‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study

Rycroft-Malone, J., Gradinger, F., Owen Griffiths, H., Anderson, R., Crane, R. S., Gibson, A., Mercer, S. W. and Kuyken, W. (2019) ‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study. BMJ Open, 9(9), e026244. (doi: 10.1136/bmjopen-2018-026244) (PMID:31501097) (PMCID:PMC6738673)

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Abstract

Objectives: Mindfulness-based cognitive therapy (MBCT) is an evidence-based approach for people at risk of depressive relapse to support their long-term recovery. However, despite its inclusion in guidelines, there is an ‘implementation cliff’. The study objective was to develop a better explanation of what facilitates MBCT implementation. Setting: UK primary and secondary care mental health services. Design, participants and methods: A national two-phase, multi-method qualitative study was conducted, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework. Phase I involved interviews with stakeholders from 40 service providers about current provision of MBCT. Phase II involved 10 purposively sampled case studies to obtain a more detailed understanding of MBCT implementation. Data were analysed using adapted framework analysis, refined through stakeholder consultation. Results: Access to MBCT is variable across the UK services. Where available, services have adapted MBCT to fit their context by integrating it into their care pathways. Evidence was often important to implementation but took different forms: the NICE depression guideline, audits, evaluations, first person accounts, experiential taster sessions and pilots. These were used to build a platform from which to develop MBCT services. The most important aspect of facilitation was the central role of the MBCT implementers. These were generally self-designated individuals who ‘championed’ grass-roots implementation. Our explanatory framework mapped out a prototypical implementation journey, often over many years with a balance of bottom-up and top-down factors influencing the fit of MBCT into service pathways. ‘Pivot points’ in the implementation journey provided windows of either challenge or opportunity. Conclusions: This is one of the largest systematic studies of the implementation of a psychological therapy. While access to MBCT across the UK is improving, it remains patchy. The resultant explanatory framework about MBCT implementation provides a heuristic that informed an implementation resource.

Item Type:Articles
Additional Information:
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Research programme—HS&DR-12/64/187. The write up was supported by the
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Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mercer, Professor Stewart
Authors: Rycroft-Malone, J., Gradinger, F., Owen Griffiths, H., Anderson, R., Crane, R. S., Gibson, A., Mercer, S. W., and Kuyken, W.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment
Journal Name:BMJ Open
Publisher:BMJ Publishing Group
ISSN:2044-6055
ISSN (Online):2044-6055
Published Online:08 September 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in BMJ Open 9(9): e026244
Publisher Policy:Reproduced under a Creative Commons License

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