Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory, evidence and person-based approach
Autor: | Joanna Moncrieff, Hannah Bowers, Samantha Williams, Geraldine Leydon, Carl May, Marta Glowacka, Adam W A Geraghty, Yvonne Nestoriuc, Gerhard Andersson, Tony Kendrick, Rebecca Laine, Christopher Dowrick |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Adult
Male Psychotherapist Guiding Principles digital intervention Primary care intervention development primary care Intervention (counseling) Medicine Humans Think aloud protocol Applied Psychology Qualitative Research Aged Cognitive Behavioral Therapy Drug Tapering Primary Health Care business.industry Depression Flexibility (personality) General Medicine Tillämpad psykologi Middle Aged Antidepressive Agents United Kingdom Discontinuation Mental Health antidepressants depression & mood disorders Practice Guidelines as Topic Female business Social cognitive theory Qualitative research |
Zdroj: | BMJ Open BMJ Open, Vol 10, Iss 3 (2020) |
ISSN: | 2044-6055 |
Popis: | ObjectivesWe aimed to develop a digital intervention to support antidepressant discontinuation in UK primary care that is scalable, accessible, safe and feasible. In this paper, we describe the development using a theory, evidence and person-based approach.DesignIntervention development using a theory, evidence and person-based approach.SettingPrimary Care in the South of England.ParticipantsFifteen participants with a range of antidepressant experience took part in ‘think aloud’ interviews for intervention optimisation.InterventionOur digital intervention prototype (called ‘ADvisor’) was developed on the basis of a planning phase consisting of qualitative and quantitative reviews, an in-depth qualitative study, the development of guiding principles and a theory-based behavioural analysis. Our optimisation phase consisted of ‘think aloud’ interviews where the intervention was iteratively refined.ResultsThe qualitative systematic review and in-depth qualitative study highlighted the centrality of fear of depression relapse as a key barrier to discontinuation. The quantitative systematic review showed that psychologically informed approaches such as cognitive–behavioural therapy were associated with greater rates of discontinuation than simple advice to reduce. Following a behavioural diagnosis based on the behaviour change wheel, social cognitive theory provided a theoretical basis for the intervention. The intervention was optimised on the basis of think aloud interviews, where participants suggested they like the flexibility of the system and found it reassuring. Changes were made to the tone of the material and the structure was adjusted based on this qualitative feedback.Conclusions‘ADvisor’ is a theory, evidence and person-based digital intervention designed to support antidepressant discontinuation. The intervention was perceived as helpful and reassuring in optimisation interviews. Trials are now needed to determine the feasibility, clinical and cost-effectiveness of this approach. |
Databáze: | OpenAIRE |
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