A qualitative inquiry of implementation factors in the Future Proofing study, a depression prevention program for Australian secondary schools (Preprint)

BACKGROUND Digital programs are increasingly being implemented in schools for student mental health. Schools are complex environments and contextual factors impact the implementation of these digital programs. OBJECTIVE The purpose of the current study by was to examine the contextual factors that influence implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools using an evidence-based smartphone app delivered universally to Year 8 students (13-14 years of age). METHODS Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with implementation delivery of the FPP. The interviews were guided by the Consolidated Framework for Implementation Research and our FPP logic model. Qualitative analysis was conducted using a modified form of Clarke and Braun’s six-stage reflexive thematic analysis guidelines, incorporating both a deductive and inductive coding approach. RESULTS Four superordinate themes were identified from qualitative responses provided by school staff. First, staff perceived the FPP as valuable because it provided necessary resources. Second, staff perceived the FPP as innovative and appropriate to implement within schools. Third, planning was essential for efficient execution; teamwork, communication, and individual staff capacity and motivation to contribute were critical in the planning and execution phase of implementation. Fourth, low student engagement with the FPP and staffing availability were identified as critical barriers for future adoption and implementation by schools. CONCLUSIONS Interpersonal factors, leadership factors, and flexibility were important for implementing the FPP in schools. Based on our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations are designed to facilitate organisational change and help staff to implement digital mental health programs within their schools. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2020-042133