Centre for Medical Ethics, University of Oslo, Postbox 1130 Blindern, 0318, Oslo, Norway.
Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1474, Nordbyhagen, Norway.
BMC Health Serv Res. 2022 Sep 12;22(1):1153. doi: 10.1186/s12913-022-08489-y.
The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders.
We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis.
Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals.
Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.
ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.
尽管有明确的证据基础、社会经济和道德理由、政策和指南建议，但精神病患者的家庭参与医疗服务的情况仍不理想。为了应对这一知识与实践之间的差距，我们开展了一项集群随机对照试验：在社区心理健康中心实施《精神障碍患者家庭参与指南》（IFIP）。这项嵌套于 IFIP 试验的子研究旨在探索当地实施团队和临床医生在实施精神障碍患者家庭参与精神卫生保健方面所面临的组织和临床障碍与促进因素。
我们进行了 21 次半结构化焦点小组访谈，共涉及 75 名参与者。实施团队成员在干预期的初始和中期接受访谈，而不在实施团队中的临床医生则在晚期接受访谈。采用目的性抽样方法招募在实施过程中有不同参与度的参与者。使用显式内容分析法对数据进行分析。
参与的组织障碍包括：1）缺乏共同的知识、观念和实践；2）缺乏常规；3）缺乏资源和后勤保障。临床障碍包括：4）患者相关因素；5）家属相关因素；6）提供者相关因素。参与的组织促进因素包括：1）全病房方法；2）指定和专门角色；3）标准化和常规。临床促进因素包括：4）外部实施支持；5）心理健康专业人员的理解、技能和自我效能感；6）心理健康专业人员的意识和态度。
通过全病房和多层次的方法，并通过组织和领导层的承诺，可以实现为精神病患者提供医疗服务时的家庭参与。向所有工作人员提供家庭心理教育培训，建立为所有患者提供基本家庭参与水平的常规，并确保临床医生获得家庭参与经验，可以减少或消除核心障碍。获得外部实施支持似乎对启动、促进和评估实施至关重要。我们的研究结果还指出了未来的政策、实践和实施发展方向，为所有患有严重精神疾病的患者及其家属提供适当的治疗和支持。
ClinicalTrials.gov 标识符 NCT03869177。注册于 19 年 3 月 11 日。
