A participatory approach to the development of a co-produced and co-delivered information programme for users of services and family members: the EOLAS programme (paper 1)

Murphy

Downes

et al. 2020

Preprint

Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n=75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. National policy; structural stability with national systems; leadership at all levels; peer payment system; local champions and support from multidisciplinary team members; evidence strength and quality of the programme design; availability of resources; referral pathways; knowledge, beliefs and self-efficacy of facilitators, as well as local culture influenced implementation. While some were specific to the programme, many barriers reflected systemic and structural challenges within health services more generally. Conclusion: Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

Section: Eolas Interventionmentioning

confidence: 99%

Section: Eolas Interventionmentioning

confidence: 99%

Factors impacting the implementation of a psychoeducation intervention within the Mental Health System: a multisite study using the Consolidation Framework for Implementation Research

Murphy

Downes

et al. 2020

Preprint

“…One of the core differences between the EOLAS programmes and other programmes in the literature is the dual nature of the facilitation, as it incorporated both peer and clinician facilitation. The background to the project, the content of each information programme, and the process used to co-design the programmes are reported elsewhere (Higgins et al 2017a).…”

Section: Eolas Mental Health Information Projectmentioning

confidence: 99%

“…The background to the project, the content of each information programme, and the process used to co‐design the programmes are reported elsewhere (Higgins et al . ).…”

Section: Introductionmentioning

confidence: 97%

Outcomes of a co‐facilitation skills training programme for mental health service users, family members, and clinicians: the EOLAS project

Int J Mental Health Nurs

Hevey

Cusack³

et al. 2017

Health policy is increasingly advocating for involvement of service users and family members in service development. In the present study, we evaluated the impact of a 4-day education programme in co-facilitation skills on clinician and peer (service users and family members) knowledge, confidence, and subsequent experience as co-facilitators. The programme was designed to train peers and clinicians as co-facilitators on a clinician and peer-led information programme for people experiencing mental health problems. The study employed a mixed-methods design involving a pre-post survey with 128 participants, and follow-up qualitative interviews with a sample of 17 participants. To examine changes in levels of knowledge and confidence in facilitating from time 1 (T1) to time 2 (T2), paired sample t-tests were conducted, and thematic analysis was conducted on the interviews. The programme had a statistically-significant positive impact on participants' knowledge, confidence, and skills, with no significant difference between the facilitator groups (i.e. service user, family member, and clinician) in terms of their improvement at the end of the training, indicating that all groups benefited equally from the training. A majority of participants reported a high level of preparedness as co-facilitators and an open and respectful approach towards each other's expertise, and many continued to gain skills and develop their confidence as they co-facilitated the 8-week EOLAS programme ('eolas' is the Irish word for knowledge). The findings also provide evidence of the acceptability and feasibility of the programme, and appears to be the first detailed study reported on a programme of this nature.

“…The intervention (called EOLAS, which is the Irish word for knowledge) consists of two parallel structured psychoeducation information programmes (one for people who have been diagnosed with schizophrenia spectrum or bipolar disorders and a seperate programme for family members and other supporters). Both programmes were developed in collaboration with service users and family members and are jointly facilitated by peers (service users and family members) and clinicians [ 36 ], thus combining lived experience with clinical knowledge and expertise. The programmes consist of 8 weekly sessions of approximately 90-min duration, with some sessions being delivered by a guest speaker who has been selected in conjunction with the participants.…”

Section: Introductionmentioning

confidence: 99%

Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research

Murphy

Downes

et al. 2020

BMC Health Serv Res

Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention’s implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. Conclusion Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.