Consistent uptake and implementation of evidence-based CBT (EB-CBT) in clinical practice remains challenging. Understanding key barriers and facilitators experienced by CBT therapists is essential for developing effective implementation strategies to enhance adoption of EB-CBT practices. This study applies the Capability, Opportunity, Motivation-Behaviour (COM-B) and Theoretical Domains Framework (TDF) to provide a theoretically driven exploration of perceived barriers and facilitators to implementing EB-CBT reported by CBT therapists. A cross-sectional survey design incorporating qualitative open-ended questions was used to gather in-depth insights from 228 UK-based CBT therapists. Data were analysed using reflexive thematic analysis. Inductive analysis identified ten barriers and eight facilitators, which were deductively mapped onto the COM-B and TDF to identify key determinants affecting practice at the individual therapist or broader organisational level. At the therapist level, barriers identified were understanding of evidence-based decision making, scepticism about EB-CBT as being rigid, based on flawed evidence, and lacking client centredness, and a preference for intuitive eclecticism. Therapist facilitators included skills in research literacy and formulation, guided self-reflection as a behaviour regulation strategy, and reinforcement through positive outcomes. Organisational barriers were limited or complex research/guidelines, difficulty accessing knowledge, lack of training/supervision, and service constraints. Organisational facilitators consisted of external monitoring as a behavioural regulation strategy, fostering communities of practice, gaining knowledge through resources, and access to training/supervision. Key perceptions as well as misconceptions around using EB-CBT in practice were identified, highlighting the need for multi-level strategies addressing both individual and organisational factors to enhance therapists’ capability, motivation, and opportunity to adopt EB-CBT practices.

As a result of reading this paper, readers should:

1. (1) Understand the key barriers UK therapists perceive as hindering the implementation of evidence-based CBT practices.

2. (2) Understand the key factors UK therapists perceive as facilitating and enhancing the implementation evidence-based CBT practices.

3. (3) Be able to use the COM-B and TDF model to map key determinants affecting adoption of evidence-based CBT practice at both the individual therapist and broader organisational level.

4. (4) Consider theoretically driven implementation interventions which could be used to target identified individual and organisational factors to improve sustained adoption of EB-CBT.

Evaluate the extent to which delivery constraints were considered during the health technology assessment (HTA) of cell and gene therapies.

Constraints on delivering cell and gene therapies were identified from guidance documents by the National Institute for Health and Care Excellence Technology Appraisal and Highly Specialised Technologies streams until October 2024. Inductive coding was performed to identify delivery constraints reported within the guidance documents. A quantitative analysis established the proportion of guidance documents that reported delivery constraints, and the distribution of these constraints across the guidance documents (frequency, mean range).

Sixteen guidance documents for cell and gene therapies were identified. Thirteen guidance documents (81.3 percent of the sample) reported constraints on delivering cell and gene therapies. Thirty-one examples of delivery constraints were reported. The mean number of constraints per guidance document was 1.9 (range: 0–6 constraints). The reported constraints were grouped by six different themes: provider experience (n = 8); testing constraints (n = 7); geographical constraints (n = 5); payment constraints (n = 5); maturity of developments in care (n = 4); and infrastructure constraints (n = 2).

Formal HTA processes are one effective way to identify constraints on delivering cell and gene therapies. Proactive identification of potential delivery constraints will help decision-makers, providers, and manufacturers generate strategies that improve the implementation of cell and gene therapies. Overcoming delivery constraints will strengthen the likelihood of realizing the expected incremental net health benefit of cost-effective cell and gene therapies for patients across a healthcare system.

Quality improvement programmes (QIPs) are designed to enhance patient outcomes by systematically introducing evidence-based clinical practices. The CONQUEST QIP focuses on improving the identification and management of patients with COPD in primary care. The process of developing CONQUEST, recruiting, preparing systems for participation, and implementing the QIP across three integrated healthcare systems (IHSs) is examined to identify and share lessons learned.

This review is organized into three stages: 1) development, 2) preparing IHSs for implementation, and 3) implementation. In each stage, key steps are described with the lessons learned and how they can inform others interested in developing QIPs designed to improve the care of patients with chronic conditions in primary care.

Stage 1 was establishing and working with steering committees to develop the QIP Quality Standards, define the target patient population, assess current management practices, and create a global operational protocol. Additionally, potential IHSs were assessed for feasibility of QIP integration into primary care practices. Factors assessed included a review of technological infrastructure, QI experience, and capacity for effective implementation.

Stage 2 was preparation for implementation. Key was enlisting clinical champions to advocate for the QIP, secure participation in primary care, and establish effective communication channels. Preparation for implementation required obtaining IHS approvals, ensuring Health Insurance Portability and Accountability Act compliance, and devising operational strategies for patient outreach and clinical decision support delivery.

