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IntroductionDepression has a significant impact on individuals and society, which is why preventive measures are important. Farmers represent an occupational group exposed to many risk factors for depression. The potential of guided, tailored internet-based interventions and a personalized telephone coaching is evaluated in a German project of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG). While user outcomes are promising, not much is known about actual routine care use and implementation of the two digital health interventions. This study evaluates the implementation from the perspective of social insurance employees to understand determinants influencing the uptake and implementation of digital interventions to prevent depression in farmers.MethodsThe data collection and analysis are based on the Consolidated Framework for Implementation Research (CFIR). Health care workers (n = 86) and implementers (n = 7) completed online surveys and/or participated in focus groups. The surveys consisted of validated questionnaires used in implementation research, adapted items from the CFIR guide or from other CFIR studies. In addition, we used reporting data to map implementation based on selected CFIR constructs.ResultsWithin the five CFIR dimensions, many facilitating factors emerged in relation to intervention characteristics (e.g., relative advantage compared to existing services, evidence and quality) and the inner setting of the SVLFG (e.g., tension for change, compatibility with values and existing working processes). In addition, barriers to implementation were identified in relation to the outer setting (patient needs and resources), inner setting (e.g., available resources, access to knowledge and information) and characteristics of individuals (e.g., self-efficacy). With regard to the implementation process, facilitating factors (formal implementation leaders) as well as hindering factors (reflecting and evaluating) were identified.DiscussionThe findings shed light on the implementation of two digital prevention services in an agricultural setting. While both offerings seem to be widely accepted by health care workers, the results also point to revealed barriers and contribute to recommendations for further service implementation. For instance, special attention should be given to “patient needs and resources” by raising awareness of mental health issues among the target population as well as barriers regarding the inner setting.Clinical Trial RegistrationGerman Clinical Trial Registration: [DRKS00017078]. Registered on 18.04.2019

The NoMAD questionnaire is a measurement instrument to assess normalisation as an implementation outcome. The original English version of the questionnaire was developed by Finch and colleagues (2018).The NoMAD has been translated into several languages. This project brings NoMAD data from German health care innovation implementation projects together to derive a common German Normalization Process Theory Measure (G-NoMAD).

Introduction: Chronic pain is highly prevalent, associated with substantial personal and economic burdens, and increased risk for mental disorders. Individuals in green professions (agriculturists, horticulturists, foresters) show increased prevalence of chronic pain and other risk factors for mental disorders. Available healthcare services in rural areas are limited. Acceptance towards face-to-face therapy is low. Internet and mobile-based interventions (IMIs) based on Acceptance and Commitment Therapy (ACT) might be a promising alternative for this population and may enable effective treatment of chronic pain. The present study aims to evaluate the clinical and cost-effectiveness of an ACT-based IMI for chronic pain in green professions in comparison with enhanced treatment as usual (TAU+). Methods and analysis: A two-armed pragmatic randomised controlled trial will be conducted. Two hundred eighty-six participants will be randomised and allocated to either an intervention or TAU+ group. Entrepreneurs in green professions, collaborating spouses, family members and pensioners with chronic pain are eligible for inclusion. The intervention group receives an internet-based intervention based on ACT (7 modules, over 7 weeks) guided by a trained e-coach to support adherence (eg, by positive reinforcement). Primary outcome is pain interference (Multidimensional Pain Interference scale; MPI) at 9 weeks post-randomisation. Secondary outcomes are depression severity (Quick Inventory Depressive Symptomology; QIDS-SR16), incidence of major depressive disorder, quality of life (Assessment of Quality of Life; AQoL-8D) and possible side effects associated with the treatment (Inventory for the Assessment of Negative Effects of Psychotherapy; INEP). Psychological flexibility (Chronic Pain Acceptance Questionnaire, Committed Action Questionnaire, Cognitive Fusion Questionnaire) will be evaluated as a potential mediator of the treatment effect. Furthermore, mediation, moderation and health-economic analyses from a societal perspective will be performed. Outcomes will be measured using online self-report questionnaires at baseline, 9-week, 6-month, 12-month, 24-month and 36-month follow-ups. Ethics and dissemination: This study was approved by the Ethics Committee of the University of Ulm, Germany (file no. 453/17-FSt/Sta; 22 February 2018). Results will be submitted for publication in peer-reviewed journals and presented at conferences. Trial registration number: German Clinical Trial Registration: DRKS00014619. Registered on 16 April 2018., publishedVersion

Supplemental material, sj-docx-1-jtt-10.1177_1357633X221106027 for Janika Thielecke, Claudia Buntrock, Ingrid Titzler, Lina Braun, Johanna Freund, Matthias Berking, Harald Baumeister and David D. Ebert by Telephone coaching for the prevention of depression in depression in farmers: Results from a pragmatic from a pragmatic randomized controlled trial in Journal of Telemedicine and Telecare

Supplemental material, sj-docx-1-jtt-10.1177_1357633X221106027 for Janika Thielecke, Claudia Buntrock, Ingrid Titzler, Lina Braun, Johanna Freund, Matthias Berking, Harald Baumeister and David D. Ebert by Telephone coaching for the prevention of depression in depression in farmers: Results from a pragmatic from a pragmatic randomized controlled trial in Journal of Telemedicine and Telecare

Additional file 1. Standards for Reporting Implementation Studies: the StaRI checklist for completion

Additional file 3. Description of the personalised tele-based coaching (IVPNetworks)

Additional file 2. Description of the GET.ON online health trainings