Figure 2 - available via license: Creative Commons Attribution 4.0 International
Content may be subject to copyright.
Partner in Balance business model canvas. The nine elements help describe a firm's or product's structure by mapping its value proposition (middle element), infrastructure, (top left three elements), customers (top right three elements), and finances (bottom two elements).
Source publication
Background:
Given the increasing use of digital interventions in health care, understanding how best to implement them is crucial. However, evidence on how to implement new academically developed interventions in complex health care environments is lacking. This case study offers an example of how to develop a theory-based implementation plan for...
Context in source publication
Context 1
... strategies were formulated to streamline Partner in Balance administration and project management (domain "process"), as well as to expand and disseminate its use (domain "outer setting"). Christie et al JMIR AGING Figure 2 presents a depiction of how sustainable implementation could hypothetically be achieved based on insights from the previous implementation phases and the stakeholder interviews. Partner in Balance has added value for caregivers, health care organizations, and municipalities ("value propositions"), and together with the "channels" and "customer relationships," this helped the team form a better view of the intervention's desirability to potential customers. ...
Citations
... A clear example of such a legal framework is the mHealthBelgium validation pyramid in Belgium, which consists of 3 levels: the first level determines the basic requirements, such as the need for Conformité Européene marking, which indicates that a product adheres to the European Union health, safety, and environmental protection standards; the second level is designed to ensure interoperability and connectivity with the broader health informatics system; and the third level regulates the funding of digital health apps by the National Institute of Health and Disability Insurance, which is acquired after a digital health app has passed the clinical review process [224]. In terms of evidence requirements, establishing different evidence tiers to distinguish digital therapeutics from other types of digital health applications (eg, those aimed at communication or administrative functions) was considered vital [5,12,93,123,157,161,203,212,224,231,265]. In practice, this is already observed in the United Kingdom, where the National Institute of Health and Care Excellence (NICE) has devised a 3-level evidence framework that distinguishes (1) digital tools with no patient-relevant outcomes, (2) digital tools that aid in communication and education, and (3) digital therapeutics that are designed to generate and deliver medical interventions [5,224,265]. ...
... The financing model for digital therapeutics was considered highly influential with respect to their uptake in the health care system [12,65,81,87,127,139,162,170,203,205,212,229,230,232]. In the included literature, eleven distinct financing models for digital therapeutics were identified: (1) periodical subscription (Germany and the United Kingdom), (2) 1-time license fee (Germany), (3) part of bundle packages with other (nondigital) therapeutics (the United States), (4) financing through (innovation) grants, subsidies, or fundraisers (the Netherlands and Germany), (5) sponsor-based agreements in which the digital therapeutic is sponsored by a large platform or institution (eg, Alzheimer Netherlands sponsors a digital health intervention for Dutch patients with dementia at no charge to caregivers), (6) public-private partnerships (eg, a private actor helps develop the local digital health infrastructure on the condition that their digital therapeutic is added in the local health care inventory), (7) inclusion in data plans, (8) performance-based contracts (the United States), (9) risk-benefit sharing contracts (the United States), (10) part of employment benefit plans, and (11) pay-as-you-go arrangements [12,65,86,87,127,143,162,170,203,205,212,229,230,232,239]. ...
... The financing model for digital therapeutics was considered highly influential with respect to their uptake in the health care system [12,65,81,87,127,139,162,170,203,205,212,229,230,232]. In the included literature, eleven distinct financing models for digital therapeutics were identified: (1) periodical subscription (Germany and the United Kingdom), (2) 1-time license fee (Germany), (3) part of bundle packages with other (nondigital) therapeutics (the United States), (4) financing through (innovation) grants, subsidies, or fundraisers (the Netherlands and Germany), (5) sponsor-based agreements in which the digital therapeutic is sponsored by a large platform or institution (eg, Alzheimer Netherlands sponsors a digital health intervention for Dutch patients with dementia at no charge to caregivers), (6) public-private partnerships (eg, a private actor helps develop the local digital health infrastructure on the condition that their digital therapeutic is added in the local health care inventory), (7) inclusion in data plans, (8) performance-based contracts (the United States), (9) risk-benefit sharing contracts (the United States), (10) part of employment benefit plans, and (11) pay-as-you-go arrangements [12,65,86,87,127,143,162,170,203,205,212,229,230,232,239]. In addition, some form of reimbursement parity (eg, service or payment parity) with traditional biomedical therapeutics was considered important [68,70,119,123,153,169,206,238]. ...
Background:
Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products.
Objective:
In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals.
