Chapter 8 198 in IT-IS applications. Moreover, in clinical practice, this would considerably facilitate and thus increase the use of IT-IS. Clinical implications Dissemination of properly implemented IMR IMR has been implemented in many countries. Both clients and caregivers appeared to appreciate the IMR (Chapter 2). Moreover, there were positive outcomes for IMR, primarily in terms of overall illness self-management and symptomatology (Table 2). The results of a review and meta-analysis of illness self-management interventions, including IMR, could indicate a larger potential impact. Therefore, it is worthwhile investing in the proper implementation of IMR, particularly in terms of fidelity and completion. IMR practitioners periodically require one or two days of specific additional training Proper implementation of IMR requires trainers to possess a broad set of advanced knowledge and specific clinical skills. Therefore, achieving high IMR fidelity requires IMR practitioners to enhance their skills, if needed. In this study, the majority of the IMR elements appeared to be sufficiently implemented. However, for most trainers, eight relevant IMR elements regarding clinical skills were difficult to implement. Consistent with two earlier studies, five of these elements had the lowest fidelity: medication management, weekly action planning, action plan follow-up, cognitivebehavioral techniques, and significant other involvement. Some cognitivebehavioral skills, especially role-play, modeling, and home assignments, are critical for applying poorly implemented elements. Therefore, to promote fidelity for most IMR practitioners, in addition to standard two-day IMR training, periodic one- or two-day training sessions are needed to acquire these specific skills. This training could be incorporated into routine supervision sessions. The need for training in specific skills can be determined by systematically providing feedback on clinicians’ fidelity ratings obtained during the program’s provision. The IT-IS provides more elaborate and detailed information than the IMR fidelity scale. Apply strategies to promote attendance The two RCTs on IMR with the highest percentages of completers selected participants based on earlier treatment adherence (5, 8) and applied the total IMR curriculum individually using home visits (6). However, choosing these options is neither preferred nor feasible for all practices and centers. Therefore, the importance of a higher completion rate with respect to IMR efficacy suggests the relevance of increasing the motivation to continue IMR among participants. In addition to reminders and phone calls, IMR trainers should employ other strategies
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