Computer-supported cooperative work (CSCW) [17] is a field of research examining how collaboration and coordination can be supported by computer systems. Early studies in CSCW were focused on a single workplace, which subsequently expanded to the study of multisite workplaces and mobility [18]. Ethnography has its roots in the social sciences and has been widely used within the CSCW field [19]. Some key principles in ethnography include studying a phenomenon in its natural setting, a holistic approach, providing a descriptive understanding of the phenomenon, and taking the community members’ perspectives into consideration [18]. These principles were considered to be well-suited to the goals of our data collection. Therefore, we used an ethnographic approach to data collection in the teams while working within a CSCW framework with focus on a workplace.

The data were collected in two phases. The first phase of data collection focused on FACT teams targeting adults, which included five teams. These teams were chosen based on purposeful selection [20] to collect relevant information for our research goals. We selected two urban and three rural teams in different geographical areas of Norway. We had planned to perform observations and semistructured interviews with these teams, but because of restrictions related to the COVID-19 pandemic, we were only able to complete the data collection for three teams. For the two remaining teams, we conducted interviews using Skype for Business. The data collection in the FACT teams targeting adults was completed from August 2020 to January 2021 by one researcher. We contacted the team leaders before the observations; the team leaders acted as gatekeepers, giving the researcher access to the teams. During the observations, the researcher participated in various types of team meetings. He also had informal discussions with team members and observed their use of ICT solutions. The researcher participated in three meetings with patients after obtaining their consent. These patients were chosen by the FACT teams themselves; several patients were asked to participate but chose not to meet with the researcher. During the observations, the researcher wrote memos containing thoughts, observations, and ideas. During the semistructured interviews, the team leaders and team coordinators in all five teams were interviewed one-to-one using an interview guide. The questions in the interview guide, provided in Textbox 1, were based on previous knowledge of the use of ICT tools in Norwegian FACT teams [9]. The interviews varied in length from 30 to 60 minutes. After the interview with the first team, the topic of team calendars was identified and added to the interview guide. The researcher took notes during the interviews, and clarified and expanded on them immediately after the interviews.

The second phase of the data collection focused on FACT youth teams, and the three FACT youth teams operating in Norway at the time were included. During the fall of 2021, one researcher conducted semistructured interviews with the teams with the following two goals: (1) to form the basis of a requirement specification for an electronic whiteboard for FACT youth teams in Norway, and (2) to provide a wider view of the ICT needs of FACT youth teams. All team members were invited to participate in the interviews, but not all members were able to participate. The number of participants ranged from 1 to 3, for a total of 7 participants. During the interviews, the researcher presented predefined use cases (see Textbox 2) tied to the use of the electronic whiteboard. This was used as a starting point for discussions on expectations concerning an ideal electronic whiteboard, supported by an interview guide for additional questions (see Textbox 3). The use cases and interview guide were designed based on our previous research on FACT teams targeting adults. During the interviews, the researcher took notes and wrote a memo after each interview with additional thoughts and impressions from the interviews. The interviews were recorded and transcribed.

Preliminary data analyses of the research have been published for FACT teams targeting adults [21] and youth [22]. In this paper, we present an in-depth analysis of the complete data set collected in the two phases of the study. We performed a thematic analysis [23,24] of the data following a theoretical “top-down” approach. During the observations, we gathered data on many aspects of the FACT teams; however, when analyzing the data, we focused on the specific goals of this study: the FACT teams’ experiences with and expectations of ICT solutions. This allowed for stronger focus on the aims of the study, but came at the expense of an explorative analysis of all the data. We chose this approach because it allowed us to meet the goals of the study in a better way. During the data analysis, we familiarized ourselves with the data by repeatedly reading the data set. We then coded the data relevant to the aims of our study using the software NVivo. Since the analysis was performed in a deductive manner with focus on our specific aims, only text that was relevant to our focus was coded. We defined initial themes, which were divided by codes using NVivo. Reviewing the themes, we found that it was useful to add subthemes to differentiate distinct aspects of the data. The new subthemes were added, as we found other interesting aspects of the data, or merged if they did not have sufficient codes to justify being classified as their own subthemes.

This project has been approved by the Data Protection Official at Innlandet Hospital Trust (137877). The project was also reviewed by the Regional Ethical Committee, who deemed the project to be outside of their mandate (REK Sør-Øst 104537).

All interviewees signed informed consent forms. The data were stored securely and deidentified. No compensation was given to the participants.

Table 1 shows the characteristics of the teams and data collection methods used.

In this study, we have explored the experiences and expectations of the FACT teams with the ICT tools that are relevant for their work. We found issues with communication, documentation, and organization. There were also some unique challenges with the COVID-19 pandemic and issues with the various technological solutions used by the teams, mainly related to integration and access to data.

