Abstract:Background
Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients’ perspective so far. This study’s purpose is to capture patients’ experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT).
Methods
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“…A variety of factors were perceived as barriers including lack of awareness regarding mental health symptoms and service availability (Farrand et al, 2018) as well as lack of expectations, and knowledge or understanding about what treatment would entail (Haller et al, 2019;Rogers et al, 2004; Rushton et al, 2020): Most people initially described themselves as ‘not knowing what to expect’ from the self‐help clinic. Nonetheless, it was clear that, for some, formulations about how the self‐help clinic might help them came from peoples' own constructions of self‐help, their previous engagement with or perception of mental health services, and what they were told by the GP.…”
Section: Resultsmentioning
confidence: 99%
“…In some studies (Farrand et al, 2018; Haller et al, 2019; Rushton et al, 2020), participants reported how remote delivery helped to avoid social stigma. Another benefit of time and location flexibility is that there is no perceived need for disclosure of a patients' participation in psychotherapy.…”
Section: Resultsmentioning
confidence: 99%
“…or understanding about what treatment would entail (Haller et al, 2019;Rogers et al, 2004;Rushton et al, 2020):…”
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.
“…A variety of factors were perceived as barriers including lack of awareness regarding mental health symptoms and service availability (Farrand et al, 2018) as well as lack of expectations, and knowledge or understanding about what treatment would entail (Haller et al, 2019;Rogers et al, 2004; Rushton et al, 2020): Most people initially described themselves as ‘not knowing what to expect’ from the self‐help clinic. Nonetheless, it was clear that, for some, formulations about how the self‐help clinic might help them came from peoples' own constructions of self‐help, their previous engagement with or perception of mental health services, and what they were told by the GP.…”
Section: Resultsmentioning
confidence: 99%
“…In some studies (Farrand et al, 2018; Haller et al, 2019; Rushton et al, 2020), participants reported how remote delivery helped to avoid social stigma. Another benefit of time and location flexibility is that there is no perceived need for disclosure of a patients' participation in psychotherapy.…”
Section: Resultsmentioning
confidence: 99%
“…or understanding about what treatment would entail (Haller et al, 2019;Rogers et al, 2004;Rushton et al, 2020):…”
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.
“…The use of the telephone for the delivery of psychological interventions has undoubtedly enabled wider access to treatment for patients [10][11][12]. The evidence for clinical effectiveness and acceptability of the telephone as a mode of treatment has been established [13,30]; challenges, however, remain around uptake and engagement. In order to gain a better understanding of the reasons, this study has explored patient perceptions of telephone treatment and identified a number of areas important to target to increase acceptability.…”
Background: Remote delivery of psychological interventions to meet growing demand has been increasing worldwide. Telephone-delivered psychological treatment has been shown to be equally effective and as satisfactory to patients as face-to-face treatment. Despite robust research evidence, however, obstacles remain to the acceptance of telephone-delivered treatment in practice. This study aimed to explore those issues using a phenomenological approach from a patient perspective to identify areas for change in current provision through the use of theoretically based acceptability and behaviour change frameworks. Methods: Twenty-eight semi-structured interviews with patients experiencing symptoms of common mental health problems, waiting, receiving or having recently received telephone-delivered psychological treatment via the UK National Health Service's Improving Access to Psychological Therapies (IAPT) programme. Interviews were recorded, transcribed verbatim, and analysed using the Theoretical Domains Framework (TDF) and Theoretical Framework of Acceptability (TFA). Results: The majority of data clustered within five key domains of the TDF (knowledge, skills, cognitive and interpersonal, environmental context and resources, beliefs about capabilities, beliefs about consequences) and mapped to all constructs of the TFA (affective attitude, ethicality, intervention coherence, self-efficacy, burden, opportunity costs, and perceived effectiveness). Themes highlighted that early stages of treatment can be affected by lack of patient knowledge and understanding, reservations about treatment efficacy, and practical obstacles such as absent non-verbal communication, which is deemed important in the development of therapeutic alliance. Yet posttreatment, patients can reflect more positively, and report gaining benefit from treatment. However, despite this, many patients say that if they were to return for future treatment, they would choose to see a practitioner face-to-face.
“…B. für die Gesprächsführung und die Fokussierung therapeutischer Inhalte unter Berücksichtigung der individuellen Situation des Patienten. Bisherige Evaluationsergebnisse zur Telefontherapie zeigen u. a., dass Patienten dieses Format, inklusive dem Telefon als Behandlungsmedium, ohne Schwierigkeiten akzeptieren und häufig als "Türöffner" erleben[15]. Auch niedrigschwellige mediengestützte Angebote (z.…”
Stepped Care (gestufte Behandlung) bietet einen passenden Rahmen, um evidenzbasierte Behandlungsempfehlungen bei Depression umzusetzen und dabei bestehende Defizite in der Versorgung zu reduzieren. Dadurch können niedrigschwellige Interventionen innerhalb eines adäquaten klinischen Rahmens durchgeführt werden. Im Beitrag werden Kernmerkmale, Evidenzlage und mögliche Weiterentwicklungen zu Stepped Care vorgestellt.
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