{"doi":"10.2196/30902","title":"Barriers and Facilitators to the Implementation of Family-Centered Technology in Complex Care: Feasibility Study","abstract":"BACKGROUND: Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. OBJECTIVE: The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. METHODS: We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children's hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (-2 strong barrier to +2 strong facilitator). RESULTS: Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo; providers: 30-minute tutorial and 5-minute video on use in a clinic visit; both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years; n=28, 80% female; n=17, 49% Caucasian; n=16, 46% Hispanic; and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK's internet accessibility and email reminders (parents), and GK's ability to set long-term goals and use at the end of visits (providers). A key barrier was GK's lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. CONCLUSIONS: Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. TRIAL REGISTRATION: ClinicalTrials.gov NCT03620071; https://clinicaltrials.gov/ct2/show/NCT03620071.","journal":"Journal of Medical Internet Research","year":2022,"id":273075,"datarank":0.6221624829195987,"base_score":2.4849066497880004,"endowment":2.4849066497880004,"self_citation_contribution":0.37273599746820013,"citation_network_contribution":0.24942648545139862,"self_endowment_contribution":0.37273599746820013,"citer_contribution":0.24942648545139862,"corpus_percentile":null,"corpus_rank":null,"citation_count":11,"citer_count":10,"citers_with_citation_signal":9,"citers_with_endowment":9,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9602,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03620071"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":940075,"name":"Bernd Huber","orcid":"0000-0002-9176-2208","position":1,"is_corresponding":false},{"id":323992,"name":"Ofra Amir","orcid":"0000-0003-2303-3684","position":2,"is_corresponding":false},{"id":323993,"name":"Sebastian Gehrmann","orcid":"0000-0002-8257-9516","position":3,"is_corresponding":false},{"id":940076,"name":"Kimberly S. Ramirez","orcid":"0000-0003-4837-0783","position":4,"is_corresponding":false},{"id":940077,"name":"Kimberly M Ochoa","orcid":"0000-0002-3571-9993","position":5,"is_corresponding":false},{"id":65243,"name":"Steven M. Asch","orcid":"0000-0001-5838-5335","position":6,"is_corresponding":false},{"id":535510,"name":"Krzysztof Z. Gajos","orcid":"0000-0002-1897-9048","position":7,"is_corresponding":false},{"id":323994,"name":"Barbara J. Grosz","orcid":"0000-0003-3031-5591","position":8,"is_corresponding":false},{"id":323995,"name":"Lee Sanders","orcid":"0000-0003-3231-6918","position":9,"is_corresponding":false},{"id":323989,"name":"Jody L. Lin","orcid":"0000-0002-9964-7984","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-19T00:27:52.048702Z","pmid":"35998021","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}