title: Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers.
abstract: BACKGROUND
  Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings.
  
  
  OBJECTIVE
  In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings.
  
  
  METHODS
  Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation.
  
  
  RESULTS
  Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients' mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation.
  
  
  CONCLUSIONS
  The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches.
authors.affiliation: Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States. sarah.e.lord@dartmouth.edu.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0001-6164-5476
authors.initials: S
authors.lastname: Lord
authors.forename: Sarah K
authors.identifier: http://orcid.org/0000-0003-2246-2970
authors.initials: SK
authors.lastname: Moore
authors.forename: Alex
authors.identifier: http://orcid.org/0000-0002-3471-3725
authors.initials: A
authors.lastname: Ramsey
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-9496-178X
authors.initials: S
authors.lastname: Dinauer
authors.forename: Kimberly
authors.identifier: http://orcid.org/0000-0002-2179-5688
authors.initials: K
authors.lastname: Johnson
keywords: mobile apps; relapse prevention; substance abuse