Stage 3 was developing three IHS implementation models. With insight into the local context from local clinicians, implementation models were adapted to work with the resources and capacity of the IHSs while ensuring the delivery of essential elements of the programme.

Developing and launching a QIP programme across primary care practices requires extensive groundwork, preparation, and committed local champions to assist in building an adaptable environment that encourages open communication and is receptive to feedback.

User engagement is recognised as a critical and pervasive challenge that has limited the potential evidence base being developed for mental health apps.

To understand young people’s motivations for participating in a randomised controlled trial for a mental health app and the role of intrinsic (e.g. improving well-being) and extrinsic (e.g. financial incentives) drivers in engagement.

Emotional Competence for Well-Being (ECoWeB) was a superiority parallel three-arm randomised cohort trial recruiting a cohort of 16–22 year-olds across the UK, Germany, Spain and Belgium, who, depending on risk, were allocated respectively to the PREVENT (n = 1262) versus PROMOTE (n = 2532) trials. We conducted in-depth semi-structured interviews in the UK (n = 18, mean age = 17.7, s.d. = 1.5) and Spain (n = 11, mean age 20.6, s.d. = 1.7) to explore participants’ self-reported motivations and engagement. The trial was registered at ClinicalTrials.gov: NCT04148508.

Across arms, 21% of participants never set up an account to access the app and approximately 50% did not complete the 3-month follow-up assessment. Engagement was not significantly higher in the intervention arm compared to the control arms across metrics. Qualitative findings demonstrated that although extrinsic factors alone may be enough to prompt someone to sign up to research, intrinsic drivers (e.g. finding the app useful) are needed to ensure longer-term engagement.

Incentivising participation in clinical trials needs to be consistent with incentives that might be utilised at the point of dissemination and implementation to ensure that findings are replicated if that intervention is adopted at scale.

Insufficient sample sizes threatened the fidelity of the primary research trials. Even if the research group recruits a sufficient sample size, the sample may lack diversity, reducing the generalizability of the results of the study. Evaluating the effectiveness of online advertising platforms (e.g., Facebook & Google Ads) versus traditional recruitment methods (e.g., flyers, clinical participation) is essential.

Patients were recruited through email, electronic direct message, paper advertisements, and word-of-mouth advertisement (traditional) or through Google Ads and Facebook Ads (advertising) for a longitudinal study on monitoring COVID-19 using wearable devices. Participants were asked to wear a smart watch-like wearable device for ∼ 24 hours per day and complete daily surveys.

The initiation conversion rate (ICR, impressions to pre-screen ratio) was better for traditional recruitment (24.14) than for Google Ads, 28.47 ([0.80, 0.88]; p << 0.001). The consent conversion rate (CCR, impressions to consent ratio) was also higher for traditional recruitment (66.54) than for Google Ads, 2961.20 ([0.015, 0.030]; p << 0.001). Participants recruited through recommendations or by paper flier were more likely to participate initially (Χ2 = 23.65; p < 0.005). Clinical recruitment led to more self-reporting white participants, while other methods yielded great diversity (Χ2 = 231.47; p << 0.001).

While Google Ads target users based on keywords, they do not necessarily improve participation. However, our findings are based on a single study with specific recruitment strategies and participant demographics. Further research is needed to assess the generalizability of these findings across different study designs and populations.

Mentorship education has been shown to positively impact the experiences of mentors and mentees. Entering Mentoring, an evidence-based mentor training curriculum, has been widely implemented to train research mentors across the country, including the mentors of clinical and translational scientists. Facilitating Entering Mentoring, a train-the-trainer based workshop, has been used as a dissemination strategy to increase the number of facilitators prepared to implement mentor training in their local contexts. The objective of this research was to examine individual and institutional factors promoting and limiting mentor training implementation efforts of trained facilitators.

Using the Consolidated Framework for Implementation Research (CFIR), we examined self-reported data from surveys administered annually to Facilitating Entering Mentoring participants. Data analyses included t-tests to compare differences between the implementer and non-implementer groups and binary logistic regression to determine which factors best predict implementation status.

Factors associated with the inner setting domain were found to have the most impact on implementation efforts, with administrative support, leadership support, and interest from potential participants being the most significant predictors of implementation. Additionally, those who implemented were more likely to report receiving institutional support compared with those who did not implement the intervention. Those who did not implement were more likely to report the presence of perceived institutional barriers.

The CFIR model provides a useful framework for understanding factors that promote and limit implementation outcomes of an evidence-based research mentor training intervention. Findings emphasize the role of institutional support to promote the implementation of research mentor training.