Barriers to Implementation of an Internet-Based Intervention in Primary Care to Prevent Adolescent Depression in Urban Ethnic Minority: Mixed Methods Analysis

Research Objective: This study determines barriers to implementation and sustainability of a mental health preventive intervention in an urban ethnic minority adolescent population.

Methods: A mixed-method analysis was undertaken to identify factors contributing to successful implementation of Chicago Urban Resiliency Building (CURB), an Internet-based depression prevention intervention for urban African-American and Latino adolescents. First, individual interviews of nurses and medical assistants at the study sites were conducted using open-ended questions.  Interviews were analyzed using thematic analysis. Second, study physicians and nurses were surveyed to assess their knowledge of depression and their evaluation of components of the CURB intervention.

Results:Qualitative findings highlighted the impact of the taboo nature of mental illness on study participation, the lack of education and community resources, and study staff-to-nursing staff communication as factors in successful implementation. Quantitative findings revealed that although 100% (n=17) of healthcare professionals and 78% (n=10) of physicians would like to use new types of therapies/interventions to help their clients to some extent, only 27.77% (n=18) of healthcare professionals and 11.11% (n=9) of physicians agreed that they would implement the entire CURB program.

Conclusions: These findings demonstrate that although medical staff members valued the CURB intervention in their community, they had difficulties with the implementation of it at their respective sites for several reasons. Study results provide insight into some existing barriers that can impede effective implementation and sustainability of interventions similar to CURB in an urban primary care setting.