Fiona Lobban|Duncan Appelbe|Victoria Appleton|Golnar Aref-Adib|Johanna Barraclough|Julie Billsborough|Naomi Fisher|Sheena Foster|Bethany Gill|David Glentworth|Chris Harrop|Sonia Johnson|Steven Jones|Tibor Zoltan Kovacs|Elizabeth Lewis|Barbara Mezes|Charlotte Morton|Elizabeth Murray|Puffin O’Hanlon|Vanessa Pinfold|Jo Rycroft?Malone|Ronald Siddle|Jo Smith|Chris Sutton|Pietro Viglienghi|A. Earl Walker|Catherine Wintermeyer
An online supported self-management toolkit for relatives of people with psychosis or bipolar experiences: the IMPART multiple case study
Lancaster University|University of Liverpool|Lancaster University|University College London|Lancaster University|McPin Foundation|Lancaster University|McPin Foundation|Lancaster University|University College London|Lancaster University|Lancaster University|Lancaster University|University College London|University College London|University College London|McPin Foundation|Bangor University|University of Worcester|Manchester Academic Health Science Centre|University of Manchester|Lancaster University|Lancaster University
background digital health interventions potential improve delivery psychoeducation people mental health problems relatives despite substantial investment development digital health interventions successful implementation routine clinical practice rare objectives use implementation relatives education coping toolkit react psychosisbipolar disorder identify critical factors affecting uptake use develop implementation plan support delivery react design implementation study using mixedmethods theorydriven multiple case study approach studyspecific implementation theory react based normalisation process theory developed tested iterations implementation plan address key factors affecting implementation developed setting earlyintervention teams six nhs mental health trusts england three north three south participants total 281 staff accounts 159 relatives accounts created 129 staff 23 relatives took part qualitative interviews experiences 132 relatives provided demographic data 56 provided baseline data 21 provided data 12 weeks followup 20 provided data 24 weeks followup interventions react online supported selfmanagement toolkit offering 12 evidencebased psychoeducation modules support via forum confidential direct messaging service relatives people psychosis bipolar disorder implementation intervention developed staff iteratively adapted address identified barriers adaptations included modifications toolkit delivered teams main outcome measures main outcome factors affecting implementation react assessed primarily indepth interviews staff relatives also assessed quantitative measures delivery staff accounts relatives invitations use react relatives logins time spent website impact react relatives distress general health questionnaire28 carer wellbeing support carer wellbeing support scale questionnaire results staff relatives generally positive content react seeing valuable resource could help services improve support meet clinical targets within comprehensive service included facetoface support additional content barriers implementation included high staff caseloads difficulties prioritising supporting relatives technical difficulties using react poor interoperability trust information technology systems care pathways lack access mobile technology information technology training restricted forum populations leading low levels use staff fears managing risk online trolling replacement technology uncertainty around reacts longterm availability evidence react would reduce staff time supporting relatives already low might increase facilitating communication 281 staff accounts created 57 staff sent relatives invitations total 355 relatives invitations sent 310 unique relatives leading creation 159 relatives accounts mean number logins relatives 378 standard deviation 443 wide variation 0 31 median 2 interquartile range 18 mean total time spent website 406 minutes standard deviation 5454 minutes range 0298 minutes median 201 minutes interquartile range 49575 minutes pattern declining mean scores distress social dysfunction depression anxiety insomnia increases relatives wellbeing ehealth literacy changes statistically significant conclusions digital health interventions react iteratively developed evaluated adapted implemented staff service user input part longterm strategy develop integrated technologyenabled services implementation strategies must instil sense ownership staff ensure adequate training risk protocols resources deliver technology costeffectiveness impact workload inequalities accessing health care need testing along generalisability findings digital health interventions limitations react offered team running implementation relatives toolkit impart study perceived staff relatives timelimited research study rather ongoing clinical service affected engagement access observational data limited trial registration current controlled trials isrctn16267685 funding project funded national institute health research nihr health services delivery research programme published full health services delivery research vol 8 37 see nihr journals library website project information