{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:50:27Z","timestamp":1753890627268,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T00:00:00Z","timestamp":1739404800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the effectiveness and potential of digital mental health interventions (DMHIs) in routine care, their uptake remains low. In Germany, digital mental health applications (DiGA), certified as low-risk medical devices, can be prescribed by healthcare professionals (HCPs) to support the treatment of mental health conditions. The objective of this proof-of-concept study was to evaluate the feasibility of using the Multiphase Optimization Strategy (MOST) framework when assessing implementation strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We tested the feasibility of the MOST by employing a 2<jats:sup>4<\/jats:sup> exploratory retrospective factorial design on existing data. We assessed the impact of the implementation strategies (calls, online meetings, arranged and walk-in on-site meetings) individually and in combination, on the number of DiGA activations in a non-randomized design. Data from <jats:italic>N<\/jats:italic>\u2009=\u200924,817 HCPs were analyzed using non-parametric tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results primarily demonstrated the feasibility of applying the MOST to a non-randomized setting. Furthermore, analyses indicated significant differences between the groups of HCPs receiving specific implementation strategies [<jats:italic>\u03c7<jats:sup>2<\/jats:sup><\/jats:italic> (15)\u2009=\u20091,665.2, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u2009.001, <jats:italic>\u025b<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u20090.07]. Combinations of implementation strategies were associated with significantly more DiGA activations. For example, combinations of arranged and walk-in on-site meetings showed higher activation numbers (e.g., <jats:italic>Z<\/jats:italic>\u2009=\u200910.60, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001, <jats:italic>\u03c7<jats:sup>2<\/jats:sup><\/jats:italic>\u2009=\u20091,665.24) compared to those receiving other strategies. We found a moderate positive correlation between the number of strategies used and activation numbers (<jats:italic>r<\/jats:italic>\u2009=\u20090.30, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and limitations<\/jats:title><jats:p>These findings support the feasibility of using the MOST to evaluate implementation strategies in digital mental health care. It also gives an exploratory example on how to conduct factorial designs with information on implementation strategies. However, limitations such as non-random assignment, underpowered analysis, and varying approaches to HCPs affect the robustness and generalizability of the results. Despite these limitations, the results demonstrate that the MOST is a viable method for assessing implementation strategies, highlighting the importance of planning and optimizing strategies before their implementation. By addressing these limitations, healthcare providers and policymakers can enhance the adoption of digital health innovations, ultimately improving access to mental health care for a broader population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2025.1509415","type":"journal-article","created":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T07:08:22Z","timestamp":1739430502000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the feasibility of using the Multiphase Optimization Strategy framework to assess implementation strategies for digital mental health applications activations: a proof of concept study"],"prefix":"10.3389","volume":"7","author":[{"given":"Ayla","family":"Aydin","sequence":"first","affiliation":[]},{"given":"Wouter","family":"van Ballegooijen","sequence":"additional","affiliation":[]},{"given":"Ilja","family":"Cornelisz","sequence":"additional","affiliation":[]},{"given":"Anne","family":"Etzelmueller","sequence":"additional","affiliation":[]}],"member":"1965","published-online":{"date-parts":[[2025,2,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1002\/wps.20038","article-title":"The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons","volume":"12","author":"Cuijpers","year":"2013","journal-title":"World Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1176\/appi.ajp.2015.15091141","article-title":"Interpersonal psychotherapy for mental health problems: a comprehensive meta-analysis","volume":"173","author":"Cuijpers","year":"2016","journal-title":"Am J Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1002\/da.22728","article-title":"Cognitive behavioral therapy for anxiety and related disorders: a meta-analysis of