Division of Health Research, Lancaster University, Bailrigg Campus, Lancaster, LA1 4YW, UK.
Clinical Trials Research Centre, University of Liverpool, Liverpool, UK.
BMC Health Serv Res. 2020 Mar 17;20(1):219. doi: 10.1186/s12913-020-5002-4.
Despite the potential of digital health interventions to improve the delivery of psychoeducation to people with mental health problems and their relatives, and substantial investment in their development, there is little evidence of successful implementation into clinical practice. We report the first implementation study of a digital health intervention: Relatives Education And Coping Toolkit (REACT), into routine mental healthcare. Our main aim was to identify critical factors affecting staff uptake and use of this online self-management tool for relatives of people with psychosis or bipolar.
A mixed-methods, theory-driven (Normalisation Process Theory), iterative multiple case study approach using qualitative analysis of interviews with staff and quantitative reporting of uptake. Carer researchers were part of the research team.
In all, 281 staff and 159 relatives from Early Intervention teams across six catchment areas (cases) in England registered on REACT; 129 staff took part in qualitative interviews. Staff were positive about REACT helping services improve support and meet clinical targets. Implementation was hindered by: high staff caseloads and difficulties prioritising carers; perception of REACT implementation as research; technical difficulties using REACT; poor interoperability with trust computer systems and care pathways; lack of access to mobile technology and training; restricted forum populations; staff fears of risk, online trolling, and replacement by technology; and uncertainty around REACT's long-term availability.
Digital health interventions, such as REACT, should be iteratively developed, evaluated, adapted and implemented, in partnership with the services they aim to support, and as part of a long term national strategy to co-develop integrated technology-enabled mental healthcare. Implementation strategies must instil a sense of ownership for staff and ensure they have adequate IT training, appropriate governance protocols for online working, and adequate mobile technologies. Wider contextual factors including adequate funding for mental health services and prioritisation of carer support, also need to be addressed for successful implementation of carer focussed digital interventions.
Study registration: ISCTRN 16267685.
尽管数字健康干预措施有可能改善心理健康问题患者及其家属的心理教育服务，并为其发展投入了大量资金，但将其成功实施到临床实践中的证据却很少。我们报告了一项数字健康干预措施的首次实施研究：亲属教育和应对工具包（REACT），将其纳入常规精神保健。我们的主要目的是确定影响工作人员接受和使用这种针对精神病或双相障碍患者亲属的在线自我管理工具的关键因素。
采用混合方法、理论驱动（正常化进程理论）、迭代多案例研究方法，对工作人员的访谈进行定性分析，并对采用情况进行定量报告。照护者研究人员是研究团队的一部分。
在英格兰六个服务区域（案例）的早期干预团队中，共有 281 名工作人员和 159 名亲属注册了 REACT；129 名工作人员参加了定性访谈。工作人员对 REACT 有助于服务提供支持并达到临床目标持积极态度。实施受到以下因素的阻碍：工作人员的工作量大，难以优先考虑照顾者；将 REACT 的实施视为研究；使用 REACT 存在技术困难；与信托计算机系统和护理途径的互操作性差；无法获得移动技术和培训；论坛人群受限；工作人员担心风险、网络骚扰和技术替代；以及对 REACT 的长期可用性存在不确定性。
数字健康干预措施，如 REACT，应与他们旨在支持的服务合作，通过迭代开发、评估、调整和实施，并作为共同制定集成技术型精神保健的国家长期战略的一部分。实施策略必须使工作人员具有归属感，并确保他们接受足够的 IT 培训、在线工作的适当治理协议以及足够的移动技术。还需要解决更广泛的背景因素，包括为精神卫生服务提供足够的资金以及优先考虑照顾者支持，以成功实施以照顾者为中心的数字干预措施。
研究注册：ISCTRN 16267685。
