Developing a hypothetical implementation framework of expectations for monitoring early signs of psychosis relapse using a mobile app: qualitative study

Allan, S., Bradstreet, S. , McLeod, H. , Farhall, J., Lambrou, M., Gleeson, J., Clark, A. and Gumley, A. (2019) Developing a hypothetical implementation framework of expectations for monitoring early signs of psychosis relapse using a mobile app: qualitative study. Journal of Medical Internet Research, 21(10), e14366. (doi: 10.2196/14366) (PMID:31651400) (PMCID:PMC6838692)

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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 (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that 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 synthesize 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 the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized 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 stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial.

Item Type:Articles
Additional Information:Also funded by the National Heath Medical Research Council (APP1095879).
Glasgow Author(s) Enlighten ID:Bradstreet, Dr Simon and McLeod, Professor Hamish and Farhall, Professor John and Allan, Ms Stephanie and Clark, Miss Andrea and Gumley, Professor Andrew
Authors: Allan, S., Bradstreet, S., McLeod, H., Farhall, J., Lambrou, M., Gleeson, J., Clark, A., and Gumley, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing
Journal Name:Journal of Medical Internet Research
Publisher:JMIR Publications Inc
ISSN (Online):1438-8871
Published Online:01 September 2019
Copyright Holders:Copyright © 2019 Stephanie Allan, Simon Bradstreet, Hamish Mcleod, John Farhall, Maria Lambrou, John Gleeson, Andrea Clark, EMPOWER Group, Andrew Gumley
First Published:First published in Journal of Medical Internet Research 21(10):e14366
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
671813EMPOWER: Early Signs Monitoring to Prevent Relapse and Promote Wellbeing, Engagement and RecoveryAndrew GumleyNational Institute for Health Research (NIHR)13/154/04IHW - MENTAL HEALTH & WELLBEING