This application for a Mentored Patient-Oriented Research Career Development Award (K23) is designed to provide the applicant with the training needed to propel him into a productive career as an implementation scientist focused on overcoming the barriers that limit access to effective psychosocial interventions for anxiety and related disorders. The applicant is a clinical psychologist with existing skills in large data analyses and experimental design, and an emerging proficiency in the identification and resolution of impediments to access to care. The career development plan is mentored by experts in intervention development, evaluation, and implementation, who are dedicated to ensuring that the applicant gains expertise in 1) clinical effectiveness trials methods, 2) implementation science, and 3) team science to test optimal implementation strategies in a psychiatrically ill population. These advanced skill domains will be critical to his success as an independent investigator. Developing as an independent investigator with expertise in these methods will improve the delivery of cognitive-behavioral interventions by identifying and eliminating barriers to implementation of evidence-based practices. Cognitive-behavioral therapy has gained an unprecedented level of empirical support over the past five decades. Despite success in developing and testing cognitive-behavioral therapy, the dissemination of cognitive-behavioral therapy into healthcare settings has not matched empirical support and enthusiasm from the scientific community. The application of cognitive behavioral therapy as a technology in the treatment of disorders of health anxiety is further complicated by features of these disorders that lead to rejection and under-engagement with treatment. This complexity provides an opportunity to harness implementation science to develop more effective strategies to deliver evidence-based practices to the population. The applicant has developed a detailed research project that matches the research objectives to the career development skill domains. The research proposal consists of a 1) hybrid effectiveness-implementation trial to evaluate the feasibility, acceptability, and preliminary effectiveness of brief CBT for health anxiety delivered in primary care by MAs on patient engagement and patient outcomes, 2) developmental formative evaluation to further identify facilitators and barriers to implementation of the intervention in routine practice using qualitative interviews with clinical practice staff, and 3) pilot of the implementation strategy in a practice setting after modifying the intervention to address barriers and utilize facilitators. A planned follow-up trial will provide an opportunity to demonstrate the applicant's expertise in effectiveness trial methods, implementation science, and team science, as he builds a scientific team capable of conducting a cluster-randomized trial of the implementation strategy piloted in this project.
The proposed study aligns with the career development plan aimed at producing an expert researcher with strengths in clinical effectiveness designs, implementation science, and team science. The study will test the effectiveness of a brief cognitive-behavioral therapy provided by Medical Assistants for health anxiety in the primary care setting, identify barriers and facilitators of implementation, and pilot implementation in a practice setting. The results of this study will be used to support a cluster-randomized trial of the implementation strategy tested in this pilot project, with the aim of increasing access to effective care, decreased prevalence of excessive health anxiety, and decreased burden on the healthcare setting.
