Implementing a Complex Intervention to Support Personal Recovery: A Qualitative Study Nested within a Cluster Randomised Controlled Trial

Abstract

ObjectiveTo investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams.DesignProcess evaluation nested within a cluster randomised controlled trial (RCT).Participants28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports.Setting14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention.ResultsThe factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles.ConclusionsThree findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure.Trial RegistrationControlled-Trials.com ISRCTN02507940

Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention

“…The findings further suggest implementation issues surrounding the way in which the intervention was implemented which included a lack of change in the relationships between staff and service users, and/or formulaic and non-individualised use of the recovery tools. These findings are consistent with the staff process evaluation, which specifically focused on the implementation of the intervention and highlighted barriers to implementation within routine practice, including organisational readiness and fit with routine targets and outcomes [29].…”

“…However rigid and formulaic implementation was not found to be helpful. Previous research has indicated that staff tend to focus on particular tasks as evidence of 'doing' recovery thus, "omitting the underlying philosophy of recovery-orientated practice" [29,30].…”

Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery‐oriented training

“…The REFOCUS intervention for community mental health teams (case study 3) took place at a similar time and Leamy et al . () state on p4 ‘the organizational changes were of such intensity that workers reported focusing on and prioritizing their own survival’. It may be overly ambitious to try to engage members of staff with a training/change programme at all in such overwhelmingly negative circumstances.…”

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers

“…; Hungerford ; Leamy et al . ). The challenge for mental health nurses is to develop sustainable and productive relationships with MHW that enhance workforce capability, are responsive to client and family needs, and embrace the recovery paradigm.…”