Facilitators and Barriers to Implementing Mobile Mental Health Interventions: Qualitative Study of the Consolidated Framework for Implementation Research in Pediatric Oncology Providers.

Twenty AYA oncology providers representing various medical and psychosocial roles participated in semistructured 1:1 interviews on facilitators and barriers to incorporating mHealth apps as psychosocial standard of care.

• Participants had a mean age of 39 years (SD 7.0 years)
• 80% of participants were female and 70% were non-Hispanic White
• Participants represented various medical and psychosocial roles in AYA oncology
• Data were analyzed using 16 CFIR constructs via directed content analysis with a standardized CFIR codebook adapted for mHealth innovations and AYAs with cancer

Four facilitators to mHealth implementation were identified within the Innovation CFIR domain.

• Facilitators in the Innovation domain included alignment with patient needs, patient-centered co-design, strong research evidence, and user-friendly design
• These facilitators reflect provider emphasis on the fit between mHealth apps and the unique psychosocial needs of AYA cancer survivors
• Patient-centered co-design was specifically identified as a facilitator, highlighting the importance of involving end users in development

Facilitators in the Outer Setting CFIR domain included shared commitment to addressing mental health needs and openness to mHealth use.

• Providers identified a shared commitment among the broader clinical community to addressing mental health needs of AYA cancer survivors
• Openness to mHealth use at the outer setting level was seen as a facilitator to adoption
• These outer setting facilitators reflect the broader organizational and community environment surrounding implementation

Openness to training on mHealth use was identified as a facilitator within the Inner Setting CFIR domain.

• Providers expressed openness to receiving training on how to use and integrate mHealth apps into clinical practice
• This finding suggests that provider willingness to learn is a key inner setting factor supporting implementation
• The Inner Setting domain addresses factors within the immediate organizational context of the clinical team

Key facilitators at the Individuals CFIR domain level included engaging bedside nurses and social workers as key implementation partners and strong clinical team buy-in.

• Bedside nurses and social workers were specifically identified as key implementation partners whose engagement was viewed as a facilitator
• Strong clinical team buy-in was identified as essential at the individual provider level
• These findings suggest that implementation success depends on identifying and mobilizing specific clinical roles

Associated costs were identified as a barrier to mHealth implementation within the Innovation CFIR domain.

• Costs associated with mHealth apps were identified as a barrier by providers
• This finding reflects concern about financial accessibility of mHealth tools for patients and/or health systems
• Cost was the sole barrier identified within the Innovation domain

Heavy clinical workloads were identified as a barrier to mHealth implementation within the Outer Setting CFIR domain.

• Providers cited heavy clinical workloads as an outer setting barrier to adopting mHealth apps into routine care
• This barrier reflects the broader systemic challenge of time and resource constraints in oncology settings
• Heavy workloads may limit providers' capacity to recommend, monitor, or support patient use of mHealth tools

Lack of cross-team collaboration and communication and difficulties with clinical workflow integration were identified as barriers within the Inner Setting CFIR domain.

• Two inner setting barriers were identified: lack of cross-team collaboration and communication, and lack of clinical workflow integration
• These barriers suggest that fragmented team communication and poor fit with existing workflows impede mHealth adoption
• The Inner Setting domain encompasses organizational culture, communication, and workflow structures within the clinical environment

The study applied a directed content analysis approach using a CFIR codebook adapted specifically for mHealth innovations and the AYA cancer population.

• A standardized CFIR codebook with construct definitions was used as the basis for analysis
• Adaptations were made to the codebook to account for mHealth-specific considerations and the AYA oncology context
• A total of 16 CFIR constructs were represented in the analysis across four CFIR domains: Innovation, Outer Setting, Inner Setting, and Individuals