Changing practice to support self-management and recovery in mental illness: application of an implementation model

Abstract

Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.

The use of the PARIHS framework in implementation research and practice—a citation analysis of the literature

“…A total of 102 (28%) articles described testing or validating PARIHS, or provided comments on the validity of the framework [ 3 , 13 , 23 , 24 , 35 , 44 , 46 , 58 , 60 , 62 , 64 , 67 , 71 , 74 , 76 , 78 – 81 , 84 , 85 , 89 , 98 , 105 , 107 , 110 , 113 , 115 , 120 , 121 , 143 , 149 , 150 , 153 , 155 , 157 – 159 , 166 , 168 , 170 , 172 , 180 – 182 , 187 , 188 , 190 , 191 , 195 , 198 , 201 , 203 , 204 , 206 – 209 , 211 , 212 , 214 , 229 , 246 , 249 , 250 , 252 , 253 , 255 , 264 , 267 , 268 , 277 , 278 ...…”

“…About 35 studies applied PARIHS for quantitative analysis, (e.g., [69,168,174,190,211]). In half of these, the Alberta Context Tool (e.g., [155,165,180,195,229]) and the Organizational Readiness to Change Assessment Tool (e.g., [74,159,219,240]) were used; both these tools being derived from PARIHS. Empirical studies using the PARIHS framework in the analysis encompassed primarily all three main elements of PARIHS (e.g., [166,181,193,221]) and the context domain (e.g., [78,152,153,207]), and in lesser extent the evidence (e.g., [185,208,214]) and the facilitation domain (e.g., [58,67,79,182]).…”

“…Testing and providing views on the validity of the framework A total of 102 (28%) articles described testing or validating PARIHS, or provided comments on the validity of or parts of the framework with a focus on: ▪ The validity of the whole framework (e.g., [24,74,157,195,209]) ▪ The validity of context (e.g., [155,190,280,287,308]) ▪ The validity of facilitation (e.g., [23,58,182,206]) ▪ The validity of evidence (e.g., [255]) ▪ Identifying gaps in the framework (e.g., [64,170,326]) Over the review study period (1998 to 2019), among empirical studies, there was a shift from primarily studying the context element of the framework to more articles evaluating the whole framework. This was also evident in the pattern found in the protocols, which mostly focused on testing facilitation (e.g., [58,182,206]).…”

Care Plans in Community Mental Health: an Audit Focusing on People with Recent Hospital Admissions

“…A defined implementable care planning intervention, supportive service settings, staff ready and able to perform care planning, and a deliberate implementation process are also needed. 27,28 Care planning interventions are available for use in mental health. 29,30 Other studies indicate barriers to practice-change for recovery-oriented care which the implementation plans should target.…”

Improving cardiovascular health and quality of life in people with severe mental illness: study protocol for a randomised controlled trial

“…The Flinders Program comprises an overarching clinical, person-centred process underpinned by cognitive and behavioural theory and motivational techniques. It integrates self-management support and tailored evidence-based preventive interventions, as identified above, and is consistent with the Chronic Care Model principles of self-management support [ 22 ] and recovery-oriented care [ 23 ]. Existing research shows sustained behaviour change, in a range of populations, conveys better disease management, improved quality of life [ 22 , 24 – 28 ] and preventive health benefits [ 29 , 30 ].…”