Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 12, 2019
Date Accepted: Jul 19, 2019
Monitoring early signs of psychosis relapse using a Mobile App: Developing a Hypothetical Implementation Framework of Expectations for staff, carers and service users using Qualitative Methods.
ABSTRACT
Background:
Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER is a peer worker supported digital intervention which aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation – both within trials and beyond.
Objective:
Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesise these data into a framework.
Methods:
To develop a hypothetical implementation framework, 149 mental health professionals, carers and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by Normalisation Process Theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analysed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions.
Results:
All groups expected EMPOWER could be successfully implemented if the intervention generated data which were meaningful to mental health staff, carers and service users within their unique roles. However, there were key differences between staff, carers and services users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cRCT stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whilst staff and carers spoke more about the impact upon staff interactions with service users.
Conclusions:
A hypothetical implementation framework synthesised from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial giving valuable insights into the accuracy of these stakeholder’s prior expectations. This is the first study to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Clinical Trial: ISRCTN: 99559262
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