Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial.
BACKGROUND
We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention.


METHODS
We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy.


RESULTS
The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills).


CONCLUSIONS
This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff.


BACKGROUND
Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).
Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. m.lean@ucl.ac.uk.
Melanie
M
Lean
The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Magee Campus, Londonderry, BT48 7JL, UK. g.leavey@ulster.ac.uk.
Gerard
G
Leavey
Rehabilitation Psychiatry, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. h.killaspy@ucl.ac.uk.
Helen
H
Killaspy
Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. nicholas.green@ucl.ac.uk.
Nicholas
N
Green
Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. isobel.harrison@ucl.ac.uk.
Isobel
I
Harrison
Occupational Therapy, Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Montgomery House, 32 Collegiate Crescent, Collegiate Campus, Sheffield, S10 2BP, UK. S.P.Cook@shu.ac.uk.
Sarah
S
Cook
Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, SE5 8AZ, UK. thomas.craig@kcl.ac.uk.
Thomas
T
Craig
South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8AZ, UK. f.holloway1@gmail.com.
Frank
F
Holloway
North London Service User Research Forum, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. mauricea@easy.com.
Maurice
M
Arbuthnott
Primary Care Psychiatry and Joint-Director, UCL PRIMENT Clinical Trials Unit, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK. michael.king@ucl.ac.uk.
Michael
M
King
D002983:Clinical Competence / Q000592:standards; D004739:England; D017144:Focus Groups; D006282:Health Personnel / Q000193:education*; D006292:Health Priorities; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D007318:Inservice Training; D007400:Interprofessional Relations; D007857:Leadership; D008603:Mental Health / Q000193:education*; D010347:Patient Care Planning / Q000458:organization & administration; D010358:Patient Participation; D000067250:Psychiatric Rehabilitation / Q000193:education*; D036301:Qualitative Research; D012423:Rural Health; D013222:State Medicine; D014504:Urban Health