Evidence

Find out more about our evidence- based healthcare intervention here.

In this section we present the findings of our research when we tested the effectiveness of REACT in increasing the wellbeing of relatives and reducing their distress.

Background

REACT was developed by combining the clinical and personal expertise of relatives, clinicians and academics within the research team, utilising extensive feedback from service users and relatives.

Originally, REACT was developed as a booklet and was first used in NHS Early Intervention Services, where a support worker guided relatives through the toolkit. These teams tested whether REACT was acceptable and used by relatives, (the REACT feasibility study).

The results of the feasibility study were promising; REACT was shown to be feasible, it was used by relatives, and those who received the additional REACT intervention as well as their usual care from mental health teams, showed reduced distress and increased perceived support and ability to cope after 6 months using the intervention.

You can find out more about this research project below.

Feasibility of a supported self-management intervention for relatives of people with recent-onset psychosis: REACT study

Abstract

Background: Relatives of people with psychosis experience high levels of distress and require support. Family interventions have been shown to be effective in improving outcomes but are difficult to access and not suitable for all relatives.

Aims: To assess the feasibility and effectiveness of a supported self-management package for relatives of people with recent-onset psychosis.

Method: A randomised controlled trial (n = 103) comparing treatment as usual (TAU) in early intervention services with TAU plus the Relatives' Education And Coping Toolkit (REACT) intervention (trial identifier: ISRCTN69299093).

Results: Compared with TAU only, those receiving the additional REACT intervention showed reduced distress and increased perceived support and perceived ability to cope at 6-month follow-up.

Conclusions: The toolkit is a feasible and potentially effective intervention to improve outcomes for relatives. A larger trial is needed to reliably assess the clinical and cost-effectiveness of REACT, and its impact on longer-term outcomes

Relatives of people with psychosis, including relatives who have used the previous version of the intervention influenced the content and current format of REACT website. Based on their feedback, we made the toolkit more suitable for a broader range of relatives, including those outside Early Intervention Services and for relatives supporting people with Bipolar Disorder. In addition, we made REACT more interactive and available online directly to relatives, and ensured that it was supported by Expert Relatives (someone with lived experience of supporting a person with mental health problems) rather than by NHS staff.

The results of the first trial showed that REACT is potentially effective to reduce distress in relatives and improve abilities to cope and support for relatives. However, the first trial included a small group of people, who received the toolkit from their Early Intervention Team. Therefore, the research team designed a larger scale research project to test whether REACT is effective in reducing distress in relatives and the cost for the NHS to support relatives, when it is delivered online and accessible for any relatives, who lived in the UK (not only the relatives, who received care from their NHS early intervention team). In this larger trial, relatives registered and used the REACT toolkit online. Half of them received the new interactive REACT toolkit, supported by Expert Relatives, and the resource directory (full range of support currently available to relatives of people with psychosis or bipolar disorder via national mental health organisations), while the other half received the Resource Directory only. Both groups continued to receive treatment as usual from their care providers. The protocol of how this trial was conducted has already been published and available below. The results of the trial will be available in Spring 2019 on this website. [Date may be changed]

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Protocol for an online randomised controlled trial to evaluate the clinical and cost-effectiveness of a peer-supported self-management intervention for relative

Abstract:

Introduction: Despite clinical guidelines recommendations, many relatives of people with psychosis or bipolar disorder do not currently receive the support they need. Online information and support may offer a solution.

Methods and analysis: This single-blind, parallel, online randomised controlled trial will determine clinical and cost-effectiveness of the Relatives Education And Coping Toolkit (REACT) (including an online resource directory (RD)), compared with RD only, for relatives of people with psychosis or bipolar disorder. Both groups continue to receive treatment as usual. Independent, web-based variable, block, individual randomisation will be used across 666 relatives. Primary outcome is distress at 24 weeks (measured by General Health Questionnaire; GHQ-28) compared between groups using analysis of covariance, adjusting for baseline score. Secondary clinical outcomes are carer wellbeing and support. Cost-effectiveness analysis will determine cost of a significant unit change (three-point reduction) in the GHQ-28. Costs include offering and supporting the intervention in the REACT arm, relevant healthcare care costs including health professional contacts, medications prescribed and time off (or ability to) work for the relative. Cost utility analysis will be calculated as the marginal cost of changes in quality-adjusted life years, based on EuroQol. We will explore relatives’ beliefs, perceived coping and amount of REACT toolkit use as possible outcome mediators. We have embedded two methodological substudies in the protocol to determine the relative effectiveness of a low-value (£10) versus higher value (£20) incentive, and an unconditional versus conditional incentive, on improving follow-up rates.

Ethics and dissemination: The trial has ethical approval from Lancaster National Research Ethics Service (NRES)Committee (15/NW/0732) and is overseen by an independent Data Monitoring and Ethics Committee and Trial Steering Committee. Protocol version 1.5 was approved on 9 January 2017. All updates to protocols are uploaded to the National Institute for Health Research (NIHR) Journals Library.

A full statistical analysis plan is available at https://figshare.com/account/home#/projects/19975. Publications will be in peer-reviewed journals (open access wherever possible). Requests for access to the data at the end of the study will be reviewed and granted where appropriate by the Trial Management Group.

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