Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory-, evidence-, and person-based approach
Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory-, evidence-, and person-based approach
Objectives We aimed to develop a digital intervention to support antidepressant discontinuation in UK primary care that is scalable, accessible, safe and feasible. In this paper, we describe the development using a theory, evidence and person-based approach. Design Intervention development using a theory, evidence and person-based approach. Setting Primary Care in the South of England. Participants Fifteen participants with a range of antidepressant experience took part in think aloud' interviews for intervention optimisation. Intervention Our digital intervention prototype (called ADvisor') was developed on the basis of a planning phase consisting of qualitative and quantitative reviews, an in-depth qualitative study, the development of guiding principles and a theory-based behavioural analysis. Our optimisation phase consisted of think aloud' interviews where the intervention was iteratively refined. Results The qualitative systematic review and in-depth qualitative study highlighted the centrality of fear of depression relapse as a key barrier to discontinuation. The quantitative systematic review showed that psychologically informed approaches such as cognitive-behavioural therapy were associated with greater rates of discontinuation than simple advice to reduce. Following a behavioural diagnosis based on the behaviour change wheel, social cognitive theory provided a theoretical basis for the intervention. The intervention was optimised on the basis of think aloud interviews, where participants suggested they like the flexibility of the system and found it reassuring. Changes were made to the tone of the material and the structure was adjusted based on this qualitative feedback. Conclusions ADvisor' is a theory, evidence and person-based digital intervention designed to support antidepressant discontinuation. The intervention was perceived as helpful and reassuring in optimisation interviews. Trials are now needed to determine the feasibility, clinical and cost-effectiveness of this approach.
antidepressants, depression & mood disorders, digital intervention, intervention development, primary care
Bowers, Hannah
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Kendrick, Tony
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Glowacka, Marta A
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Williams, Samantha
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Leydon, Geraldine
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May, Carl
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Dowrick, Chris
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Moncrieff, Joanna
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Laine, Rebecca
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Nestoriuc, Yvonne
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Andersson, Gerhard
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Geraghty, Adam
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8 March 2020
Bowers, Hannah
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Kendrick, Tony
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Glowacka, Marta A
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Williams, Samantha
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Leydon, Geraldine
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May, Carl
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Dowrick, Chris
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Moncrieff, Joanna
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Laine, Rebecca
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Nestoriuc, Yvonne
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Andersson, Gerhard
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Geraghty, Adam
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Bowers, Hannah, Kendrick, Tony, Glowacka, Marta A, Williams, Samantha, Leydon, Geraldine, May, Carl, Dowrick, Chris, Moncrieff, Joanna, Laine, Rebecca, Nestoriuc, Yvonne, Andersson, Gerhard and Geraghty, Adam
(2020)
Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory-, evidence-, and person-based approach.
BMJ Open, 10 (3), [e032312].
(doi:10.1136/bmjopen-2019-032312).
Abstract
Objectives We aimed to develop a digital intervention to support antidepressant discontinuation in UK primary care that is scalable, accessible, safe and feasible. In this paper, we describe the development using a theory, evidence and person-based approach. Design Intervention development using a theory, evidence and person-based approach. Setting Primary Care in the South of England. Participants Fifteen participants with a range of antidepressant experience took part in think aloud' interviews for intervention optimisation. Intervention Our digital intervention prototype (called ADvisor') was developed on the basis of a planning phase consisting of qualitative and quantitative reviews, an in-depth qualitative study, the development of guiding principles and a theory-based behavioural analysis. Our optimisation phase consisted of think aloud' interviews where the intervention was iteratively refined. Results The qualitative systematic review and in-depth qualitative study highlighted the centrality of fear of depression relapse as a key barrier to discontinuation. The quantitative systematic review showed that psychologically informed approaches such as cognitive-behavioural therapy were associated with greater rates of discontinuation than simple advice to reduce. Following a behavioural diagnosis based on the behaviour change wheel, social cognitive theory provided a theoretical basis for the intervention. The intervention was optimised on the basis of think aloud interviews, where participants suggested they like the flexibility of the system and found it reassuring. Changes were made to the tone of the material and the structure was adjusted based on this qualitative feedback. Conclusions ADvisor' is a theory, evidence and person-based digital intervention designed to support antidepressant discontinuation. The intervention was perceived as helpful and reassuring in optimisation interviews. Trials are now needed to determine the feasibility, clinical and cost-effectiveness of this approach.
Text
REDUCE WS3 patient development paper v3.5 clean revisions - 16.12.2019
- Accepted Manuscript
More information
Accepted/In Press date: 13 January 2020
e-pub ahead of print date: 8 March 2020
Published date: 8 March 2020
Additional Information:
Funding Information:
Contributors TK led on the grant application for the 6-year REDUCE programme. SW conducted primary qualitative interviews which informed the intervention content. AWAG led the development of the intervention. AWAG and HMB conducted theoretical modelling, behavioural analysis and developed guiding principles. HMB drafted intervention content and discussed with the intervention development team (AWAG and MG) and the wider team (TK, SW, GL, CM, CFD, JM, RL, YN and GA). MG developed the intervention into a digital format using Lifeguide software and led on intervention testing. Think aloud interviews were conducted by HMB, SW and TK. RL provided support with recruitment for think aloud interviews. Think aloud transcripts were coded by HMB and the results were discussed with AWAG, GL, TK and CM for interpretation. HMB, MG and AWAG refined the intervention in line with patient feedback, with comments from the wider team when necessary. The manuscript was prepared by HMB and AWAG, and has been approved by all coauthors. Funding This work was supported by NIHR Programme Grant for Applied Research (PGfAR) grant number RP-PG-1214-20004. Competing interests TK reports grants from National Institute for Health Research, during the conduct of the study. JM reports grants from National Institute of Health Research, during the conduct of the study; and is a member of the Council for Evidence-based Psychiatry which is an unfunded organisation, whose mission is to 'communicate evidence of the potentially harmful effects of psychiatric drugs to the people and institutions in the UK that can make a difference'.
Publisher Copyright:
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.
Keywords:
antidepressants, depression & mood disorders, digital intervention, intervention development, primary care
Identifiers
Local EPrints ID: 437414
URI: http://eprints.soton.ac.uk/id/eprint/437414
ISSN: 2044-6055
PURE UUID: f9a74141-73e0-4333-8f36-a6dad144e93f
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Date deposited: 29 Jan 2020 17:35
Last modified: 17 Mar 2024 03:21
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Contributors
Author:
Marta A Glowacka
Author:
Carl May
Author:
Chris Dowrick
Author:
Joanna Moncrieff
Author:
Rebecca Laine
Author:
Yvonne Nestoriuc
Author:
Gerhard Andersson
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