At the same time with the REACT trial (see more under ‘Evidence’ section), the REACT team was also interested and explored what influences the use of the interactive REACT website in Early Intervention NHS Teams and this website section summarises our work related to implementing REACT in NHS.
As part of the IMPART study (Implementation a Relatives’ toolkit) the REACT Team observed the work taking place in NHS Trusts to implement and use REACT and interviewed relatives and staff members in Six NHS Trusts, 3 from the South and 3 from the North of England (as part of the IMPART study). The Research Team worked with one Trust from the South and one Trust from the North at one time, and learned what happened in these Trusts to develop an implementation plan. The new plan was then shared and further developed in collaboration with another Trust in the South and one in the North. Learning from these second wave Trusts was then shared with the third Trusts from both the South and the North. In this study, relatives and staff members were not only research participants, but they had an active role in developing the various (improved) versions of the implementation plans by sharing their experiences of using REACT as part of their clinical services. More information about the design of this implementation study is available below. The results will be available in September 2019 on this website. These results will be very important and will make REACT unique.
IMPlementation of A Relatives’ Toolkit (IMPART study): an iterative case study to identify key factors impacting on the implementation of a web-based supported self-management intervention for relatives of people with psychosis or bipolar experiences in a National Health Service: a study protocol
BACKGROUND: Web-based interventions to support people to manage long-term health conditions are available and effective but rarely used in clinical services. The aim of this study is to identify critical factors impacting on the implementation of an online supported self-management intervention for relatives of people with recent onset psychosis or bipolar disorder into routine clinical care and to use this information to inform an implementation plan to facilitate widespread use and inform wider implementation of digital health interventions.
METHODS: A multiple case study design within six early intervention in psychosis (EIP) services in England, will be used to test and refine theory-driven hypotheses about factors impacting on implementation of the Relatives' Education And Coping Toolkit (REACT). Qualitative data including behavioural observation, document analysis, and in-depth interviews collected in the first two EIP services (wave 1) and analysed using framework analysis, combined with quantitative data describing levels of use by staff and relatives and impact on relatives' distress and wellbeing, will be used to identify factors impacting on implementation. Consultation via stakeholder workshops with staff and relatives and co-facilitated by relatives in the research team will inform development of an implementation plan to address these factors, which will be evaluated and refined in the four subsequent EIP services in waves 2 and 3. Transferability of the implementation plan to non-participating services will be explored.
DISCUSSION: Observation of implementation in a real world clinical setting, across carefully sampled services, in real time provides a unique opportunity to understand factors impacting on implementation likely to be generalizable to other web-based interventions, as well as informing further development of implementation theories. However, there are inherent challenges in investigating implementation without influencing the process under observation. We outline our strategies to ensure our design is transparent, flexible, and responsive to the timescales and activities happening within each service whilst also meeting the aims of the project.