Barriers and facilitators when implementing family involvement for persons with psychotic disorders in community mental health centres - a nested qualitative study

Kristiane Myckland Hansson, Maria Romøren, Reidar Pedersen, Bente Weimand, Lars Hestmark, Irene Norheim, Torleif Ruud, Inger Stølan Hymer, Kristin Sverdvik Heiervang, Kristiane Myckland Hansson, Maria Romøren, Reidar Pedersen, Bente Weimand, Lars Hestmark, Irene Norheim, Torleif Ruud, Inger Stølan Hymer, Kristin Sverdvik Heiervang

Abstract

Background: The uptake of family involvement in health care services for patients with psychotic disorders is poor, despite a clear evidence base, socio-economic and moral justifications, policy, and guideline recommendations. To respond to this knowledge-practice gap, we established the cluster randomised controlled trial: Implementation of guidelines on Family Involvement for persons with Psychotic disorders in community mental health centres (IFIP). Nested in the IFIP trial, this sub-study aims to explore what organisational and clinical barriers and facilitators local implementation teams and clinicians experience when implementing family involvement in mental health care for persons with psychotic disorders.

Methods: We performed 21 semi-structured focus groups, including 75 participants in total. Implementation team members were interviewed at the initial and middle phases of the intervention period, while clinicians who were not in the implementation team were interviewed in the late phase. A purposive sampling approach was used to recruit participants with various engagement in the implementation process. Data were analysed using manifest content analysis.

Results: Organisational barriers to involvement included: 1) Lack of shared knowledge, perceptions, and practice 2) Lack of routines 3) Lack of resources and logistics. Clinical barriers included: 4) Patient-related factors 5) Relative-related factors 6) Provider-related factors. Organisational facilitators for involvement included: 1) Whole-ward approach 2) Appointed and dedicated roles 3) Standardisation and routines. Clinical facilitators included: 4) External implementation support 5) Understanding, skills, and self-efficacy among mental health professionals 6) Awareness and attitudes among mental health professionals.

Conclusions: Implementing family involvement in health care services for persons with psychotic disorders is possible through a whole-ward and multi-level approach, ensured by organisational- and leadership commitment. Providing training in family psychoeducation to all staff, establishing routines to offer a basic level of family involvement to all patients, and ensuring that clinicians get experience with family involvement, reduce or dissolve core barriers. Having access to external implementation support appears decisive to initiate, promote and evaluate implementation. Our findings also point to future policy, practice and implementation developments to offer adequate treatment and support to all patients with severe mental illness and their families.

Trial registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Keywords: Barriers; Facilitators; Family interventions; Family involvement; Family psychoeducation; Implementation; Mental health services research; Psychotic disorders.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Visual map of data analysis with themes and categories