Methods:
A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis.
Results:
We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure.
Conclusions:
The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
... Faculty members experience barriers such as shortage of time to work with technologies, lack of funding for new technologies and upgrades of existing technologies, need to learn, need for access to specialists and a support system, and need for recognition. This is consistent with prior studies (Jouparinejad, et al., 2020;Jiao et al., 2020;Christie, et al., 2020;Tahani et al., 2020), that outlined some barriers in advancing to using technology to include lack of funding for new technologies and upgrades of existing technologies, need to learn new technologies, need for specialists. ...
Faculty members are interested in the impact of technology on education and are supported by regulatory bodies promoting technology standards, recruiters seeking teachers with technology skills, legislated technology in the curriculum, and a demand for a technically skilled workforce. In response to the interest in technology in education and faculty members incorporating technology in their research, this study was carried out to assess faculty needs concerning technology in the educational delivery system of Nigerian universities. The study adopted a qualitative approach to investigate the research needs of faculties concerning technology. This qualitative study randomly selected a convenience sample of 100 faculty and administrators in the faculty of education of 12 universities in Nigeria across several states. Using focus-group discussion sessions and interviews, the researchers met with 100 participants in groups of 10 to 15 each session. Data were transcribed and entered into a database for analysis. The use of technology in research such as searching (search engines), data gathering, analysis, and publishing was discussed before explaining the needs and concerns of faculties with regards to technology. The study shows that there is a need for government and universities to adopt and institutionalize e-learning which will help to close the gap in technology
... In Partner in Balance, caregivers watch video vignettes, read background information, make self-reflection assignments and set goals for the future together with a personal coach. Currently, efforts are made to implement the intervention (Christie et al., 2020). The web-based format showed to be a good fit for caregivers of persons with YOD as they are more likely to participate due to the online nature, compared to older caregivers . ...
... Furthermore, an implementation strategy is required to sustain the Partner in Balance intervention because less than 3% of the dementia care and support interventions are implemented in daily practice (Gitlin et al., 2015). Therefore, the development of a business-model including a license agreement is underway to ensure that healthcare professionals can structurally work with the intervention (Christie et al., 2020). To facilitate the development of the business-model, a cost-effectiveness study seems a direction for the future to obtain insight in long-term benefits of the Partner in Balance intervention such as prevention of psychological problems in caregivers or delayed institutionalization of persons with dementia. ...
Young-onset dementia (YOD) poses specific challenges for caregivers involved. However, most available support does not address their specific needs. Previously, the web-based Partner in Balance intervention showed promising results and facilitated role adaptation in dementia caregivers. Although the web-based format proved a good fit for YOD caregivers, the evaluation showed a need for tailored content on YOD. Therefore, new content was iteratively developed respectively for spouses and other family caregivers of persons with YOD. This study evaluates how caregivers perceived the tailored content.
Methods
A pre-post design was used to prospectively evaluate how end-users perceived two tailored versions of the Partner in Balance intervention, one for spouses and one for other family members of people with YOD. After the intervention, participants were interviewed for approximately 60 min in-person or by telephone using the Program Participation Questionnaire. A qualitative deductive content analysis was used to evaluate (1) usability, (2) feasibility and acceptability, (3) perceptions on intervention content. To evaluate if the intervention facilitated role adaptation, preliminary effects were examined using pre-post questionnaires on self-efficacy, mastery, stress, anxiety and depression.
Results
Spouses (n = 11) and other family members (n = 14) both positively evaluated the tailored content on YOD and valued that the web-based approach could easily be integrated in daily life. Participants perceived the intervention as usable, feasible and acceptable. Participants valued the recognizability of the content. Goal-setting helped participants to translate the intervention to daily life, although for some participants setting goals was difficult. Caregivers of persons with frontotemporal dementia suggested incorporating specific content to further increase recognizability. After participation, participants felt better equipped for the caregiving role. In line with previously demonstrated effects on generic modules of Partner in Balance, the tailored version increased levels of self-efficacy in the group of other family caregivers, t(12) = 3.37, p = .006.
Conclusion
The tailored Partner in Balance intervention was positively evaluated by YOD caregivers. Offering participants more guidance on goal-setting and adding content about frontotemporal dementia may facilitate implementation.
... In the Netherlands, healthcare organizations receive a budget per patient and can partly allocate this to caregiver support. Therefore, a business model for sustainable implementation was developed enabling healthcare organizations to license Partner in Balance per caregiver (Christie et al., 2020). The non-profit license is used to cover expenses for website maintenance and technological support. ...
