Search

BackgroundDigital mental health interventions (DMHIs) represent a promising solution to address the growing unmet mental health needs and increase access to care. Integrating DMHIs into clinical and community settings is challenging and complex. Frameworks that explore a wide range of factors, such as the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, can be useful for examining multilevel factors related to DMHI implementation efforts.ObjectiveThis paper aimed to identify the barriers to, facilitators of, and best practice recommendations for implementing DMHIs across similar organizational settings, according to the EPIS domains of inner context, outer context, innovation factors, and bridging factors.MethodsThis study stems from a large state-funded project in which 6 county behavioral health departments in California explored the use of DMHIs as part of county mental health services. Our team conducted interviews with clinical staff, peer support specialists, county leaders, project leaders, and clinic leaders using a semistructured interview guide. The development of the semistructured interview guide was informed by expert input regarding relevant inner context, outer context, innovation factors, and bridging factors in the exploration, preparation, and implementation phases of the EPIS framework. We followed a recursive 6-step process to conduct qualitative analyses using inductive and deductive components guided by the EPIS framework.ResultsOn the basis of 69 interviews, we identified 3 main themes that aligned with the EPIS framework: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Individual-level readiness referred to the extent to which clients had the necessary technological tools (eg, smartphones) and knowledge (digital literacy) to support the DMHI. Innovation-level readiness pertained to the accessibility, usefulness, safety, and fit of the DMHI. Organization- and system-level readiness concerned the extent to which providers and leadership collectively held positive views about DMHIs as well as the extent to which infrastructure (eg, staffing and payment model) was appropriate.ConclusionsThe successful implementation of DMHIs requires readiness at the individual, innovation, and organization and system levels. To improve individual-level readiness, we recommend equitable device distribution and digital literacy training. To improve innovation readiness, we recommend making DMHIs easier to use and introduce, clinically useful, and safe and adapting them to fit into the existing client needs and clinical workflow. To improve organization- and system-level readiness, we recommend supporting providers and local behavioral health departments with adequate technology and training and exploring potential system transformations (eg, integrated care model). Conceptualizing DMHIs as services allows the consideration of both the innovation characteristics of DMHIs (eg, efficacy, safety, and clinical usefulness) and the ecosystem around DMHIs, such as individual and organizational characteristics (inner context), purveyors and intermediaries (bridging factor), client characteristics (outer context), as well as the fit between the innovation and implementation settings (innovation factor).

Severe infections of parsley plants and soil infestations with Meloidogyne javanica during an autumn surveys for the pathogenic root-knot nematode infestations were found in Monopoli at Bari province in Southern Italy. This unusual severe infection of parsley, considered a winter crop, was possibly instigated by a very warm autumn from the previous year. Nematodes were extracted from soil samples according to the Coolen’s method. Morphological analysis (based on stylet length, tail length and shape, adult females perineal pattern, excretory pore position and Ep/stylet ratio) and molecular studies were used for the nematode characterization and identification. In the soil of infested area a severely deformed root systems were observed, showing a galling rate = 2.5 - 4 (scale 0-5) and a soil nematode population densities ranging from 350 to 2,730 eggs and J2 per 5 g of fresh root. M. javanica attack on parsley roots is a limiting factor for plant growth. Considering that curly-leaf parsley varieties resistant to the nematodes are not yet available control strategies must be focused on reduction of soil infestation level below tolerance limit of the target nematode species. Due to the higher cost and reduced availability of fumigant and non-fumigant nematicides, soil solarization, organic amendments or biological control approaches should be preferably used as alternatives.