Therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions.
Improving Access to Psychological Therapies
cognitive behavioural therapy
long-term conditions
online therapy
psychological therapy
qualitative
Journal
British journal of health psychology
ISSN: 2044-8287
Titre abrégé: Br J Health Psychol
Pays: England
ID NLM: 9605409
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
revised:
24
07
2020
received:
12
11
2019
pubmed:
13
10
2020
medline:
8
6
2021
entrez:
12
10
2020
Statut:
ppublish
Résumé
Improving Access to Psychological Therapies (IAPT) services in England have established a long-term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs. A qualitative design was employed using semi-structured interviews. Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation. Four key themes highlighted patient, therapist, and service-level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of 'embedded' versus 'separate' psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints. Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
307-324Informations de copyright
© 2020 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.
Références
American Psychological Association (2019). Journal reporting standards. Retrieved from https://apastyle.apa.org/jars/qualitative
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., … Gask, L. (2015). Integrated primary care for patients with mental and physical multimorbidity: Cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. British Medical Journal, 350, h638. https://doi.org/10.1136/bmj.h638
Damian, A. J., & Gallo, J. J. (2018). Models of care for populations with chronic conditions and mental/behavioral health comorbidity. International Review of Psychiatry, 30(6), 157-169. https://doi.org/10.1080/09540261.2019.1568233
Fusch, P. I., & Ness, L. R. (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20, 1408-1416. Retrieved from http://nsuworks.nova.edu/tqr/vol20/iss9/3
Garzonis, K., Mann, E., Wyrzykowska, A., & Kanellakis, P. (2015). Improving patient outcomes: Effectively training healthcare staff in psychological practice skills: A mixed systematic literature review. Europe's Journal of Psychology, 11, 535. https://doi.org/10.5964/ejop.v11i3.923
Knowles, S. E., Chew-Graham, C., Adeyemi, I., Coupe, N., & Coventry, P. A. (2015). Managing depression in people with multimorbidity: A qualitative evaluation of an integrated collaborative care model. BMC Family Practice, 16(1), 32. https://doi.org/10.1186/s12875-015-0246-5
Knowles, S. E., Chew-Graham, C., Coupe, N., Adeyemi, I., Keyworth, C., Thampy, H., & Coventry, P. A. (2013). Better together? A naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implementation Science, 8(1), 110. https://doi.org/10.1186/1748-5908-8-110
May, C. R., Mair, F., Finch, T., MacFarlane, A., Dowrick, C., Treweek, S., … Rogers, A. (2009). Development of a theory of implementation and integration: Normalization Process Theory. Implementation Science, 4(1), 29. https://doi.org/10.1186/1748-5908-4-29
Mental Health Task Force (2016). Implementing the Five Year Forward View For Mental Health. Retrieved from London: https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf
Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., … O'Donnell, C. (2010). Normalisation process theory: A framework for developing, evaluating and implementing complex interventions. BMC Medicine, 8(1), 63. https://doi.org/10.1186/1741-7015-8-63
National Collaborating Centre for Mental Health. (2018). The Improving Access to Psychological Therapies (IAPT) Pathway for People with Long-term Physical Health Conditions and Medically Unexplained Symptoms. Full Implementation Guidelines. London, UK: National Collaborating Centre for Mental Health. Retrieved from https://www.england.nhs.uk/wp-content/uploads/2018/03/improving-access-to-psychological-therapies-long-term-conditions-pathway.pdf
National Institute for Health and Care Excellence (2011). Common mental health problems: Identification and pathways to care. Retrieved from https://www.nice.org.uk/guidance/cg123/history
Naylor, C., Das, P., Ross, S., Honeyman, M., Thompson, J., & Gilburt, H. (2016). Bringing together physical and mental health. Retrieved from https://www.kingsfund.org.uk/publications/physical-and-mental-health
Naylor, C., Parsonage, M., McDaid, D., Knapp, M., Fossey, M., & Galea, A. (2012). Long-term conditions and mental health: The cost of co-morbidities (1857176332). Retrieved from https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/long-term-conditions-mental-health-cost-comorbidities-naylor-feb12.pdf
O’Reilly, P., Lee, S. H., O’Sullivan, M., Cullen, W., Kennedy, C., & MacFarlane, A. (2017). Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review. PLoS One, 12(5), e0177026. https://doi.org/10.1371/journal.pone.0177026
Sharpe, M., Walker, J., Holm Hansen, C., Martin, P., Symeonides, S., Gourley, C., … Murray, G. (2014). Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): A multicentre randomised controlled effectiveness trial. Lancet, 384, 1099-1108. https://doi.org/10.1016/s0140-6736(14)61231-9
Shaw, R. L., Bishop, F. L., Horwood, J., Chilcot, J., & Arden, M. A. (2019). Enhancing the quality and transparency of qualitative research methods in health psychology. British Journal of Health Psychology, 24, 739-745. https://doi.org/10.1111/bjhp.12393