A worked example of initial theory-building: PARTNERS2 collaborative care for people who have experienced psychosis in England

Abstract

In this article, we present an exemplar of the initial theory-building phase of theory-driven evaluation for the PARTNERS2 project, a collaborative care intervention for people with experience of psychosis in England. Initial theory-building involved analysis of the literature, interviews with key leaders and focus groups with service users. The initial programme theory was developed from these sources in an iterative process between researchers and stakeholders (service users, practitioners, commissioners) involving four activities: articulation of 442 explanatory statements systematically developed using realist methods; debate and consensus; communication; and interrogation. We refute two criticisms of theory-driven evaluation of complex interventions. We demonstrate how the process of initial theory-building made a meaningful contribution to our complex intervention in five ways. Although time-consuming, it allowed us to develop an internally coherent and well-documented intervention. This study and the lessons learnt provide a detailed resource for other researchers wishing to build theory for theory-driven evaluation.

Refining a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses in England: a qualitative formative evaluation

“…Where there was evidence of the intervention being delivered as intended, the themes identified in relation to each of the intended outcome domains reflected the mechanisms proposed within the programme theory. This indicates that the programme theory itself does not require revision in advance of the full trial and provides some validation of the comprehensive theory development process outlined in Gwernan-Jones et al [9]. However, the model requires more robust testing during the full trial, when we anticipate that increased implementation support will lead to greater fidelity and there will be thus be more opportunity to explore in depth how the intervention may have its effects.…”

“…Subsequent analysis focussed on the intended outcomes of the intervention. The themes identified for each outcome domain were compared to the mechanisms hypothesised in the programme theory, as articulated in the intervention logic model and ‘explanatory statements’ [9] (see Fig. 1 and Table 2).…”

“…The PARTNERS2 (develoPing integrAted primaRy care for paTieNts with sERiouS mental illness) programme intends to address this gap through the development of a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses, which will be tested through a randomised controlled trial in three sites in England. The process of the development of the model and the intervention theory are described in more detail in Gwernan-Jones et al [9]. A Cochrane review [8] of collaborative care approaches for people with severe mental illness, defined as schizophrenia or other types of schizophrenia like psychosis (e.g.…”

“…Mechanisms include a diverse range of processes, such as increasing acceptance, motivation, knowledge and skills, trust, and self-confidence [14–16]. The initial programme theory development resulted in a large number of ‘explanatory statements’ [9], which are summarised in Fig. 1 and Table 2.

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Evaluation of a primary care-based collaborative care model (PARTNERS2) for people with diagnoses of schizophrenia, bipolar, or other psychoses: study protocol for a cluster randomised controlled trial

“…The intervention was founded on Wagner's Chronic Care Model (2), principles of personal recovery (3) and coaching for mental health (4). The programme theory and practice were iteratively developed utilising a Realist approach (5,6), wider literature, primary data and stakeholder input (7). The intervention was 'fixed' after the refinement in this feasibility stage (8).…”