Fyhn Tonje, Ludvigsen Kari, Reme Silje E, Schaafsma Frederieke
NORCE Norwegian Research Centre, Postboks 7810, 5020 Bergen, Norway.
Department of Pedagogy, Religion and Social Studies, Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Norway.
Implement Sci Commun. 2020 Oct 30;1:95. doi: 10.1186/s43058-020-00083-9. eCollection 2020.
Individual Placement and Support (IPS) is an evidence-based work rehabilitation program helping people with moderate to severe mental illness to obtain ordinary employment. Although IPS has proven superior to other work rehabilitation programs, in many studies, the majority of the participants remain unemployed. Structured process evaluations of IPS that use mixed methods are scarce, although they could identify implementation aspects that may enhance its effect. The aim of the current study is to assess reach, fidelity, and identify barriers and facilitators to implement IPS.
The process evaluation was conducted alongside a randomized controlled trial including six IPS centers, comparing IPS with treatment as usual in a population of patients in treatment for moderate to severe mental illness. Mixed methods were used in the process evaluation, including focus group interviews with service providers, individual interviews and survey data from participants, and fidelity reviews using the validated IPS Fidelity Scale.
The intervention reached the intended target group. All centers reached fair to good fidelity according to the IPS Fidelity Scale within the project period (range 97-109, SD 8.1) (see Table 5). Certain fidelity items indicated implementation issues related to employer contact, community-based services, and integration with health services. Survey data showed that less than half of the participants regarded their illness as a barrier for participating in IPS and that freedom of disclosure was important. Participant interviews gave further insight into the role of the IPS specialist, emphasizing their availability and consistent job focus.
Indications of implementation challenges across centers during the first year suggest special attention should be given to these aspects in an early phase to ensure higher fidelity from the start and thus enhance the effectiveness of IPS. The IPS specialist played an important role for participants and was described as positive, pushing in a positive way, and encouraging. More knowledge on the characteristics of successful IPS specialists could further enhance the effectiveness of the intervention.
The study was registered on clinicaltrials.gov prior to the inclusion period (reg.no: NCT01964092, registered 17/07/2013).
accompanies this paper at 10.1186/s43058-020-00083-9.
个体安置与支持（IPS）是一项循证工作康复项目，旨在帮助中重度精神疾病患者获得普通就业机会。尽管IPS已被证明优于其他工作康复项目，但在许多研究中，大多数参与者仍未就业。虽然采用混合方法对IPS进行结构化过程评估可能会识别出可能增强其效果的实施方面，但此类评估却很稀少。本研究的目的是评估IPS的覆盖范围、保真度，并识别实施过程中的障碍和促进因素。
过程评估与一项随机对照试验同时进行，该试验包括六个IPS中心，在中重度精神疾病患者群体中，将IPS与常规治疗进行比较。过程评估采用混合方法，包括与服务提供者进行焦点小组访谈、收集参与者的个人访谈和调查数据，以及使用经过验证的IPS保真度量表进行保真度审查。
干预措施覆盖了目标群体。在项目期间，根据IPS保真度量表，所有中心的保真度达到了中等至良好水平（范围为97 - 109，标准差8.1）（见表5）。某些保真度项目表明在雇主联系、社区服务以及与健康服务整合方面存在实施问题。调查数据显示，不到一半的参与者认为他们的疾病是参与IPS的障碍，并且信息披露的自由度很重要。参与者访谈进一步深入了解了IPS专家的作用，强调了他们随时可提供帮助以及始终专注于工作。
第一年各中心出现的实施挑战迹象表明，应在早期阶段特别关注这些方面，以确保从一开始就有更高的保真度，从而提高IPS的有效性。IPS专家对参与者发挥了重要作用，被描述为积极、以积极的方式推动并鼓励他人。更多关于成功IPS专家特征的知识可能会进一步提高干预措施的有效性。
该研究在纳入期之前已在clinicaltrials.gov上注册（注册号：NCT01964092，于2013年7月17日注册）。
与本文一同发布于10.1186/s43058 - 020 - 00083 - 9。
