scholarly journals Implementation of a lifestyle intervention for people with a severe mental illness (SMILE): a process evaluation

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Florine S. Walburg ◽  
Johanna W. de Joode ◽  
Hella E. Brandt ◽  
Maurits W. van Tulder ◽  
Marcel C. Adriaanse ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Process Evaluation ◽  
Lifestyle Intervention ◽  
Controlled Trial ◽  
Intervention Group ◽  
Individual Characteristics ◽  
Structured Interviews ◽  
Lifestyle Behaviour ◽  
Group Sessions

Abstract Background Several interventions have been developed to improve physical health and lifestyle behaviour of people with a severe mental illness (SMI). Recently, we conducted a pragmatic cluster-randomised controlled trial which evaluated the effects of the one-year Severe Mental Illness Lifestyle Evaluation (SMILE) lifestyle intervention compared with usual care in clients with SMI. The SMILE intervention is a 12-month group-based lifestyle intervention with a focus on increased physical activity and healthy food intake. The aim of the current study was to explore the experiences of people with SMI and healthcare professionals (HCPs) regarding implementation feasibility of the SMILE intervention and the fidelity to the SMILE intervention. Methods A process evaluation was conducted alongside the pragmatic randomized controlled trial. The experiences of clients and HCPs in the lifestyle intervention group were studied. First, descriptive data on the implementation of the intervention were collected. Next, semi-structured interviews with clients (n = 15) and HCPs (n = 13) were performed. Interviews were audiotaped and transcribed verbatim. A thematic analysis of the interview data was performed using MAXQDA software. In addition, observations of group sessions were performed to determine the fidelity to the SMILE intervention using a standardised form. Results Ten out of 26 HCPs who conducted the group sessions discontinued their involvement with the intervention, primarily due to changing jobs. 98% of all planned group sessions were performed. Four main themes emerged from the interviews: 1) Positive appraisal of the SMILE intervention, 2) Suggestions for improvement of the SMILE intervention 3) Facilitators of implementation and 4) Barriers of implementation. Both clients and HCPs had positive experiences regarding the SMILE intervention. Clients found the intervention useful and informative. The intervention was found suitable and interesting for all people with SMI, though HCPs sometimes had to tailor the intervention to individual characteristics of patients (e.g., with respect to cognitive functioning). The handbook of the SMILE intervention was perceived as user-friendly and helpful by HCPs. Combining SMILE with daily tasks, no support from other team members, and lack of staff and time were experienced as barriers for the delivery of the intervention. Conclusion The SMILE intervention was feasible and well-perceived by clients and HCPs. However, we also identified some aspects that may have hindered effective implementation and needs to be considered when implementing the SMILE intervention in daily practice.

scholarly journals The blended electronic-Illness Management and Recovery program for people with severe mental illness: a qualitative process evaluation alongside a trial (Preprint)

2020 ◽  
Author(s):  
Titus, A. A. Beentjes ◽  
Betsie, G.I. van Gaal ◽  
Hester Vermeulen ◽  
Maria W. G. Nijhuis-van der Sanden ◽  
Peter, J.J. Goossesns
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Added Value ◽  
Great Promise ◽  
Illness Management ◽  
Structured Interviews ◽  
Illness Management And Recovery ◽  
It Resources

