensic Ment Health. 2015;44(1–2):107–23.CrossRef
41.
Rees CS, Stone S. Therapeutic alliance in face-to-face versus videoconferenced psychotherapy. Prof Psychol Res Pract. 2005 Dec;36(6):649.CrossRef
42.
Wells M, Mitchell KJ, Finkelhor D, Becker-Blease KA. Online mental health treatment: concerns and considerations. Cyberpsychol Behav. 2007;10(3):453–9.CrossRefPubMed
43.
Jones MD, Etherage JR, Harmon SC, Okiishi JC. Acceptability and cost-effectiveness of military telehealth mental health screening. Psychol Serv. 2012;9(2):132.CrossRefPubMed
44.
Germain V, Marchand A, Bouchard S, Guay S, Drouin MS. Assessment of the therapeutic alliance in face-to-face or videoconference treatment for posttraumatic stress disorder. Cyberpsychol Behav Soc Netw. 2010;13(1):29–35.CrossRefPubMed
45.
Rosen CS, Matthieu MM, Stirman SW, Cook JM, Landes S, Bernardy NC, et al. A review of studies on the system-wide implementation of evidence-based psychotherapies for posttraumatic stress disorder in the veterans health administration. Adm Policy Ment Health Ment Health Serv Res. 2016;43(6):957–77.CrossRef
46.
Egede LE, Frueh CB, Richardson LK, Acierno R, Mauldin PD, Knapp RG, et al. Rationale and design: telepsychology service delivery for depressed elderly veterans. Trials. 2009;10(1):22.CrossRefPubMedPubMedCentral
47.
Gros DF, Morland LA, Greene CJ, Acierno R, Strachan M, Egede LE, et al. Delivery of evidence-based psychotherapy via video telehealth. J Psychopathol Behav Assess. 2013;35(4):506–21.CrossRef
48.
Morland LA, Greene CJ, Rosen C, Mauldin PD, Frueh BC. Issues in the design of a randomized noninferiority clinical trial of telemental health psychotherapy for rural combat veterans with PTSD. Contemp Clin Trials. 2009;30(6):513–22.CrossRefPubMed
49.
Jolley GM, Lawless AP, Baum FE, Hurley CJ, Fry D. Building an evidence base for community health: a review of the quality of program evaluations. Aust Health Rev. 2007;31(4):603–10.CrossRefPubMed
50.
Schwarzman J, Bauman A, Gabbe B, Rissel C, Shilton T, Smith BJ. Organizational determinants of evaluation practice in Australian prevention agencies. Health Educ Res. 2018;33(3):243–55.CrossRefPubMed
51.
van Koperen TM, Renders CM, Spierings EJ, Hendriks AM, Westerman MJ, Seidell JC, et al. Recommendations and improvements for the evaluation of integrated community-wide interventions approaches. J Obes. 2016;2016:2385698.
52.
Crowley MJ, Edelman D, McAndrew AT, Kistler S, Danus S, Webb JA, et al. Practical telemedicine for veterans with persistently poor diabetes control: a randomized pilot trial. Telemed e-Health. 2016;22(5):376–84.CrossRef
53.
Naik AD, Lawrence B, Kiefer L, Ramos K, Utech A, Masozera N, et al. Building a primary care/research partnership: lessons learned from a telehealth intervention for diabetes and depression. Fam Pract. 2014;32(2):216–23.CrossRefPubMed
54.
Stetler CB, Legro MW, Rycroft-Malone J, Bowman C, Curran G, Guihan M, et al. Role of" external facilitation" in implementation of research findings: a qualitative evaluation of facilitation experiences in the veterans health administration. Implement Sci. 2006 Dec;1(1):23.CrossRefPubMedPubMedCentral
55.
Reed C, Burr R, Melcer T. Navy telemedicine: a review of current and emerging research models. Telemed J e-Health. 2004;10(3):343–56.CrossRefPubMed
56.
Cook JM, Biyanova T, Coyne JC. Barriers to adoption of new treatments: an internet study of practicing community psychotherapists. Adm Policy Ment Health Ment Health Serv Res. 2009;36(2):83–90.CrossRef
57.
Sloan DM, Gallagher MW, Feinstein BA, Lee DJ, Pruneau GM. Efficacy of telehealth treatments for posttraumatic stress-related symptoms: a meta-analysis. Cogn Behav Ther. 2011;40(2):111–25.CrossRefPubMed
58.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629.CrossRefPubMedPubMedCentral
59.
Muir SD, de Boer K, Thomas N, Seabrook E, Nedeljkovic M, Meyer D. Videoconferencing psychotherapy in the public sector: synthesis and model for implementation. JMIR Mental Health. 2020;7(1):e14996.CrossRefPubMedPubMedCentral
60.
Bach-Mortensen AM, Lange BC, Montgomery P. Barriers and facilitators to implementing evidence-based interventions among third sector organisations: a systematic review. Implement Sci. 2018;13(1):103.CrossRefPubMedPubMedCentral
61.
Saliba V, Legido-Quigley H, Hallik R, Aaviksoo A, Car J, McKee M. Telemedicine across borders: a systematic review of factors that hinder or support implementation. Int J Med Inform. 2012;81(12):793–809.CrossRefPubMed
Metadata
Title
Barriers and facilitators of videoconferencing psychotherapy implementation in veteran mental health care environments: a systematic review
Authors
Samuel D. Muir
Kathleen de Boer
Maja Nedeljkovic
Denny Meyer
Publication date
01-12-2020
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2020
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-020-05858-3

Other articles of this Issue 1/2020

BMC Health Services Research 1/2020 Go to the issue

Research article

Barriers to accessing health care services: a qualitative study of migrant construction workers in a southwestern Indian city

Research article

Dissonances and disconnects: the life and times of community-based accountability in the National Rural Health Mission in Tamil Nadu, India

Research article

Compliance of primary and secondary care public hospitals with standard practices for reprocessing and steam sterilization of reusable medical devices in Nepal: findings from nation-wide multicenter clustered audits

Research article

How do guideline developers identify, incorporate and report patient preferences? An international cross-sectional survey

Research article

Impact of suspending minimum volume requirements for knee arthroplasty on hospitals in Germany: an uncontrolled before–after study

Research article

Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study