Barriers and facilitators to implementing the Let's Talk about Children intervention in China: A qualitative study

Evidence-based interventions often fail to translate into practice. This study aims to identify facilitators and barriers that affect the implementation of Let's Talk about Children (LTC), a family-focused intervention for families of children with parental mental illness (COPMI). Furthermore, we aim to offer actionable strategies to scale up LTC in China.

We assessed 48 Consolidated Framework for Implementation (CFIR) constructs and selected 10 constructs. We conducted focus groups guided by the CFIR to describe diverse stakeholders' experience during the implementation process. Eight sites in China were selected based on geographic and economic feasibility. Focus groups were audio-recorded and transcribed for analysis.

Implementation facilitators identified included: (1) acceptance of advantages, (2) adaptability, (3) access to knowledge and information, (4) fulfilled needs, (5) strong motivation, (6) teamwork. Study participants expressed mixed views on: (1) compatibility, that is, integration with workflow processes, and (2) engagement, that is, effect of attracting and encouraging participation. Implementation barriers included: (1) local attitudes on mental health, and (2) local resources, both of which were in the Outer Setting domain. Actionable strategies scaling up the implementation of LTC intervention were summarized.

As the advantages of the LTC program were widely recognized during our initial implementation, tailored training for mental health staff is essential to facilitate the development of family-focused practices to address the needs of COPMI and their families. Long-term efforts are necessary to decrease the negative impact of the identified barriers and refine the LTC program for future scalability.