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Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation
Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation

Purpose: Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. Methods: A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results: The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions: Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

Care planning, Implementation, Mental health, Process evaluation, Qualitative, User involvement
0933-7954
1-13
Brooks, Helen
0056a0c8-f97a-4215-99e1-652291fcd6eb
Lovell, Karina
5d35b37c-4545-4ba4-a66c-9d94e1e9e780
Bee, Penny
76e373ee-12be-4966-8bb6-8157e1dc037d
Fraser, Claire
aebecd2c-85c7-4e2f-92a6-00b11b8f1326
Molloy, Christine
4181ba54-25c1-44e5-8436-cefe2abd12b5
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7
Brooks, Helen
0056a0c8-f97a-4215-99e1-652291fcd6eb
Lovell, Karina
5d35b37c-4545-4ba4-a66c-9d94e1e9e780
Bee, Penny
76e373ee-12be-4966-8bb6-8157e1dc037d
Fraser, Claire
aebecd2c-85c7-4e2f-92a6-00b11b8f1326
Molloy, Christine
4181ba54-25c1-44e5-8436-cefe2abd12b5
Rogers, Anne
105eeebc-1899-4850-950e-385a51738eb7

Brooks, Helen, Lovell, Karina, Bee, Penny, Fraser, Claire, Molloy, Christine and Rogers, Anne (2018) Implementing an intervention designed to enhance service user involvement in mental health care planning: a qualitative process evaluation. Social Psychiatry and Psychiatric Epidemiology, 1-13. (doi:10.1007/s00127-018-1603-1).

Record type: Article

Abstract

Purpose: Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental health interventions. A randomised controlled trial of a user- and carer-informed training package in the United Kingdom to enhance SDM in care planning in secondary mental health care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, carer, mental health professional and organisational levels. Methods: A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental health service users, carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results: The process evaluation demonstrated that despite buy-in from those delivering care planning in mental health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions: Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of health care relationships and include elements which seek to address these directly.

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Accepted/In Press date: 18 September 2018
e-pub ahead of print date: 28 September 2018
Keywords: Care planning, Implementation, Mental health, Process evaluation, Qualitative, User involvement

Identifiers

Local EPrints ID: 425069
URI: https://eprints.soton.ac.uk/id/eprint/425069
ISSN: 0933-7954
PURE UUID: 233585e4-ce4b-46f2-87f3-4e677e0fc798

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Date deposited: 10 Oct 2018 16:30
Last modified: 13 Mar 2019 17:57

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Contributors

Author: Helen Brooks
Author: Karina Lovell
Author: Penny Bee
Author: Claire Fraser
Author: Christine Molloy
Author: Anne Rogers

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