References

    1. Dixon L, McFarlane WR, Lefley H, Lucksted A, Cohen M, Falloon I, et al. Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatr Serv. 2001;52(7):903–910. doi: 10.1176/appi.ps.52.7.903.
    1. Bucci S, Berry K, Barrowclough C, Haddock G. Family interventions in psychosis: a review of the evidence and barriers to implementation. Aust Psychol. 2016;51(1):62–68. doi: 10.1111/ap.12172.
    1. Hestmark L, Heiervang KS, Pedersen R, Hansson KM, Ruud T, Romøren M. Family involvement practices for persons with psychotic disorders in community mental health centres – a cross-sectional fidelity-based study. BMC Psychiatry. 2021;21(1):285. doi: 10.1186/s12888-021-03300-4.
    1. Bighelli I, Rodolico A, García-Mieres H, Pitschel-Walz G, Hansen W-P, Schneider-Thoma J, et al. Psychosocial and psychological interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry. 2021;8(11):969–80. doi: 10.1016/S2215-0366(21)00243-1.
    1. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev. 2010;12:CD000088. doi: 10.1002/14651858.CD000088.pub2.
    1. Pitschel-Walz G, Leucht S, Bäuml J, Kissling W, Engel RR. The effect of family interventions on relapse and rehospitalization in schizophrenia—A meta-analysis. Schizophr Bull. 2001;27(1):73–92. doi: 10.1093/oxfordjournals.schbul.a006861.
    1. Rodolico A, Bighelli I, Avanzato C, Concerto C, Cutrufelli P, Mineo L, et al. Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. Lancet Psychiatry. 2022 doi: 10.1016/s2215-0366(21)00437-5.
    1. Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, et al. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2015;206(4):268–274. doi: 10.1192/bjp.bp.114.147561.
    1. Lobban F, Postlethwaite A, Glentworth D, Pinfold V, Wainwright L, Dunn G, et al. A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev. 2013;33(3):372–382. doi: 10.1016/j.cpr.2012.12.004.
    1. Ma CF, Chien WT, Bressington DT. Family intervention for caregivers of people with recent-onset psychosis: A systematic review and meta-analysis. Early Interv Psychiatry. 2018;12(4):535–560. doi: 10.1111/eip.12494.
    1. Helsedirektoratet. Nasjonal faglig retningslinje for utredning, behandling og oppfølging av personer med psykoselidelser. Oslo: Helsedirektoratet; 2013. Available from: . Accessed Feb 2022.
    1. Helsedirektoratet. Veileder om pårørende i helse- og omsorgstjenesten. Oslo: Helsedirektoratet; 2017. Available from: . Accessed Feb 2022.
    1. Helsedirektoratet. Psykoselidelser, inkludert mistanke om psykoseutvikling – barn, unge og voksne. Pakkeforløp 2018. Oslo: Helsedirektoratet; 2018. Available from: . Accessed Feb 2022.
    1. Wallcraft J, Amering M, Freidin J, Davar B, Froggatt D, Jafri H, et al. Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry. 2011;10(3):229–236. doi: 10.1002/2Fj.2051-5545.
    1. The National Institute for Health and Care Excellence (NICE). Psychosis and schizophrenia in adults (CG178). London: National Institute for Health and Clinical Excellence; 2014 Report No.: CG178. Available from: . Accessed Feb 2022.
    1. Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand college of psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry. 2016;50(5):410–472. doi: 10.1177/0004867416641195.
    1. Westerlund A, Sundberg L, Nilsen P. Implementation of implementation science knowledge: The research-practice gap paradox. Worldviews Evid Based Nurs. 2019;16(5):332–334. doi: 10.1111/wvn.12403.
    1. Lucksted A, McFarlane W, Downing D, Dixon L. Recent developments in family psychoeducation as an evidence-based practice. J Marital Fam Ther. 2012;38(1):101–121. doi: 10.1111/j.1752-0606.2011.00256.x.
    1. The American Psychiatric Association Practice guideline for the treatment of patients with schizophrenia; Third edition. Washington DC: The American Psychiatric Association; 2021. 10.1176/appi.books.9780890424841.
    1. Mueser KT, Deavers F, Penn DL, Cassisi JE. Psychosocial treatments for schizophrenia. Annu Rev Clin Psychol. 2013;9(1):465–497. doi: 10.1146/annurev-clinpsy-050212-185620.
    1. McFarlane WR. Family interventions for schizophrenia and the psychoses: A review. Fam Process. 2016;55(3):460–482. doi: 10.1111/famp.12235.
    1. Selick A, Durbin J, Vu N, O'Connor K, Volpe T, Lin E. Barriers and facilitators to implementing family support and education in early psychosis intervention programmes: A systematic review. Early Interv Psychiatry. 2017;11(5):365–374. doi: 10.1111/eip.12400.
    1. Szmukler G, Bloch S. Family involvement in the care of people with psychoses: An ethical argument. Br J Psychiatry. 1997;171(5):401–5. doi: 10.1192/bjp.171.5.401.
    1. Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and new Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry. 2016;50(5):410–72. 10.1177/0004867416641195.
    1. Mairs H, Bradshaw T. Implementing family intervention following training: what can the matter be? J Psychiatr Ment Health Nurs. 2005;12(4):488–494. doi: 10.1111/j.1365-2850.2005.00871.x.
    1. Landeweer E, Molewijk B, Hem MH, Pedersen R. Worlds apart? A scoping review addressing different stakeholder perspectives on barriers to family involvement in the care for persons with severe mental illness. BMC Health Serv Res. 2017;17(1):349. doi: 10.1186/s12913-017-2213-4.
    1. Haddock G, Eisner E, Boone C, Davies G, Coogan C, Barrowclough C. An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. J Ment Health. 2014;23(4):162–165. doi: 10.3109/09638237.2013.869571.
    1. Eassom E, Giacco D, Dirik A, Priebe S. Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors. BMJ Open. 2014;4(10):e006108. doi: 10.1136/bmjopen-2014-006108.
    1. Chen F. A fine line to walk: Case managers' perspectives on sharing information with families. Qual Health Res. 2008;18(11):1556–1565. doi: 10.1177/1049732308325539.
