Hermes EDA, Burrone L, Heapy A, et al. (2019). Beliefs and attitudes about the dissemination and implementation of internet-based self-care programs in a large integrated healthcare system. Administration and Policy in Mental Health and Mental Health Services Research. 10.1007/s10488-018-0913-7

Researchers interviewed providers (n=12) and administrators or policy makers (n=8) from 10 Veterans Health Administration (VHA) programs to explore determinants of dissemination and implementation of digital health. Interviews were guided by the Unified Theory of Acceptance and Use of Technology. Researchers thematically coded interview transcripts and identified 8 distinct themes. All participants noted that current healthcare systems, including clinical norms and workflows do not facilitate use of digital health. Nineteen participants (95%) mentioned gaps in provider understanding of digital health and when or how to use digital health in practice, inadequate digital infrastructures (e.g., VHA internet systems, patient technology access), and the influence of support from leadership. Eighteen (90%) participants mentioned a need for organizational dissemination and implementation strategies (e.g., provider training, consumer advertising), specifically highlighting the need for a learning management system that allows providers and patients to access digital health programs. Fourteen participants (70%) mentioned that health system strategic priorities need to promote dissemination and implementation of digital health and that current strategies that may complement digital health implementation (e.g., measurement-based care, electronic health record development) also compete for funding. Twelve participants (60%) discussed how organizational structures and an emphasis on specialty care rather than integrated care can result in siloed information between central administration, specialty care facilities, and primary care facilities. Finally, 11 (55%) participants discussed regulations and policies relating to privacy and security (e.g. against the transmission of patient-reported information to health records) reducing the utility of digital health.