Frontotemporal dementia (FTD) typically starts before the age of 65 years, and symptoms differ from other dementias (e.g. Alzheimer's dementia). Spouses are often caregiver and experience difficulty coping with the profound changes in personality and behavior accompanying FTD. Most interventions available to these spouses do not match their need for tailored and flexible psychosocial support. Therefore, tailored content for spouses of persons with FTD was recently incorporated in the proven effective and web-based Partner in Balance intervention.
Methods
This feasibility study prospectively evaluated the tailored Partner in Balance content for spouses of persons with FTD. Spouses followed the 8-week intervention, and qualitative and quantitative measures were used to evaluate expectations and barriers prior to participation and aspects of usability, feasibility, and acceptability of content. Additionally, effects were explored regarding caregiver self-efficacy, sense of mastery, stress, depression and anxiety.
Results
Twenty-seven spouses caring for a spouse with FTD at home started the intervention. Eventually, 20 completed the intervention (74.1%). Partner in Balance matched the expectations of participating spouses and helped them to find a better balance between caregiving and personal life, acquire more peace of mind, and facilitated coping with behavioral and communication difficulties. Before participation, time restraints were identified as a potential barrier, but afterwards spouses positively evaluated the flexibility of the web-based approach that allowed them to participate at a convenient time and place. They valued the recognizability of the videos and narrative stories on FTD. Post-intervention, spouses qualitatively felt more confident, more at ease, and strengthened as a caregiver. Quantitatively, levels of self-efficacy, anxiety and depression significantly improved.
Conclusions
Partner in Balance is a usable, feasible, and acceptable intervention for spouses caring for a spouse with FTD at home. Healthcare organizations could consider adopting Partner in Balance in their daily practice to offer flexible and tailored support to spouses.
... Although studies demonstrate the effectiveness and benefits of digital interventions, the interventions often remain at a low implementation readiness level [31]. Even though there are already considerations on how to achieve sustainable implementations, these are elaborated only on theoretical examples [32]. The need for digital interventions in practice was reaffirmed in a survey from 2019 among service providers in the dementia care landscape, which found a gap between digital and nondigital dementia services and interventions [13]. ...
The benefits of eHealth interventions for people with dementia and their informal caregivers have been demonstrated in several studies. In times of contact restrictions, digital solutions have become increasingly important, especially for people with dementia and their mostly elderly caregiving relatives, which are at increased risk of severe illness from COVID-19. As in many other health areas, there is a lack of digital interventions in the dementia landscape that are successfully implemented (i.e., put into practice), especially digital interventions that are scientifically evaluated. Evaluated and proven effective digital interventions exist, but these often do not find their way from research into practice and stay on low-level implementation readiness. Within the project digiDEM Bayern, a digital platform with digital services and interventions for people affected by dementia (people with dementia, caregivers, volunteers and interested citizens) is established. As one digital intervention for informal caregivers, the ‘Angehörigenampel’ (caregivers’ traffic-light) was developed, which is able to assess the physical and psychological burden of caregivers. This can help to counteract the health effects of caregiving burden early on before it is too late. The development of the digital intervention as a WordPress-plugin was kept generic so that it can easily be adapted to other languages on further websites. The ‘intervention as a plugin’ approach demonstrates an easy and flexible way of deploying eHealth interventions to other service providers, especially from other countries. The implementation barriers for other service providers are low enough for them to be able to easily integrate the eHealth intervention on their website, enabling more caregivers to benefit from the disseminated eHealth intervention.
Introduction
Informal caregivers offer continuous unpaid support to loved ones who are unable to live independently. Providing care can be a very burdensome commitment, that heavily impacts informal caregivers’ mental health. eMental health is a possible, yet challenging, solution to improve caregivers’ mental health and their overall experience of caregiving. In fact, eMental health technologies often face challenges of implementation. The present work gathers knowledge on how to best deal with these challenges by collecting testimonies of implementation experts of eight eMental health technologies for informal caregivers with the aim of comparing them and extracting lessons learned.
Methods
For this multiple case study, technologies were selected (through informal suggestions and independent search) according to the following inclusion criteria: they were intended for informal caregivers as main user group, were aimed at improving informal caregivers’ mental wellbeing and caregiving experience and were available and running in real life settings in Europe. Ten interviews were conducted (two pilots and eight included cases). The interviewees were asked to provide a description of the technology and its aims and their implementation approach, method and frameworks used. Finally, determinants of implementation, the influence of the Covid-19 pandemic on implementation processes and lessons learned were investigated.