BACKGROUND Against the backdrop of the great promise of e-mental health, we tested the e- Illness Management and Recovery (IMR) intervention, which coincide the standard IMR programme content and methodology into face-to-face and Internet based strategies on the constructed e-IMR platform. The e-IMR platform was used too little to provide definite conclusions on the potential efficacy of e-health for people with severe mental illness (SMI). OBJECTIVE This study aims to identify if the added value of the e-IMR intervention and which barriers and facilitators can explain the low use of the e-IMR platform. METHODS This process evaluation was designed alongside a multi-centre cluster randomised controlled trial (RCT). Qualitative data were gathered at the endpoint in semi-structured interviews with trial participants and trainers. Baseline characteristics were used to compare the users and non-users. The study population comprised of participants and trainers from the intervention arm of the e-IMR RCT. RESULTS Out of 41 participants 14 used the e-IMR platform. Twenty-seven participants and eleven trainers were interviewed at the endpoint. e-IMR’s components that had added value were the persuasive nature of using goal-tracking sheets and monitoring and the peer-testimonials’ potential to enhance group discussions and participants’ disclosure. The low use of the e-IMR platform was influence by: the platform’s inflexibility, the lack of IT resources, the group context, the participants’ low computer skills and disabilities, and the trainers’ hesitant e-health attitude. CONCLUSIONS The extent of e-health readiness and correlations with vulnerabilities in persons with SMI need to be further investigated. this study shows that use of e-IMR components need flexible options, provided only in response to a participant’s need. Providing the e-IMR in the future is preconditioned by checking available IT resources, providing tablets to participants in group settings, providing computer/Internet guidance to participants before or parallel to the group sessions, checking the e-health attitude and skills of trainers, and providing necessary e-health training to increase the skills of future e-IMR trainers. CLINICALTRIAL https://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4772 INTERNATIONAL REGISTERED REPORT RR2-10.1186/s12913-016-1267-z

scholarly journals Supported employment: randomised controlled trial

2010 ◽  
Vol 196 (5) ◽  
pp. 404-411 ◽  
Author(s):  
Louise M. Howard ◽  
Margaret Heslin ◽  
Morven Leese ◽  
Paul McCrone ◽  
Christopher Rice ◽  
...  
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Supported Employment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Competitive Employment ◽  
Treatment As Usual ◽  
The Individual ◽  
Randomised Controlled ◽  
The Uk

BackgroundThere is evidence from North American trials that supported employment using the individual placement and support (IPS) model is effective in helping individuals with severe mental illness gain competitive employment. There have been few trials in other parts of the world.AimsTo investigate the effectiveness and cost-effectiveness of IPS in the UK.MethodIndividuals with severe mental illness in South London were randomised to IPS or local traditional vocational services (treatment as usual) (ISRCTN96677673).ResultsTwo hundred and nineteen participants were randomised, and 90% assessed 1 year later. There were no significant differences between the treatment as usual and intervention groups in obtaining competitive employment (13% in the intervention group and 7% in controls; risk ratio 1.35, 95% CI 0.95–1.93, P = 0.15), nor in secondary outcomes.ConclusionsThere was no evidence that IPS was of significant benefit in achieving competitive employment for individuals in South London at 1-year follow-up, which may reflect suboptimal implementation. Implementation of IPS can be challenging in the UK context where IPS is not structurally integrated with mental health services, and economic disincentives may lead to lower levels of motivation in individuals with severe mental illness and psychiatric professionals.

Pharmacists in general practice: a qualitative process evaluation of the General Practice Pharmacist (GPP) study

2020 ◽  
Vol 37 (5) ◽  
pp. 711-718
Author(s):  
Oscar James ◽  
Karen Cardwell ◽  
Frank Moriarty ◽  
Susan M Smith ◽  
Barbara Clyne
Keyword(s):  
General Practice ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Qualitative Approach ◽  
Structured Interviews ◽  
Practice Staff ◽  
Practice Nurses ◽  
Practice Team ◽  
Prescribing Quality ◽  
Descriptive Qualitative

Abstract Background There is some evidence to suggest that pharmacists integrated into primary care improves patient outcomes and prescribing quality. Despite this growing evidence, there is a lack of detail about the context of the role. Objective To explore the implementation of The General Practice Pharmacist (GPP) intervention (pharmacists integrating into general practice within a non-randomized pilot study in Ireland), the experiences of study participants and lessons for future implementation. Design and setting Process evaluation with a descriptive qualitative approach conducted in four purposively selected GP practices. Methods A process evaluation with a descriptive qualitative approach was conducted in four purposively selected GP practices. Semi-structured interviews were conducted, transcribed verbatim and analysed using a thematic analysis. Results Twenty-three participants (three pharmacists, four GPs, four patients, four practice nurses, four practice managers and four practice administrators) were interviewed. Themes reported include day-to-day practicalities (incorporating location and space, systems and procedures and pharmacists’ tasks), relationships and communication (incorporating GP/pharmacist mode of communication, mutual trust and respect, relationship with other practice staff and with patients) and role perception (incorporating shared goals, professional rewards, scope of practice and logistics). Conclusions Pharmacists working within the general practice team have potential to improve prescribing quality. This process evaluation found that a pharmacist joining the general practice team was well accepted by the GP and practice staff and effective interprofessional relationships were described. Patients were less clear of the overall benefits. Important barriers (such as funding, infrastructure and workload) and facilitators (such as teamwork and integration) to the intervention were identified which will be incorporated into a pilot cluster randomized controlled trial.

