IMPlementation of A Relatives’ Toolkit (IMPART study): an iterative case study to identify key factors impacting on the implementation of a web-based supported self-management intervention for relatives of people with psychosis or bipolar experiences in a National Health Service: a study protocol

Abstract

BackgroundWeb-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions.MethodsA multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives’ Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives’ distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored.DiscussionObservation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project.Trial registrationISCTRN 16267685 (09/03/2016).

Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial

“…Living in any of six geographical areas by postcode taking part in a parallel implementation study of the same intervention (IMPART) [42]. Only one relative per service user was allowed to participate, to avoid a clustering effect.…”

A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT

“…Exclusion criteria included living in any of the six geographical areas by postcode taking part in the parallel IMPART study 104 of the same intervention. In addition, only one relative per service user was allowed to participate, to avoid a clustering effect.…”

IMPlementation of An online Relatives’ Toolkit for psychosis or bipolar (IMPART study): iterative multiple case study to identify key factors impacting on staff uptake and use

“…NPT has been extensively applied in eHealth settings [29][30][31] allowing us to compare our findings with previous studies. The protocol was published prior to the end of recruitment [24], and StaRI guidelines [32] used for reporting.…”

“…'Mytoolbox' offered users a confidential space to save links to any information they might want to access easily later, including specific toolkit content, self-reflection tasks, and external web links. REACT Supporters were members of the EI team, identified by [24]. Table 2 shows the different roles allocated within each team and their levels of site access.…”

“…The Relatives' Education And Coping Toolkit (REACT) is a supported self-management toolkit, providing accessible evidence-based information and support for relatives of people with psychosis or bipolar. Following evidence to support feasibility, acceptability, and effectiveness in reducing relatives' distress as a paper-based tool [23], REACT was developed into an online resource, incorporating a peer support forum, direct messaging, and extended to relatives of people with bipolar [24]. The clinical and cost effectiveness of REACT when offered directly to relatives recruited from outside clinical services is being tested [25].…”