title: Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals?
abstract: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH).
  
  
  
  The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations.
  
  
  
  A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team.
  
  
  
  Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers' lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource.
  
  
  
  A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH's health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients.
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, Australia.
authors.forename: James
authors.identifier: 0000-0003-0998-116X
authors.initials: J
authors.lastname: Bennett-Levy
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, Australia.
authors.forename: Judy
authors.identifier: 0000-0002-9403-3393
authors.initials: J
authors.lastname: Singer
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, Australia.
authors.forename: Simon
authors.identifier: 0000-0002-9680-5123
authors.initials: S
authors.lastname: DuBois
authors.affiliation: University Centre for Rural Health, University of Sydney, Lismore, Australia.
authors.forename: Kelly
authors.identifier: 0000-0003-4464-6463
authors.initials: K
authors.lastname: Hyde
mesh_terms: D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008603:Mental Health / Q000208:ethnology*; D017216:Telemedicine / Q000379:methods*
keywords: Aboriginal and Torres Strait Islander peoples; e-mental health; health education; indigenous populations; mobile apps; professional consultation; professional supervision; service implementation