scholarly journals Effectiveness of one-to-one peer support for patients with severe mental illness – a randomised controlled trial

2017 ◽  
Vol 42 ◽  
pp. 103-110 ◽  
Author(s):  
C.I. Mahlke ◽  
S. Priebe ◽  
K. Heumann ◽  
A. Daubmann ◽  
K. Wegscheider ◽  
...  
Keyword(s):  
Mental Illness ◽  
Peer Support ◽  
Self Efficacy ◽  
Controlled Trial ◽  
Intervention Group ◽  
Treatment As Usual ◽  
Secondary Outcomes ◽  
One To One ◽  
Randomised Controlled

AbstractBackgroundOne-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments.MethodsThis is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years’ duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations.ResultsPatients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses.ConclusionsThe findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.

scholarly journals Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial

2008 ◽  
Vol 192 (3) ◽  
pp. 224-231 ◽  
Author(s):  
Jocelyn Catty ◽  
Pascale Lissouba ◽  
Sarah White ◽  
Thomas Becker ◽  
Robert E. Drake ◽  
...  
Keyword(s):  
Mental Illness ◽  
Randomised Controlled Trial ◽  
Severe Mental Illness ◽  
Controlled Trial ◽  
Patient Characteristics ◽  
Employment Outcomes ◽  
Social Needs ◽  
Vocational Outcomes ◽  
Randomised Controlled ◽  
Ips Model

BackgroundAn international six-centre randomised controlled trial comparing individual placement and support (IPS) with usual vocational rehabilitation for people with serious mental illness found IPS to be more effective for all vocational outcomes.AimsTo determine which patients with severe mental illness do well in vocational services and which process and service factors are associated with better outcomes.MethodPatient characteristics and early process variables were tested as predictors of employment outcomes. Service characteristics were explored as predictors of the effectiveness of IPS.ResultsPatients with previous work history, fewer met social needs and better relationships with their vocational workers were more likely to obtain employment and work for longer. Remission and swifter service uptake were associated with working more. Having an IPS service closer to the original IPS model was the only service characteristic associated with greater effectiveness.ConclusionsThe IPS service was found to be more effective for all vocational outcomes. In addition, maintaining high IPS fidelity and targeting relational skills would be a valuable focus for all vocational interventions, leading to improved employment outcomes. Motivation to find work may be decreased by satisfaction with current life circumstances.

Abstract WP419: Secondary Prevention Of Cardiovascular Events With Lifestyle Intervention In Patients With Mild Ischemic Stroke - A Randomized Controlled Trial -

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Sumio Yamada ◽  
Yuji Kono ◽  
Kotaro Iwatsu ◽  
Hisako Okumura ◽  
Junko Yamaguchi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Lifestyle Intervention ◽  
Lifestyle Modification ◽  
Controlled Trial ◽  
Intervention Group ◽  
Stroke Recurrence ◽  
Control Group ◽  
Vascular Events ◽  
Randomized Controlled ◽  
New Onset

