The Let's Talk toolkit: developing a theory-informed complex intervention to improve nurse-patient therapeutic engagement on an acute mental health ward by employing Experience-based Co-design and the Behaviour Change Wheel
Abstract Background Lack of high-quality nurse-patient therapeutic engagement is a longstanding problem on acute mental health wards, with a dearth of interventions to address this. A collaborative, theory-driven approach to developing and implementing complex interventions is more likely to be effective and sustainable. This paper describes an integrated co-design-behaviour change approach which developed the Let’s Talk intervention toolkit for improving the quality of therapeutic engagement on acute mental health wards. Methods We describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Fieldwork was informed by the results of a systematic integrative review and was guided by our co-design-behaviour change approach. It was conducted over 12-months at an acute mental health organisation in England. We undertook semi-structured interviews with 14 service users (seven of which were filmed), two carers and 12 clinicians, 80 hours of non-participant observations and a facilitated intervention co-design process that involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development. Results The co-designed Let’s Talk toolkit addressed four joint priorities for change: 1) improve communication with withdrawn people; 2) nurses to help service users help themselves; 3) nurses to feel confident when engaging with service users; 4) improving team relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design-behaviour change approach with service users, carers and clinicians to co-design the toolkit to improve nurse-patient therapeutic engagement. Conclusions Our theory-driven approach enhances both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.