Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, Australia.
Early Interv Psychiatry. 2023 Feb;17(2):212-222. doi: 10.1111/eip.13324. Epub 2022 Jun 29.
Physical activity interventions are recommended for community-based youth mental health services to prevent physical health disparities. Implementation is challenging, and studies focusing on the methods to achieve change are needed. This study aims to identify the context, implementation strategies, and implementation outcomes that illustrate how physical activity interventions were implemented within an early intervention service in Australia.
A theoretically informed case study was undertaken. Data from a community-based youth mental health service that delivers an early psychosis programme were collected between July and November 2020. Three data sources were accessed (1) interviews with service managers, mental health clinicians and exercise physiologists; (2) document review of organizational policies and procedures; and (3) survey using the Program Sustainability Assessment Tool. The implementation outcomes investigated were acceptability, fidelity, penetration, and sustainability. Framework analysis was used, and a logic model developed guided by an established template, to interpret findings.
Forty-three contextual factors and 43 implementation strategies were identified. The data suggests that creating a new clinical team and auditing and feedback are critical for implementation. High levels of acceptability and sustainability were described, while fidelity of implementation was difficult to establish, and penetration was low.
The relationship between constructs suggests several mechanisms underpinned implementation. These include changing professional beliefs, establishing new organizational norms, augmenting existing work processes, and aligning physical activity with priorities of the mental healthcare system and existing work tasks. This case study provides direction for future health service planning of physical activity interventions in community-based youth mental health service.
身体活动干预措施被推荐用于社区为基础的青少年心理健康服务，以预防身体健康差距。实施具有挑战性，需要研究专注于实现变革的方法。本研究旨在确定背景、实施策略和实施结果，这些结果说明了如何在澳大利亚的早期干预服务中实施身体活动干预措施。
进行了一项理论上有依据的案例研究。2020 年 7 月至 11 月期间，收集了一家提供早期精神病计划的社区为基础的青少年心理健康服务的数据。共使用了三种数据源：（1）与服务经理、心理健康临床医生和运动生理学家的访谈；（2）对组织政策和程序的文件审查；（3）使用计划可持续性评估工具进行的调查。研究调查了可接受性、保真度、渗透和可持续性这四个实施结果。采用框架分析，并使用既定模板开发逻辑模型，以解释研究结果。
确定了 43 个背景因素和 43 个实施策略。数据表明，创建新的临床团队和审核与反馈对于实施至关重要。描述了高接受度和可持续性，而实施的保真度难以确定，渗透率较低。
结构之间的关系表明，实施有几个机制。这些机制包括改变专业信念、建立新的组织规范、增强现有工作流程，以及使身体活动与精神卫生保健系统的优先事项和现有工作任务保持一致。本案例研究为未来在社区为基础的青少年心理健康服务中规划身体活动干预措施提供了方向。