    1. Hestmark L, Romoren M, Heiervang KS, Weimand B, Ruud T, Norvoll R, et al. Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial. BMC Health Serv Res. 2020;20(1):934. doi: 10.1186/s12913-020-05792-4.
    1. Gilissen J, Pivodic L, Smets T, Gastmans C, Stichele RV, Deliens L, et al. Preconditions for successful advance care planning in nursing homes: A systematic review. Int J Nurs Stud. 2017;66:47–59. doi: 10.1016/j.ijnurstu.2016.12.003.
    1. Bond GR, Evans L, Salyers MP, Williams J, Kim HW. Measurement of fidelity in psychiatric rehabilitation. Ment Health Serv Res. 2000;2(2):75–87. doi: 10.1023/a:1010153020697.
    1. Feyissa GT, Woldie M, Munn Z, Lockwood C. Exploration of facilitators and barriers to the implementation of a guideline to reduce HIV-related stigma and discrimination in the Ethiopian healthcare settings: A descriptive qualitative study. PLoS ONE. 2019;14(5):e0216887. doi: 10.1371/journal.pone.0216887.
    1. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Acad Med. 2014;89(9):1245–1251. doi: 10.1097/acm.0000000000000388.
    1. Stetler CB, Legro MW, Wallace CM, Bowman C, Guihan M, Hagedorn H, et al. The role of formative evaluation in implementation research and the QUERI experience. J Gen Intern Med. 2006;21(2):S1. doi: 10.1111/j.1525-1497.2006.00355.
    1. Abma TA. The practice and politics of responsive evaluation. Am J Eval. 2006;27(1):31–43. doi: 10.1177/1098214005283189.
    1. UK Government. Evaluation in health and wellbeing. A guide to evaluation of health and wellbeing projects and programmes. Available from: . Accessed Feb 2022.
    1. Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health. 2015;42(5):533–544. doi: 10.1007/s10488-013-0528.
    1. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurse. 2008;62(1):107–115. doi: 10.1111/j.1365-2648.2007.04569.x.
    1. Erlingsson C, Brysiewicz P. A hands-on guide to doing content analysis. African J Emerg Med. 2017;7(3):93–9. doi: 10.1016/j.afjem.2017.08.001.
    1. Patton MQ. Enhancing the quality and credibility of qualitative analysis. Health Serv Res. 1999;34(5 Pt 2):1189–208.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Dirik A, Sandhu S, Giacco D, Barrett K, Bennison G, Collinson S, et al. Why involve families in acute mental healthcare? A collaborative conceptual review. BMJ Open. 2017;7(9):e017680. doi: 10.1136/bmjopen-2017-017680.
    1. Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: A framework for change. Milbank Q. 2001;79(2):281–315. doi: 10.1111/1468-0009.00206.
    1. Ince P, Haddock G, Tai S. A systematic review of the implementation of recommended psychological interventions for schizophrenia: Rates, barriers, and improvement strategies. Psychol Psychother. 2016;89(3):324–350. doi: 10.1111/papt.12084.
    1. Prytys M, Garety PA, Jolley S, Onwumere J, Craig T. Implementing the NICE guideline for schizophrenia recommendations for psychological therapies: a qualitative analysis of the attitudes of CMHT staff. Clin Psychol Psychother. 2011;18(1):48–59. doi: 10.1002/cpp.691.
    1. Cohen AN, Glynn SM, Hamilton AB, Young AS. Implementation of a family intervention for individuals with schizophrenia. J Gen Intern Med. 2010;25(1):32–37. doi: 10.1007/s11606-009-1136.
    1. Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):581–629. doi: 10.1111/j.0887-378x.2004.00325.x.
    1. Rowlands P. The NICE schizophrenia guidelines: the challenge of implementation. Adv Psychiatr Treat. 2004;10(6):403–412. doi: 10.1192/apt.10.6.403.
    1. Chatzidamianos G, Lobban F, Jones S. A qualitative analysis of relatives', health professionals' and service users' views on the involvement in care of relatives in bipolar disorder. BMC Psychiatry. 2015;15:228. doi: 10.1186/s12888-015-0611-x.
    1. Gray B, Robinson CA, Seddon D, Roberts A. An emotive subject: insights from social, voluntary and healthcare professionals into the feelings of family carers for people with mental health problems. Health Soc Care Comm. 2009;17(2):125–132. doi: 10.1111/j.1365-2524.2008.00803.x.
    1. Slade M, Pinfold V, Rapaport J, Bellringer S, Banerjee S, Kuipers E, et al. Best practice when service users do not consent to sharing information with carers. National multimethod study. Br J Psychiatry. 2007;190:148–55. doi: 10.1192/bjp.bp.106.024935.
    1. Cohen AN, Glynn SM, Hamilton AB, Young AS. Implementation of a family intervention for individuals with schizophrenia. J Gen Intern Med. 2010;25(Suppl 1):32–37. doi: 10.1007/s11606-009-1136-0.
    1. Outram S, Harris G, Kelly B, Bylund CL, Cohen M, Landa Y, et al. ‘We didn’t have a clue’: Family caregivers’ experiences of the communication of a diagnosis of schizophrenia. Int J Soc Psychiatry. 2015;61(1):10–16. doi: 10.1177/0020764014535751.
    1. Kuipers E. Cognitive behavioural therapy and family intervention for psychosis evidence-based but unavailable? The next steps. Psychoanal Psychother. 2011;25(1):69–74. doi: 10.1080/02668734.2011.542966.
    1. Kuipers E, Yesufu-Udechuku A, Taylor C, Kendall T. Management of psychosis and schizophrenia in adults: summary of updated NICE guidance. BMJ. 2014;348:g1173. doi: 10.1136/bmj.g1173.
    1. Cohen AN, Drapalski AL, Glynn SM, Medoff D, Fang LJ, Dixon MB. Preferences for family involvement in care among consumers with serious mental illness. Psychiatr Serv. 2013;64(3):257–263. doi: 10.1176/appi.ps.201200176.
    1. Ramanadhan S, Davis MM, Armstrong R, Baquero B, Ko LK, Leng JC, et al. Participatory implementation science to increase the impact of evidence-based cancer prevention and control. Cancer Causes Control. 2018;29(3):363–369. doi: 10.1007/s10552-018-1008-1.

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