Developing implementation strategies for digital ICU diaries targeting ICU professionals: an implementation mapping...

Digital Intensive Care Unit (ICU) diaries can enhance the mental health of ICU survivors and their relatives by bridging memory gaps, improving understanding of ICU experiences, and providing emotional support. However, integrating digital diaries into routine ICU practice poses challenges, including privacy concerns, time constraints, and limited staff motivation. To date, no standardized implementation strategy exists. This study aimed to develop a theory-driven, stepwise implementation guide.

A methodological, iterative developmental design was employed, guided by the Implementation Mapping (IM) framework. The first four IM steps structured the process. Step 1 involved a needs assessment using prior qualitative and quantitative studies, including focus groups and a survey with ICU professionals, to identify barriers and facilitators. In step 2, a collaborative session defined implementation outcomes, performance objectives, and key determinants for change. Step 3 involved selecting theory-based methods and implementation strategies using the taxonomy of behavior change methods. In step 4, these strategies were translated into practical actions and materials to support implementation.

The needs assessment (Step 1) identified 23 facilitators and 40 barriers, with survey findings confirming these insights. In step 2, fidelity, adoption, and sustainability were established as key implementation outcomes, with seven performance objectives linked to determinants such as knowledge, attitudes, and motivation. Step 3 resulted in the selection of twelve theory-based methods, including active learning, peer role modeling, and perspective-shifting, to inform strategy development. Finally, step 4 produced a structured implementation guide, adaptable to local contexts, designed to support ICU teams and champions in adopting and sustaining digital ICU diaries.

This study demonstrates the value of Implementation Mapping for developing theory-driven implementation strategies for digital ICU diaries. The resulting guide systematically addresses barriers and facilitators, offering a scalable model for integrating digital health innovations into clinical practice.