Remote Care for Caregivers of People With Psychosis: Mixed Methods Pilot Study

Abstract

Background A reduced availability of resources has hampered the implementation of family work in psychosis. Web-based support programs have the potential to increase access to high-quality, standardized resources. This pilot study tested the Norwegian version of the Relatives Education and Coping Toolkit (REACT), a web-based United Kingdom National Health Service program in combination with phone-based support by trained family therapists. Objective We investigated how the program was perceived by its users and identified the facilitators and barriers to its clinical implementation. Methods Relatives of people with psychosis were offered access to REACT and to weekly family therapist support (with 1 of 2 trained family therapists) for 26 weeks. Level of distress and level of expressed emotion data were collected at baseline and after 26 weeks using the Family Questionnaire and the Relatives Stress Scale. Both family therapists and a subset of the relatives were interviewed about their experiences after completing the program. Results During the program, relatives (n=19) had a median of 8 (range 4-11) consultations with the family therapists. Postintervention, there was a significant reduction in stress and in expressed emotions in the relatives of people with psychosis. Interviews with the relatives (n=7) and the family therapists (n=2) indicated the following themes as important—the intervention turned knowledge into action; the intervention strengthened the feeling of being involved and taken seriously by the health services; and management support and the ability for self-referral were important, while lack of reimbursement and clinician resistance to technology were barriers to implementation. Conclusions The service was found to offer a valued clinical benefit; however, strategies that aim to engage clinicians and increase organizational support toward new technology need to be developed.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review

“…With respect to process measures, professionals reported rigidity in their work process [ 146 , 187 , 192 , 196 ], as well as a tendency to be risk averse and to resist change unless a digital therapeutic had been nationally accredited or endorsed [ 63 , 104 , 139 , 147 , 231 , 248 ], reemphasizing the need for policy mechanisms aimed at the accreditation of digital therapeutics. Approval from the institutional or social environment was also reported as an important indicator of the uptake and use of digital therapeutics by health professionals [ 19 , 42 , 62 , 104 , 112 , 115 , 139 , 156 , 159 , 174 , 200 , 202 , 203 ].…”

“…At the patient level, the most reported relative advantages were improvements in health outcomes and shortened disease duration through novel health care options, faster diagnoses, decrease in adverse medical events, and improved monitoring of clinical and patient-reported outcome measures [ 11 , 17 , 41 , 43 , 45 , 47 - 49 , 53 , 60 , 61 , 69 , 71 , 74 , 80 , 81 , 88 , 92 , 94 , 95 , 100 , 102 , 105 , 124 , 128 , 130 , 132 , 133 , 135 , 137 , 138 , 146 , 153 , 163 , 172 , 173 , 179 , 189 , 202 , 207 , 218 , 224 , 226 , 228 , 229 , 231 , 232 , 234 , 239 - 242 , 244 , 246 , 248 , 257 , 260 , 262 , 263 , 265 , 266 , 270 , 275 ], as well as changes in the quality of life, well-being, and life expectancy [ 13 , ...…”

“…Our search strategy yielded 49,192 1). Out of 244 documents, our final sample comprised 60 (24.6%) literature reviews [19,; 49 (20.1%) viewpoints, commentaries, and editorials [11,13,17,; 43 (17.6%) cross-sectional studies [83,; 39 (16%) qualitative research articles [1,15,; 13 (5.3%) case reports [4,5,12,[224][225][226][227][228][229][230][231][232][233]; 11 (4.5%) longitudinal studies [234][235][236][237][238][239][240][241][242][243][244]; 9 (3.7%) mixed methods studies [245][246][247][248][249][250][251][252][253]; 5 (2%) economic evaluations [254][255][256][257][258]; ...…”

Crossing boundaries in the delivery of healthcare – a qualitative study of an eHealth intervention in relation to boundary object theory

“… 45 REACT-NOR is a Norwegian version previously pilot tested with a slightly different design, using telephone support by supporters trained in psychoeducational family therapy instead of peer support. 46 Due to the COVID-19 pandemic, REACT-NOR was relaunched, this time with video support to enable safe support for caregivers, named REACT-NORV (REACT-NOR + Video). This enabled supporters and caregivers to meet and work with the toolkit while being able to see each other, and literally, be on the same (web) page.…”

Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review

“…As mentioned, early referral to specialist mental health services is critical, so that appropriate interventions can be provided to improve outcomes and long-term outlook. The younger the patient is, and the more severe the symptoms are, the more important it is to collaborate not just with the individual, but also with the family and other network members ( 15 ). Providing specialized early intervention to treat recent−onset psychosis is likely to have benefits: more people continue with their treatment, and the number of people who recover increases in comparison to treatment as usual (TAU) ( 16 ).…”