Division of Psychiatry, University College London, London, United Kingdom.
Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom.
PLoS One. 2023 Feb 27;18(2):e0282157. doi: 10.1371/journal.pone.0282157. eCollection 2023.
There is robust evidence for offering supported self-management interventions for people with severe mental illness (SMI) throughout secondary mental health services, but their availability remains patchy. The aim of this systematic review is to synthesise the evidence on barriers and facilitators to implementing self-management interventions for people with SMI in secondary mental health care settings.
The review protocol was registered with PROSPERO (CRD42021257078). Five databases were searched to identify relevant studies. We included full-text journal articles with primary qualitative or quantitative data on factors which affect the implementation of self-management interventions for people with SMI in secondary mental health services. The included studies were analysed using narrative synthesis, using the Consolidated Framework for Implementation Research and an established taxonomy of implementation outcomes.
Twenty-three studies from five countries met eligibility criteria. The barriers and facilitators identified in the review were mainly on the organisational level, but included some individual-level influences. Facilitators included high feasibility, high fidelity, a strong team structure, sufficient number of staff, support from colleagues, staff training, supervision, the presence of an implementation champion and adaptability of the intervention. Barriers to implementation include high staff turnover, staff shortage, lack of supervision, lack of support for staff delivering the programme, staff struggling with their increased workload, a lack of senior clinical leadership, and programme content perceived as irrelevant.
The findings from this research suggest promising strategies to improve implementation of self-management interventions. For services providing support for people with SMI, organisational culture should be considered, as well as the adaptability of interventions.
有强有力的证据表明，在二级精神卫生服务中为严重精神疾病（SMI）患者提供支持性自我管理干预措施，但这些措施的提供仍然参差不齐。本系统评价的目的是综合二级精神卫生保健环境中实施SMI 患者自我管理干预措施的障碍和促进因素的证据。
本评价方案已在 PROSPERO（CRD42021257078）上注册。检索了五个数据库以确定相关研究。我们纳入了全文期刊文章，这些文章主要包含影响二级精神卫生服务中 SMI 患者自我管理干预措施实施的定性或定量数据。使用实施研究综合框架和既定实施结果分类法对纳入的研究进行叙述性综合分析。
来自五个国家的 23 项研究符合入选标准。本评价中确定的障碍和促进因素主要在组织层面上，但也包括一些个体层面的影响。促进因素包括高可行性、高保真度、强大的团队结构、足够数量的员工、同事的支持、员工培训、监督、实施拥护者的存在和干预措施的适应性。实施障碍包括员工高流动率、员工短缺、缺乏监督、为实施计划的员工提供的支持不足、员工难以应对工作量增加、缺乏高级临床领导力以及项目内容被认为不相关。
这项研究的结果表明，有一些有前途的策略可以改善自我管理干预措施的实施。对于为 SMI 患者提供支持的服务，应该考虑组织文化，以及干预措施的适应性。