randomized placebo-controlled trials","volume":"35","author":"Carpenter","year":"2018","journal-title":"Depress Anxiety"},{"key":"B4","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1002\/wps.20388","article-title":"Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries","volume":"16","author":"Jorm","year":"2017","journal-title":"World Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e1003901","DOI":"10.1371\/journal.pmed.1003901","article-title":"The global gap in treatment coverage for major depressive disorder in 84 countries from 2000 to 2019: a systematic review and Bayesian meta-regression analysis","volume":"19","author":"Moitra","year":"2022","journal-title":"PLoS Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"101675","DOI":"10.1016\/j.eclinm.2022.101675","article-title":"Quantifying the global burden of mental disorders and their economic value","volume":"54","author":"Arias","year":"2022","journal-title":"eClinicalMedicine"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e24387","DOI":"10.2196\/24387","article-title":"Barriers to and facilitators of user engagement with digital mental health interventions: systematic review","volume":"23","author":"Borghouts","year":"2021","journal-title":"J Med Internet Res"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e1782","DOI":"10.1002\/mpr.1782","article-title":"Barriers of mental health treatment utilization among first-year college students: first cross-national results from the WHO world mental health international college student initiative","volume":"28","author":"Ebert","year":"2019","journal-title":"Int J Methods Psychiatr Res"},{"key":"B9","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1177\/0004867415582054","article-title":"Developing a roadmap for the translation of e-mental health services for depression","volume":"49","author":"Batterham","year":"2015","journal-title":"Aust N Z J Psychiatry"},{"year":"2020","key":"B10","article-title":"Driving the digital transformation of Germany\u2019s healthcare system for the good of patients, Federal Ministry of Health"},{"year":"2021","key":"B11","article-title":"CE marking, European Commision"},{"year":"2024","key":"B12","article-title":"Digitale Gesundheitsanwendungen (DIGA), Bundesministerium f\u00fcr Gesundheit"},{"year":"2021","key":"B13","article-title":"DiGA: Apps on prescription, gesund.bund.de"},{"year":"2024","key":"B14","article-title":"Stress und Burnout | Online-Kurs von HelloBetter, HelloBetter"},{"key":"B15","doi-asserted-by":"publisher","first-page":"776","DOI":"10.2337\/dc14-1728","article-title":"Efficacy of a web-based intervention with mobile phone support in treating depressive symptoms in adults with type 1 and type 2 diabetes: a randomized controlled trial","volume":"38","author":"Nobis","year":"2015","journal-title":"Diabetes Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e13346","DOI":"10.2196\/13346","article-title":"Efficacy of a self-help web-based recovery training in improving sleep in workers: randomized controlled trial in the general working population","volume":"22","author":"Behrendt","year":"2020","journal-title":"J Med Internet Res"},{"key":"B17","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1037\/ccp0000665","article-title":"Efficacy of internet-based treatment for genito-pelvic pain\/penetration disorder: results of a randomized controlled trial","volume":"89","author":"Zarski","year":"2021","journal-title":"J Consult Clin Psychol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"2140","DOI":"10.1007\/s12671-022-01949-w","article-title":"Effectiveness, acceptability, and mechanisms of change of the internet-based intervention StudiCare mindfulness for college students: a randomized controlled trial","volume":"13","author":"K\u00fcchler","year":"2022","journal-title":"Mindfulness (N Y)"},{"article-title":"DIGA-Report II. In DiGA-Report II","year":"2024","author":"Baas","key":"B19"},{"key":"B20","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s00406-018-0974-3","article-title":"\u2019Smartphone applications for depression: a systematic literature review and a survey of health care professionals\u2019 attitudes towards their use in clinical practice\u2019","volume":"270","author":"Kerst","year":"2020","journal-title":"Eur Arch Psychiatry Clin Neurosci"},{"year":"2023","key":"B21","article-title":"Prim\u00e4re Gesundheitsversorgung\/Primary Health Care, Bundeszentrale F\u00fcr Gesundheitliche Aufkl\u00e4rung (BZgA)"},{"year":"2023","key":"B22","article-title":"Bericht des GKV-Spitzenverbandes \u00fcber die Inanspruchnahme und Entwicklung der Versorgung mit Digitalen Gesundheitsanwendungen (DiGA-Bericht), GKV-Spitzenverband"},{"key":"B23","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1097\/MLR.0b013e3182408812","article-title":"Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact","volume":"50","author":"Curran","year":"2012","journal-title":"Med Care"},{"key":"B24","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1186\/s12913-021-06190-0","article-title":"The effectiveness of implementation strategies for promoting evidence informed interventions in allied healthcare: a systematic review","volume":"21","author":"Goorts","year":"2021","journal-title":"BMC Health Serv Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s43058-020-00023-7","article-title":"Ten recommendations for using implementation frameworks in research and practice","volume":"1","author":"Moullin","year":"2020","journal-title":"Implement Sci Commun"},{"key":"B26","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-022-01245-0","article-title":"The updated consolidated framework for implementation research based on user feedback","volume":"17","author":"Damschroder","year":"2022","journal-title":"Implement Sci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.2105\/AJPH.89.9.1322","article-title":"Evaluating the public health impact of health promotion interventions: the RE-AIM framework","volume":"89","author":"Glasgow","year":"1999","journal-title":"Am J Public Health"},{"volume-title":"Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy (MOST)","year":"2018","author":"Collins","key":"B28"},{"key":"B29","doi-asserted-by":"publisher","first-page":"735","DOI":"10.1007\/s11948-015-9654-0","article-title":"What is proof of concept research and how does it generate epistemic and ethical categories for future scientific practice?","volume":"22","author":"Kendig","year":"2016","journal-title":"Sci Eng Ethics"},{"key":"B30","first-page":"2","volume-title":"The Logic Model Guidebook: Better Strategies for Great Results","author":"Knowlon","year":"2013"},{"key":"B31","doi-asserted-by":"publisher","first-page":"CD005470","DOI":"10.1002\/14651858.cd005470.pub3","article-title":"Tailored interventions to address determinants of practice","volume":"2015","author":"Baker","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"key":"B32","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1186\/1748-5908-8-139","article-title":"Implementation strategies: recommendations for specifying and reporting","volume":"8","author":"Proctor","year":"2013","journal-title":"Implement Sci"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e32","DOI":"10.2196\/jmir.5774","article-title":"The benefit of web- and computer-based interventions for stress: a systematic review and meta-analysis","volume":"19","author":"Heber","year":"2017","journal-title":"J Med Internet Res"},{"key":"B34","doi-asserted-by":"publisher","first-page":"e20829","DOI":"10.2196\/20829","article-title":"Evaluating a hybrid web-based training program for panic disorder and agoraphobia: randomized controlled trial","volume":"23","author":"Ebenfeld","year":"2021","journal-title":"J Med Internet Res"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e300846","DOI":"10.1136\/bmjment-2023-300846","article-title":"Are web-based stress management interventions effective as an indirect treatment for depression? An individual participant data meta-analysis of six randomised trials","volume":"27","author":"Harrer","year":"2024","journal-title":"BMJ Mental Health"},{"volume-title":"Discovering Statistics Using R","year":"2012","author":"Field","key":"B36"},{"key":"B37","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1186\/s13012-020-0971-6","article-title":"\u2018Effectiveness of guideline dissemination and implementation strategies on health care professionals\u2019 behaviour and patient outcomes in the cancer care context: a systematic review\u2019","volume":"15","author":"Tomasone","year":"2020","journal-title":"Implement Sci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1258\/jrsm.2011.110180","article-title":"The answer is 17 years, what is the question: understanding time lags in translational research","volume":"104","author":"Morris","year":"2011","journal-title":"J R Soc Med"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1509415\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,13]],"date-time":"2025-02-13T07:08:26Z","timestamp":1739430506000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2025.1509415\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,13]]},"references-count":38,"alternative-id":["10.3389\/fdgth.2025.1509415"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2025.1509415","relation":{},"ISSN":["2673-253X"],"issn-type":[{"type":"electronic","value":"2673-253X"}],"subject":[],"published":{"date-parts":[[2025,2,13]]},"article-number":"1509415"}}