Introduction Internet-based cognitive behavioural therapy (ICBT) for chronic pain and chronic fatigue syndrome (CFS) has a high potential to increase the number of patients who can receive an evidence based treatment aimed to reduce symptoms and/or disability and to lower burden on (mental) health care. However, implementing a new behaviour-change intervention, and especially an online intervention, has shown to be a challenge. This study aimed to identify factors influencing the implementation process of ICBT for chronic pain and CFS in mental health care. Methods A qualitative study using semi-structured interviews with therapists and managers from twelve mental health care clinics was conducted. Questions and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), covering five domains: (1) the implemented intervention, (2) individual characteristics of the users, (3) the inner setting of implementation, (4) the outer setting, and (5) the implementation process. Results In all five domains important facilitators and barriers were found. Key themes were: (1) the quality of the content, its perceived effectiveness and usability, (2) the attitude, self-efficacy and ability to learn new skills among therapists, and motivation to start online treatment among patients, (3) internal communication within a team, existing workload, and top-down support from the management, (4) availability of reimbursement options and marketing strategies, and (5) involvement of all key stakeholders, steering towards independence of the implementation sites during the process and adequate training of therapists. Conclusions This study provides insight in the challenge of implementing ICBT for chronic pain and CFS in daily clinical practice. Several lessons can be learned from the interviews with therapists and managers which can also be more broadly applied to (ICBT) implementation projects in general. Development of practical tools to support the implementation process would be a valuable next step to overcome certain challenges at forehand and to properly prepare for those expected to come along.

中文翻译：

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实施指导 ICBT 治疗慢性疼痛和疲劳：治疗师和管理人员的定性评估。

简介 基于互联网的慢性疼痛和慢性疲劳综合征 (CFS) 认知行为疗法 (ICBT) 具有很大的潜力，可以增加可以接受旨在减轻症状和/或残疾并减轻负担的循证治疗的患者数量。 （精神）保健。然而，实施新的行为改变干预，尤其是在线干预，已证明是一项挑战。本研究旨在确定影响 ICBT 治疗慢性疼痛和 CFS 在精神卫生保健中实施过程的因素。方法 对来自 12 家精神卫生保健诊所的治疗师和管理人员进行半结构化访谈的定性研究。问题和分析以实施研究综合框架 (CFIR) 为指导，涵盖五个领域：(1)实施的干预，(2)用户的个体特征，(3)实施的内部设置，(4)外部设置，(5)实施过程。结果 在所有五个领域中都发现了重要的促进因素和障碍。关键主题是：(1) 内容的质量、感知的有效性和可用性，(2) 治疗师的态度、自我效能和学习新技能的能力，以及患者开始在线治疗的动机，(3) 内部团队内部的沟通、现有工作量和管理层自上而下的支持，(4) 报销选项和营销策略的可用性，以及 (5) 所有关键利益相关者的参与，在过程中转向实施站点的独立性和充分治疗师的培训。结论 本研究为在日常临床实践中实施 ICBT 治疗慢性疼痛和 CFS 的挑战提供了见解。从与治疗师和管理人员的访谈中可以学到一些经验教训，这些经验教训也可以更广泛地应用于（ICBT）实施项目。开发支持实施过程的实用工具将是下一步克服某些挑战并为预期出现的挑战做好适当准备的宝贵下一步。