Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives

Fiona Davies, Heather L. Shepherd, Lisa Beatty, Brodie Clark, Phyllis Butow, Joanne Shaw

Research output: Contribution to journalReview articlepeer-review

38 Citations (Scopus)
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Background: Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low.

Objective: Our objective in this review was to summarize what is known about health care professionals’ perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings.

Methods: We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals’ views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet.

Results: We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer.

Conclusions: Without health professionals’ support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns.

Original languageEnglish
Article numbere17362
Number of pages12
JournalJournal of Medical Internet Research
Issue number7
Publication statusPublished - 23 Jul 2020

Bibliographical note

This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution,and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.


  • barriers
  • cognitive behavioral therapy
  • facilitators
  • health professional views
  • implementation
  • internet-based intervention
  • models of care
  • online CBT
  • online psychological therapy


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