Therapist experiences with implementation of blended (iCBT and face-to-face) treatment of alcohol use disorder (Blend-A): mixed methods study.

Introduction: Though therapists' experiences of offering internet-based treatment for alcohol use disorder have been examined in previous studies, the process of implementing blended internet-based and face-to-face treatment has so far not been studied. This study aims to investigate therapist experiences during implementation of blended face-to-face and internet-based treatment for alcohol use disorder.

Methods: The study employed a mixed methods design, more specifically a triangulation design with a convergence model. Quantitative data using NoMAD were collected in two waves, involving 48 therapists at the 1st wave and 18 at the 2nd wave. Qualitative interviews were conducted six months after the 2nd wave. Eleven therapists participated in focus group interviews for qualitative data collection, and an additional three semi-structured interviews were recorded, transcribed, and subsequently analyzed using the Normalization Process Theory.

Results: We found that the therapists generally had a positive experience with implementing blended face-to-face and internet-based treatment for alcohol use disorder and that their motivation to implement increased. The therapists found it challenging to find coherence between digital and face-to-face treatment in the beginning of the implementation process; however, later in the process, they experienced sense-making. Furthermore, the therapists reflected on their own practice regarding the intervention, both in terms of the amount of time spent on the platform and how it was received by the patients. Moreover, the therapists perceived that if they had all been engaged in the intervention to begin with, it would have led to a shared understanding of the platform and collective ownership. Finally, through each of their individual experiences, the therapists had gained adequate knowledge of the digital intervention; thus, had come to each of their individual perceptions of the best way to incorporate the digital technology in their workday.

Discussion: Familiarity and perceived normalcy of using Blend-A did not change significantly over time, but the cognitive attitude to Blend-A did. The therapists were optimistic about the possible use of a blended treatment format, and that this had a positive effect on the implementation process. Over time, the therapists developed confidence in benefits and disadvantages of a blended format.