IMPlementation of An online Relatives’ Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use
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Published:2020-03-17
Issue:1
Volume:20
Page:
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ISSN:1472-6963
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Container-title:BMC Health Services Research
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language:en
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Short-container-title:BMC Health Serv Res
Author:
Lobban FionaORCID, Appelbe Duncan, Appleton Victoria, Billsborough Julie, Fisher Naomi Ruth, Foster Sheena, Gill Bethany, Glentworth David, Harrop Chris, Johnson Sonia, Jones Steven H., Kovacs Tibor Zoltan, Lewis Elizabeth, Mezes Barbara, Morton Charlotte, Murray Elizabeth, O’Hanlon Puffin, Pinfold Vanessa, Rycroft-Malone Jo, Siddle Ronald, Smith Jo, Sutton Chris J., Viglienghi Pietro, Walker Andrew
Abstract
Abstract
Background
Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.
Methods
A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.
Results
In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT’s long-term availability.
Conclusions
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.
Trial registration
Study registration: ISCTRN 16267685.
Funder
National Institute for Health Research
Publisher
Springer Science and Business Media LLC
Reference46 articles.
1. Ben-Zeev D, Brenner CJ, Begale M, Duffecy J, Mohr DC, Mueser KT. Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia. Schizophr Bull. 2014;40(6):1244–53. 2. van der Krieke L, Wunderink L, Emerencia AC, de Jonge P, Sytema S. E-mental health self-management for psychotic disorders: state of the art and future perspectives. Psychiatr Serv. 2014;65(1):33–49. 3. Rotondi AJ, Anderson CM, Haas GL, Eack SM, Spring MB, Ganguli R, et al. Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes. Psychiatr Serv. 2010;61(11):1099–105. 4. Alvarez-Jimenez M, Alcazar-Corcoles MA, Gonzalez-Blanch C, Bendall S, McGorry PD, Gleeson JF. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res. 2014;156(1):96–106. 5. Batra S, Baker RA, Wang T, Forma F, DiBiasi F, Peters-Strickland T. Digital health technology for use in patients with serious mental illness: a systematic review of the literature. Med Devices (Auckl). 2017;10:237–51.
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