Introduction: Lifestyle modification is associated with a substantially decreased risk of cardiovascular events. However, the role of lifestyle intervention for the secondary prevention in patients with ischemic stroke (IS) is inadequately defined. We assessed the hypothesis that lifestyle intervention which comprised exercise, salt reduction and nutrition advice could reduce new onset of vascular events in patients with mild IS. Methods: We conducted a single-blind randomized controlled trial that enrolled 66 patients (45 men, 21 women; mean age, 63.5 yo) with acute mild ischemic stroke. The patients were randomly allocated to a lifestyle intervention group (n = 33) or control group (n = 33). We performed lifestyle interventions, which comprised exercise training, salt restriction and nutrition advice for 24 weeks. The primary endpoint was ospitalization due to stroke recurrence and new onset of coronary heart disease. We also evaluated blood pressure, serum lipid profile and hemoglobin A1c to compare the efficacy of the lifestyle modification intervention. Results: This trial was terminated earlier than expected because the prespecified early stopping rule for efficacy had been met. After 24 weeks intervention period, the intervention group showed a significant decrease in the clinic and home blood pressure and significant increase in the high density lipoprotein cholesterol (HDL-C) levels from the baseline to the 6-month assessment (clinic and home SBP, P <0.001; HDL-C, P =0.018), with significant differences between the randomized groups (clinic and home SBP, P <0.001; HDL-C, P =0.022). Median duration of follow-up was 2.9 years, 12 patients allocated the control group and 1 patient allocated the lifestyle intervention group had at least one major vascular event. A sequential plans analysis indicated that lifestyle intervention superior to control in interim analysis. Kaplan-Meier survival curves after log-rank test showed significant prognostic difference between randomized groups ( P =0.005). Conclusions: In conclusion, the results of this study indicate that lifestyle intervention is beneficial for preventing stroke recurrence and other vascular events.

scholarly journals A mixed methods process evaluation of a person-centred falls prevention program

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rebecca L. Morris ◽  
Keith D. Hill ◽  
Ilana N. Ackerman ◽  
Darshini Ayton ◽  
Glenn Arendts ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Process Evaluation ◽  
Prevention Program ◽  
Social Issues ◽  
Controlled Trial ◽  
Intervention Group ◽  
Implementation Fidelity ◽  
Falls Prevention ◽  
Barriers And Facilitators ◽  
Trial Registration

Abstract Background RESPOND is a telephone-based falls prevention program for older people who present to a hospital emergency department (ED) with a fall. A randomised controlled trial (RCT) found RESPOND to be effective at reducing the rate of falls and fractures, compared with usual care, but not fall injuries or hospitalisations. This process evaluation aimed to determine whether RESPOND was implemented as planned, and identify implementation barriers and facilitators. Methods A mixed-methods evaluation was conducted alongside the RCT. Evaluation participants were the RESPOND intervention group (n = 263) and the clinicians delivering RESPOND (n = 7). Evaluation data were collected from participant recruitment and intervention records, hospital administrative records, audio-recordings of intervention sessions, and participant questionnaires. The Rochester Participatory Decision-Making Scale (RPAD) was used to evaluate person-centredness (score range 0 (worst) - 9 (best)). Process factors were compared with pre-specified criteria to determine implementation fidelity. Six focus groups were held with participants (n = 41), and interviews were conducted with RESPOND clinicians (n = 6). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation – Behaviour’ (COM-B) behaviour change framework. Results RESPOND was implemented at a lower dose than the planned 10 h over 6 months, with a median (IQR) of 2.9 h (2.1, 4). The majority (76%) of participants received their first intervention session within 1 month of hospital discharge with a median (IQR) of 18 (12, 30) days. Clinicians delivered the program in a person-centred manner with a median (IQR) RPAD score of 7 (6.5, 7.5) and 87% of questionnaire respondents were satisfied with the program. The reports from participants and clinicians suggested that implementation was facilitated by the use of positive and personally relevant health messages. Complex health and social issues were the main barriers to implementation. Conclusions RESPOND was person-centred and reduced falls and fractures at a substantially lower dose, using fewer resources, than anticipated. However, the low dose delivered may account for the lack of effect on falls injuries and hospitalisations. The results from this evaluation provide detailed information to guide future implementation of RESPOND or similar programs. Trial registration This study was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614000336684 (27 March 2014).

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