One topic brought up in the analysis was the suitability of video consultations. Some teams used video consultations, but they did not think this was a suitable solution for all patients. Access to equipment and internet connection was also an issue for some patients. These results are similar to those of other studies on the use of video conferencing with patients of ACT and FACT teams during the COVID-19 pandemic [12,13], and are also consistent with findings on the use of video conferencing in multidisciplinary team–based treatment in somatic care [15]. This finding also matches a study on adaptations of the FACT model when implemented in rural areas in Norway, which showed that use of video meetings and video consultations were some of the adaptations made [7]. A study on therapists’ experiences of the use of video consultation in specialist mental health care during the COVID-19 pandemic highlighted that the therapists were hesitant to talk about the most sensitive themes and subjects. This was related to expectations or fear that the consultation would be interrupted by technical issues [26]. Use of video conference compared to phone calls has been documented as a better solution leading to fewer errors and better decision-making accuracy [27]. This has also been shown in our study, where one team leader reported that video conference had advantages over the use of phone calls, for instance by seeing if the patient was intoxicated. The successful use of video conference in some teams shows that it can be a useful tool for some patients, especially for teams with long travel distances.

Issues with documentation were mostly related to travel to meet the patients. Many eHealth solutions aim to reduce or eliminate the need for the patient or health care worker to travel [28]. However, due to the assertive outreach of FACT teams, traveling is an integral part of their work. Team workers often postpone documentation in the EHR, especially when they have long travel times. Some advantages and disadvantages of completing the documentation while with the patients were brought up in the interviews. On the one hand, letting the patient participate in documentation can be a good example of patient involvement. On the other hand, if done wrong, this can take the focus away from the patient during the meeting. The issues related to traveling also highlight that the ICT systems for FACT teams should be available on mobile devices such as smartphones and tablets. One issue that was unique to FACT youth teams was the dilemma regarding the type of health information that should be documented for family members in the youth EHR. While this information can be relevant for the youth, the health information for other individuals must be kept confidential.

Various organizational issues were brought up during the interviews. One common theme was that many ICT systems and ways of working are not adjusted to FACT teams. This is a consequence of the organization of most teams in both primary and secondary care, and the fact that the outreach model of FACT teams does not match the structure of many systems within health care.

The COVID-19 pandemic brought many challenges that forced the FACT teams to change the way they were working. Some of these changes were based on precautions that were common in other settings, such as the use of face masks and social distancing. A concern for some teams was that all team members would be quarantined at the same time due to being exposed to an infected person. The pandemic also changed the ways the teams were communicating with the patients, with increased use of phone and video consultations. For some teams, the implementation of video conferencing was accelerated because of the pandemic. These findings are similar to those of other studies on adaptations made by ACT and FACT teams during the COVID-19 pandemic [12,13]. These studies reported on various adaptations made during the pandemic, such as dividing the teams into two groups and increased use of telephone and video when communicating with patients.

The teams brought up various issues with the technologies they use. Access to EHR information was challenging for most teams, mainly because of the different EHR systems used in specialist and primary care. There were also challenges related to the electronic whiteboards. The main issue is the lack of integration between the electronic whiteboards and other systems such as EHRs. Integration could allow the sharing of data such as patient IDs, health care worker IDs, and diagnoses. Electronic whiteboards should also be able to extract statistical information that can be used for administrative purposes. FACT youth team members said they wished that the electronic whiteboards had a larger focus on family and network, even if the whiteboards in use have basic text fields for this. This was not brought up by the teams targeting adults, and thus reflects the increased focus on family and network in FACT youth teams. There was also a wish for electronic whiteboards to display information about deadlines related to standardized patient pathways.

There are several different calendar solutions available to FACT teams, but some teams still want one calendar system that gives an overview of the teams’ appointments. This is useful for administrative purposes and there is also safety in knowing where the team members are at any given time. However, the teams varied to the degree that they considered this to be a relevant issue. For example, this was not an issue focused on by the FACT youth teams.

The main challenge with respect to the ICT systems is a lack of integration between the various systems and access to relevant data. These issues are not unique to FACT teams, and were pointed out in the government strategy document One citizen–One Journal [29] in 2012. There is a need for EHR systems where FACT team members and other health care workers can easily access the relevant EHR data needed for their work. The electronic whiteboards should have integration toward these EHR systems.

One limitation of this study was that different methods were used in the data collection for teams targeting adults and youth. This was because of the availability of the teams and the added goals of the data collection for youth to serve as the basis of a requirement specification for an electronic whiteboard. At the same time, the focus on the teams’ ICT solutions was the same.

Another limitation is the choice of a theoretical, top-down data analysis approach. This limited our ability to perform an explorative analysis of all data, but allowed greater focus on the specific goals of our study.

Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. We are working on proposing an ideal solution for an electronic whiteboard, including a requirement specification and a description of how the electronic whiteboard should integrate toward EHR systems. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. Some differences between the types of teams are a greater focus on family and network in teams targeting youth, and the challenges regarding information about family members in the youth EHRs. Regarding ICT solutions for FACT teams, these differences should be minor, and it should be possible to accommodate for the differences with configurations within the solutions.