title: Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial.
abstract: OBJECTIVE
  To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams.
  
  
  METHODS
  Process evaluation nested within a cluster randomised controlled trial (RCT).
  
  
  METHODS
  28 interviews with mental health care staff, 3 interviews with trainers, 4 focus groups with intervention teams and 28 written trainer reports.
  
  
  METHODS
  14 community-based mental health teams in two UK sites (one urban, one semi-rural) who received the intervention.
  
  
  RESULTS
  The factors influencing the implementation of the intervention can be organised under two over-arching themes: Organisational readiness for change and Training effectiveness. Organisational readiness for change comprised three sub-themes: NHS Trust readiness; Team readiness; and Practitioner readiness. Training effectiveness comprised three sub-themes: Engagement strategies; Delivery style and Modelling recovery principles.
  
  
  CONCLUSIONS
  Three findings can inform future implementation and evaluation of complex interventions. First, the underlying intervention model predicted that three areas would be important for changing practice: staff skill development; intention to implement; and actual implementation behaviour. This study highlighted the importance of targeting the transition from practitioners' intent to implement to actual implementation behaviour, using experiential learning and target setting. Second, practitioners make inferences about organisational commitment by observing the allocation of resources, Knowledge Performance Indicators and service evaluation outcome measures. These need to be aligned with recovery values, principles and practice. Finally, we recommend the use of organisational readiness tools as an inclusion criteria for selecting both organisations and teams in cluster RCTs. We believe this would maximise the likelihood of adequate implementation and hence reduce waste in research expenditure.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN02507940.
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Mary
authors.initials: M
authors.lastname: Leamy
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Clarke
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Clair
authors.initials: C
authors.lastname: Le Boutillier
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Victoria
authors.initials: V
authors.lastname: Bird
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Monika
authors.initials: M
authors.lastname: Janosik
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Kai
authors.initials: K
authors.lastname: Sabas
authors.affiliation: 2gether NHS Foundation Trust, Rikenel, Montpellier, Gloucester, United Kingdom.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Riley
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Julie
authors.initials: J
authors.lastname: Williams
authors.affiliation: King's College London, Institute of Psychiatry, Denmark Hill, London, United Kingdom.
authors.forename: Mike
authors.initials: M
authors.lastname: Slade
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D015397:Program Evaluation; D011575:Psychoanalytic Therapy; D011618:Psychotic Disorders / Q000628:therapy*; D036301:Qualitative Research; D012107:Research Design