Douglas S, Bovendeerd B, van Sonsbeek M, Manns M, Milling XP, Tyler K, Bala N, Satterthwaite T, Hovland RT, Amble I, Atzil-Slonim D, Barkham M, de Jong K, Kendrick T, Nordberg SS, Lutz W, Rubel JA, Skjulsvik T, and Moltu C
Background: Progress feedback, also known as measurement-based care (MBC), is the routine collection of patient-reported measures to monitor treatment progress and inform clinical decision-making. Although a key ingredient to improving mental health care, sustained use of progress feedback is poor. Integration into everyday workflow is challenging, impacted by a complex interrelated set of factors across patient, clinician, organizational, and health system levels. This study describes the development of a qualitative coding scheme for progress feedback implementation that accounts for the dynamic nature of barriers and facilitators across multiple levels of use in mental health settings. Such a coding scheme may help promote a common language for researchers and implementers to better identify barriers that need to be addressed, as well as facilitators that could be supported in different settings and contexts., Methods: Clinical staff, managers, and leaders from two Dutch, three Norwegian, and four mental health organizations in the USA participated in semi-structured interviews on how intra- and extra-organizational characteristics interact to influence the use of progress feedback in clinical practice, supervision, and program improvement. Interviews were conducted in the local language, then translated to English prior to qualitative coding., Results: A team-based consensus coding approach was used to refine an a priori expert-informed and literature-based qualitative scheme to incorporate new understandings and constructs as they emerged. First, this hermeneutic approach resulted in a multi-level coding scheme with nine superordinate categories and 30 subcategories. Second-order axial coding established contextually sensitive categories for barriers and facilitators., Conclusions: The primary outcome is an empirically derived multi-level qualitative coding scheme that can be used in progress feedback implementation research and development. It can be applied across contexts and settings, with expectations for ongoing refinement. Suggestions for future research and application in practice settings are provided. Supplementary materials include the coding scheme and a detailed playbook., Competing Interests: Declarations: Vanderbilt University and Susan Douglas receive compensation related to the Peabody Treatment Progress Battery; and Susan Douglas has a financial relationship with MIRAH, and both are Measurement-Based Care (MBC) tools. The author declares a potential conflict of interest. There is a management plan in place at Vanderbilt University to monitor that this potential conflict does not jeopardize the objectivity of Dr. Douglas’ research. Christian Moltu and Samuel S. Nordberg own equity in a Norwegian private company that markets and sells a clinical feedback technology based on the Norse Feedback methodology. The authors declare a potential conflict of interest. There is a management plan in place at Førde Hospital Trust to monitor that this potential conflict does not jeopardize the objectivity of Dr. Moltu’s research. Michael Barkham was the Principal Investigator in the development of the CORE Outcome Measure (1995-98) which has been used in feedback research. He is a CORE System Trustee but receives no financial benefit from the use of the measure., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)