# Implementing a digital treatment program for patients with irritable bowel syndrome into routine care: a qualitative evaluation of barriers and facilitators perceived by key stakeholders

## TL;DR

This study explores the barriers and facilitators to implementing a digital treatment program for irritable bowel syndrome in routine healthcare, focusing on stakeholder perspectives.

## Contribution

The study provides novel insights into multilayered factors influencing digital treatment program implementation in secondary healthcare systems.

## Key findings

- Key barriers included financing and lack of planning, while facilitators included innovation source and stakeholder motivation.
- Stakeholder characteristics like leadership capability and stakeholder engagement were crucial for successful implementation.
- The findings suggest the importance of early planning and adaptive approaches in digital healthcare initiatives.

## Abstract

Digital treatment programs for irritable bowel syndrome offer multiple advantages as they enhance patient access to effective multidisciplinary lifestyle interventions while reducing individual symptom burden, in addition to alleviating strain on the healthcare systems. Despite the substantial benefits offered by digital treatment programs, exploring their implementation into routine care remain insufficient. This study aimed to systematically identify factors influencing the implementation of a digital treatment program for patients with irritable bowel syndrome as a routine intervention within a somatic secondary healthcare system.

A qualitative study design was employed, and data was collected through semi-structured interviews with 16 key stakeholders involved in the implementation process. The sample represented several roles, ranging from high level leaders, implementation leads and physicians referring patients to the program. The Consolidated Framework for Implementation Research was utilised to guide the development of the interview guide, data collection, data analysis and interpretation of the results.

Key barriers were identified in the Outer Setting Domain: financing and Implementation Process Domain: planning, whereas key facilitators were found in the Innovation Domain: innovation source and innovation relative advantage; Outer Setting Domain: critical incidents; Inner Setting Domain: tension for change; and Implementation Process Domain: teaming. Among the individuals involved in the implementation, three key characteristics were identified as facilitating the implementation process: capability among high-level leaders, opportunity among mid-level leaders and referring physicians, in addition to motivation among deliverers, implementation leads, and other implementation support.

This study provides novel insight into the multilayered factors that influence the implementation process of a digital treatment program in routine care of patients with irritable bowel syndrome. Our findings demonstrate that leveraging factors that aid implementation is important, while addressing barriers is crucial to ensure sustainable implementation. Moreover, our findings provide valuable insights for future digital healthcare initiatives, highlighting the value of early planning, engagement of stakeholders, and recognition of the dynamic nature of factors influencing the implementation process in secondary healthcare systems. Secondary healthcare systems should prioritise early strategic planning, identify and engage diverse stakeholders, and develop adaptive approaches that respond to the dynamic interplay of implementation factors. We suggest that this may facilitate the adoption of effective digital interventions for chronic conditions, also beyond irritable bowel syndrome.

The study fell outside the scope of the Health Research Act (1) and could be conducted without the approval of the regional ethics committee. The study was registered in Helse Bergen’s internal control system for research, innovation and quality improvement with project number 5226-5226 and received approval from the local Data Protection Officer who reviewed the study and the materials.

The online version contains supplementary material available at 10.1186/s12913-025-13171-0.