title: How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy.
abstract: BACKGROUND
  The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway.
  
  
  METHODS
  A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes.
  
  
  RESULTS
  Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life.
  
  
  CONCLUSIONS
  The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice.Trial registrationClinicalTrials.gov NCT02077829. Registered 25 February 2014.
authors.affiliation: Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.
authors.forename: Karina Myhren
authors.initials: KM
authors.lastname: Egeland
authors.affiliation: Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.|Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: Torleif
authors.initials: T
authors.lastname: Ruud
authors.affiliation: Norwegian Center for Child Behavioral Development, Essendropsgate 3, 0368 Oslo, Norway.|Institute of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Terje
authors.initials: T
authors.lastname: Ogden
authors.affiliation: Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.|Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
authors.forename: Rickard
authors.initials: R
authors.lastname: Färdig
authors.affiliation: Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.
authors.forename: Jonas Christoffer
authors.initials: JC
authors.lastname: Lindstrøm
authors.affiliation: Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.
authors.forename: Kristin Sverdvik
authors.initials: KS
authors.lastname: Heiervang
keywords: Feasibility; Fidelity; Illness Management and Recovery; Implementation strategies