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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.

Lean, M; Leavey, G; Killaspy, H; Green, N; Harrison, I; Cook, S; Craig, T; Holloway, F; Arbuthnott, M; King, M (2015) 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. BMC Psychiatry, 15. p. 209. ISSN 1471-244X
SGUL Authors: Harrison, Isobel

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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. METHOD: 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). CONCLUSION: 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. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).

Item Type: Article
Additional Information: © 2015 Lean et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Keywords: Clinical Competence, England, Focus Groups, Health Personnel, Health Priorities, Hospitalization, Hospitals, Psychiatric, Humans, Inpatients, Inservice Training, Interprofessional Relations, Leadership, Mental Health, Patient Care Planning, Patient Participation, Psychiatric Rehabilitation, Qualitative Research, Rural Health, State Medicine, Urban Health, Humans, Hospitalization, Focus Groups, Leadership, Interprofessional Relations, Mental Health, Qualitative Research, Clinical Competence, Inservice Training, Health Personnel, Inpatients, Rural Health, Urban Health, Hospitals, Psychiatric, Patient Participation, Health Priorities, State Medicine, Patient Care Planning, England, Psychiatric Rehabilitation, Psychiatry, 1103 Clinical Sciences
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: BMC Psychiatry
ISSN: 1471-244X
Language: eng
2 September 2015Published
19 August 2015Accepted
Publisher License: Creative Commons: Attribution 4.0
Project IDFunderFunder ID
RP-PG-0610-10097National Institute for Health Research
PubMed ID: 26328771
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