Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial

Abstract

Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.Trial Registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

“The most important thing is that those closest to you, understand you”: a nested qualitative study of persons with psychotic disorders’ experiences with family involvement

“…A strength of this study is the context and design of how it was performed—in a real world clinical setting, as part of a large cluster randomised study which has succeeded in improving the implementation of systematic family involvement ( 41 ). Close collaborations with many researchers in an interdisciplinary research group guided the research, and the authors of this article are well experienced in accommodating vulnerable groups in research and clinical practice.…”

“…The IFIP-study was established to improve health services and the health of individuals with psychotic disorders and their relatives through implementing evidence-based national recommendations on family involvement. Based on the national guidelines ( 1 , 39 , 40 ), the project group developed the IFIP-interventions ( Table 1 ) which is thoroughly described in the protocol article ( 38 ) and the fidelity outcomes article ( 41 ).…”

Clinicians’ perceptions of family involvement in the treatment of persons with psychotic disorders: a nested qualitative study

“…Being nested in a successful implementation trial ( 37 ), the present study is in a unique position to explore how clinicians perceive the benefits of family involvement when major barriers to implementation on both organisational and clinical levels have been traversed ( 34 , 51 , 52 ). Similarly, it can give an outline of the disadvantages or challenges that clinicians nonetheless experience.…”

“…All clinicians in the experimental clusters were offered training and supervision in FPE and BFIS. They were encouraged to offer BFIS to all patients and their relatives, and FPE to as many of them as possible ( 37 ).…”

Efficacy and feasibility of aerobic exercise interventions as an adjunctive treatment for patients with schizophrenia: a meta-Analysis

“…These interventions are often time-consuming and financially burdensome 16 . Given the current shortage of psychotherapists and low treatment adherence among patients with schizophrenia, the widespread adoption of these two non-drug treatment methods remains challenging 17 . In contrast, exercise interventions offer the benefits of ease of implementation, broad applicability, and lower costs, making them a more feasible option for widespread adoption 18 – 20 .…”