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Table 4 Preconditions to use blended care for depression in secondary care, according to therapists (n = 9) (phase 2)

From: Blending online therapy into regular face-to-face therapy for depression: content, ratio and preconditions according to patients and therapists using a Delphi study

Preconditions Practical steps to incorporate this precondition
Flexibility in the online program Blended therapy should be tailored to the individual patient, based on individual needs.
Ratio of online and offline sessions should be chosen during the therapy.
Content of online sessions should be flexible, by working with separate online assignments or modules.
Take patient characteristics into account Involve patients into the choice for (and ratio of) blended therapy.
Consider patients’:
 ▪ Co-morbidity (rule out crises; depression should be the main focus of therapy)
 ▪ Needs and motivation
 ▪ Intelligence (can they express themselves in writing)
 ▪ Skills (can they use a computer)
 ▪ Personality (self-management, discipline)
Meta-communication with patients on blended care Tell them why you work with blended therapy.
Show them how the program works.
Tell them it is important to finish the whole therapy, even though they might feel better half way through.
Tell them it is essential that they do the work and that the therapist only plays a supporting role.
Use online registration and intake modules The patient knows that online technology will be used in therapy from the start.
Patients are offered help immediately, they can start their therapy (intake) without waiting for an available therapist.
Emphasis is on patient self-management from the start of the therapy.
Use innovations that technology offers beneficially Do not just copy a face-to-face protocol in an online program.
Alternate reading texts with active assignments.
Use animated examples and videos.
Use persuasive technology to motivate patients and to support discipline.
Create a database with varying online tools and modules that can be applied as suited on each individual patient.
Train and educate therapists Therapists should be motivated to work with blended therapy.
Workflow and time investment will change.
Technical and practical skills are needed (how to support patients, when and how to provide online feedback).
Balance in “letting patients go” and stimulating and supporting them.
Implementation should be initiated and stimulated from the management Therapists need to be trained which costs time and effort, this should be accommodated by the management.