Abstract / Summary
Background: Rural youth experience significant barriers to accessing timely and effective mental health care, and digital self-guided interventions may help expand service reach in resource-constrained settings. However, little is known about the implementation determinants influencing adoption of such tools by providers and community partners in rural contexts.
Method: The current study used a rapid qualitative approach to examine barriers and facilitators to implementing a self-guided digital mental health intervention for youth across rural Montana. Semi-structured interviews were conducted with outpatient mental health providers (n = 8) and school-based providers (n = 8) in Montana. Interviews explored experiences with implementation, perceived feasibility, and factors influencing the recommendation and use of the tool with youth. Data were analyzed using a rapid analytic approach and mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model and the Theoretical Domains Framework (TDF) to identify implementation determinants.
Results: Findings indicated that capability-related determinants included uncertainty about crisis response procedures, need for clearer implementation guidance, and challenges translating digital tools into practice workflows. Opportunity-related determinants reflected structural and contextual barriers, including limited time, workforce constraints, broadband and access limitations, and concerns regarding privacy, data security, and alignment with rural community needs. Motivation was shaped by a tension between perceived liability and professional risk and strong interest in expanding access to care for underserved youth. Across domains, participants emphasized the importance of trust, transparency, and community alignment in shaping implementation feasibility.
Conclusion: Findings informed the development of a dissemination toolkit designed for providers, youth, and caregivers to support implementation of digital mental health tools in rural settings. By translating COM-B- and TDF-informed determinants into practical resources, this work demonstrates how implementation science frameworks can guide real-world strategies to support adoption of digital mental health interventions in underserved communities.