Results
The results highlight key differences between technologies developed within academia and the industry regarding efficacy testing and use and use and choice of frameworks. Also, similarities in terms of recognized barriers such as financing are illustrated.
Discussion
Possible ways to overcome main barriers and examples of best practices, such as structuring a business model and discussing tool maintenance and long-term hosting in advance, are discussed.
Background:
Informal caregivers commonly experience mental health difficulties related to their caregiving role. E-mental health interventions provide mental health support in a format that may be more accessible for informal caregivers. However, e-mental health interventions are seldom implemented into real-world practice.
Objective:
The overall aim of this mixed-methods systematic review was to examine factors associated with the effectiveness and implementation of e-mental health interventions for informal caregivers of adults with chronic diseases. To achieve this aim, two approaches were adopted: (1) combinations of implementation and/or intervention characteristics sufficient for intervention effectiveness were explored using a qualitative comparative analysis; and (2) barriers and facilitators to the implementation of e-mental health interventions for informal caregivers were explored using a thematic synthesis.
Methods:
Relevant studies published from January 1, 2007 to July 6, 2022 were identified by systematically searching six electronic databases, clinical trial registries, and various secondary search strategies. Studies were included if they reported on the effectiveness or implementation of e-mental health interventions for informal caregivers of adults with cancer, chronic obstructive pulmonary disease, dementia, diabetes, heart disease, or stroke. Randomized controlled trials reporting on caregivers' mental health outcomes were included in a crisp-set qualitative comparative analysis. Randomized controlled trials were assessed for bias using the Risk of Bias 2.0 tool, and for how pragmatic or explanatory their trial design was using the PRagmatic Explanatory Continuum Indicator Summary 2 (PRECIS-2) tool. Studies of any design reporting on implementation were included in a thematic synthesis using the Consolidated Framework for Implementation Research (CFIR) to identify barriers and facilitators to implementation.
Results:
53 reports, representing 29 interventions, were included in the review. The majority of interventions (93%) focused on informal cancer or dementia caregivers. 14 reports were included in the qualitative comparative analysis with conditions including the presence of peer or professional support, and key persuasive design features explored. Low consistency and coverage prevented the determination of condition sets sufficient for intervention effectiveness. 44 reports were included in the thematic synthesis. 152 barriers and facilitators were identified, with the majority related to the intervention and individual (informal caregiver) characteristic domains of the CFIR. Implementation barriers and facilitators at the inner (e.g. organizational culture) and outer setting (e.g. external policies and resources) domains are largely unexplored.
Conclusions:
E-mental health interventions for informal caregivers tend to be well-designed and easy to use, with a number of barriers and facilitators to implementation identified related to the intervention and individual user characteristics. Future work should focus on exploring the views of stakeholders involved in implementation to determine barriers or facilitators to implementing e-mental health interventions for informal caregivers, taking into consideration inner and outer setting barriers and facilitators.
Clinicaltrial:
Prospero CRD42020155727.
International registered report:
RR2-10.1136/bmjopen-2019-035406.
Objectives. Digital health interventions enable services to support people living with dementia and Mild Cognitive Impairment (MCI) remotely. This literature review gathers evidence on the effectiveness of digital health interventions on physical, cognitive, behavioural and psychological outcomes, and Activities of Daily Living in people living with dementia and MCI.
Methods/Design. Searches, using nine databases, were run in November 2021. Two authors carried out study selection/appraisal using the Critical Appraisal Skills Programme checklist. Study characteristics were extracted through the Cochrane handbook for systematic reviews of interventions data extraction form. Data on digital health interventions were extracted through the template for intervention description and replication (TIDieR) checklist and guide. Intervention effectiveness was determined through effect sizes. Meta-analyses were performed to pool data on intervention effectiveness.
Results. Twenty studies were included in the review, with a diverse range of interventions, modes of delivery, activities, duration, length, frequency, and intensity. Compared to controls, the interventions produced a moderate effect on cognitive abilities (SMD = 0.36; 95% CI = -0.03 – 0.76; I2 = 61%), and a negative moderate effect on basic ADLs (SMD = -0.40; 95% CI = -0.86 – 0.05; I2 = 69%). Stepping exergames generated the largest effect sizes on physical and cognitive abilities. Supervised training produced larger effect sizes than unsupervised interventions.
Conclusion. Supervised intervention delivery is linked to greatest benefits. A mix of remote and face-to-face delivery could maximise benefits and optimise costs. Accessibility, acceptability and sustainability of digital interventions for end-users must be pre-requisites for the development of future successful services.
