Service users experience of psychological interventions in primary care settings: A qualitative meta‐synthesis

Abstract

Primary care mental health services play a crucial role in public mental health by providing local and accessible psychological interventions that meet individuals' needs. Despite growing research investigating service users' perspectives of psychological interventions, a qualitative systematic review in this context is not available. The present meta-synthesis collates the existing articles and gives a thematic synthesis of qualitative studies on service users' experience of psychological interventions in primary care. Multiple databases (CINAHL, EMBASE, PsychINFO, MEDLINE, and Cochrane Library) were searched for published qualitative studies of service users' experiences of psychological interventions delivered in primary care. Articles were included if they met inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme tool. All types of psychological interventions were considered across model and delivery format (e.g., face-to-face, computerised programmes, and group). NVIVO was used to code the dataset and themes were extracted following thematic synthesis. Twenty-two studies were included. Four analytical themes and 10 subthemes emerged. The identified themes were as follows: (1) 'Access and Acceptability: facilitators and barriers', (2) 'Structural aspects'; (3) 'Therapeutic process' and (4) 'Outcomes'. A model of interrelationships between themes is proposed. Findings suggest several 'essential ingredients' across psychological interventions and modalities. The crucial role of relational factors, the importance of assessing service users' perceptions of treatment features (e.g., remote delivery) and of tailoring the intervention to their needs were emphasised. Results also suggest involving service users more in discussions and decisions about psychological interventions offered might enhance access, acceptability, and engagement. Recommendations for practice and research are provided.

Exploring service users experiences of remotely delivered CBT interventions in primary care during COVID-19: An interpretative phenomenological analysis

“…Participants described the role of their expectations, ambivalence and feelings before accessing PLOS ONE psychological interventions. This finding is in line with other studies conducted in primary care settings [39,52] and the previous qualitative meta-synthesis [41]. Existing research suggests that patients' expectations and attitudes are predictors of engagement [71] and outcome [72] and a small but significant meta-analytic association between pre-intervention expectations of outcomes and post-treatment outcomes [73].…”

“…IPA, as a qualitative research approach, has been used in different psychological studies to gain a deeper understanding of service users' experiences of treatment [e.g. 41,42]. This study applied IPA throughout the entire research process to explore how patients experienced accessing and engaging in psychological therapies in a Scottish primary care service during the pandemic.…”

“…Following discussion with supervisors and review of the existing qualitative literature on this topic [41] the researcher (EF) developed the interview schedule with open-ended questions and prompts aimed to elicit rich data and limit researcher bias as recommended by IPA methodology [63]. Questions covered participants' personal experiences of accessing, receiving and completing psychological treatment.…”

“…On the contrary, more qualitative research conducted in England and other countries has been published [41]. A series of qualitative studies from IAPT services have explored service users' experience of low-intensity interventions for common mental health disorders [42,43], interventions adapted to perinatal [44,45], veterans [46], and refugees and asylum seeker populations [47].…”

“…Whilst Khan et al [55] meta-synthesis focused solely on depression management in primary care services other qualitative research explored practitioners' perspectives [24,56,57]. The aforementioned qualitative meta-synthesis of service users' experiences of psychological treatment in primary care services [41] identified a range of factors related to structural and processual features of psychological interventions impact on treatment access, acceptability and outcome. However, none of these studies provide specific insights into service users' experience of individual psychological interventions for common mental health disorders in Scotland where PMHCS organisation differs from an IAPT model and when COVID-19 pandemic changed the delivery format of psychological interventions worldwide [58].…”