‘I didn’t know what to expect’: Exploring patient perspectives to identify targets for change to improve telephone-delivered psychological interventions

Abstract

Background: Remote delivery of psychological interventions to meet growing demand has been increasing worldwide. Telephone-delivered psychological treatment has been shown to be equally effective and as satisfactory to patients as face-to-face treatment. Despite robust research evidence, however, obstacles remain to the acceptance of telephone-delivered treatment in practice. This study aimed to explore those issues using a phenomenological approach from a patient perspective to identify areas for change in current provision through the use of theoretically based acceptability and behaviour change frameworks. Methods: Twenty-eight semi-structured interviews with patients experiencing symptoms of common mental health problems, waiting, receiving or having recently received telephone-delivered psychological treatment via the UK National Health Service's Improving Access to Psychological Therapies (IAPT) programme. Interviews were recorded, transcribed verbatim, and analysed using the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability (TFA). Results: The majority of data clustered within five key domains of the TDF (knowledge, skills, cognitive and interpersonal, environmental context and resources, beliefs about capabilities, beliefs about consequences) and mapped to all constructs of the TFA (affective attitude, ethicality, intervention coherence, self-efficacy, burden, opportunity costs, and perceived effectiveness). Themes highlighted that early stages of treatment can be affected by lack of patient knowledge and understanding, reservations about treatment efficacy, and practical obstacles such as absent non-verbal communication, which is deemed important in the development of therapeutic alliance. Yet posttreatment, patients can reflect more positively, and report gaining benefit from treatment. However, despite this, many patients say that if they were to return for future treatment, they would choose to see a practitioner face-to-face.

What influences practitioners’ readiness to deliver psychological interventions by telephone? A qualitative study of behaviour change using the Theoretical Domains Framework

“…In addition, clarification of patients' expectations and treatment procedures (attendance, cancellation, discharge, confidentiality, environment, and boundaries) should be addressed at the initial assessment and/or early on in treatment to prevent misunderstandings/disappointment as well as to facilitate engagement with telephone treatment. These findings are in line recent findings that identified that patients referred to mental health services are often unaware about remote delivery and have unrealistic expectations of what their treatment might involve [46].…”

Service users experience of psychological interventions in primary care settings: A qualitative meta‐synthesis

“…Nearly all articles highlighted the importance of practitioners' qualities and skills (Amos et al, 2019;Bahu, 2019;Christodoulou et al, 2018;Doukani et al, 2020;Farrand et al, 2018;Foy et al, 2019;Goldman et al, 2016;Hadfield et al, 2019;Haller et al, 2019;Leonidaki et al, 2016;Lillevoll et al, 2013;Mackinnon & Murphy, 2016;Millett et al, 2018;Rushton et al, 2020).…”

Psychotherapy by Telephone or Internet in Austria and Germany Which CBT Psychotherapists Rate It more Comparable to Face-to-Face Psychotherapy in Personal Contact and Have more Positive Actual Experiences Compared to Previous Expectations?

“…Knowledge and understanding of remote treatment are also influencing factors regarding patients attitudes and acceptance towards telephone treatment. Addressing to these two factors, with special focus on existing prejudices and preconceptions about telephone treatment, is key to improve the acceptability with telephone treatment [ 40 , 41 ]. Previous research shows that patients also benefit from telemedicine.…”

“…The most frequently cited factors from the patients′ perspective were, for example, user-friendliness, low costs, improved communication, and shorter travel times [ 42 , 43 ]. Important factors influencing patient satisfaction include their overall understanding of telehealth [ 41 ], quality of care received, and telehealth′s convenience [ 44 ]. It is therefore important to support this digital progress and to further establish telemedicine in the health care system.…”