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• W2890980905 abstract "Event Abstract Back to Event A comprehensive, multi-level investigation of the implementation of a novel digital substance misuse intervention, Breaking Free Online: conceptualising implementation processes within services using the MRC framework and health psychology theory. Stephanie Dugdale1*, Sarah Elison1, Glyn Davies1, Jonathan Ward1 and Martha Dalton2 1 Breaking Free Online, Research, United Kingdom 2 Crime Reduction Initiatives, Research, United Kingdom Background: Medical Research Council (MRC: Craig et al., 2008) guidelines outline the importance of a cycle of continual development, feasibility testing, outcomes evaluation and implementation analysis when creating and evaluating complex interventions. However the implementation analysis phase of the intervention creation and evaluation process is often neglected within behavioural change intervention development research. This is problematic as the implementation process is important when developing and evaluating innovative interventions that could be seen to be ‘disruptive’, such as digital health interventions, in order to be able to effectively translate these interventions into real-world, standard clinical practice. One such digital health innovation is Breaking Free Online (BFO), a technology-enhanced treatment and recovery programme for substance misuse and comorbid mental health difficulties (‘dual diagnosis’), which contains theoretically defined, evidence-based psychosocial intervention techniques informed by cognitive behavioural therapy and mindfulness principles. Following the MRC guidelines, a process of development, feasibility testing and clinical outcomes evaluation has taken place using BFO, with findings suggest that the programme is effective in reducing substance use and social impairment and improving depression, anxiety and overall quality of life (Elison et al., 2013, 2014, 2015a, 2015b). Currently BFO is being implemented in services across the UK including Crime Reduction Initiatives (CRI), a health and social care charity and one of the largest substance misuse treatment providers in the UK. Aim: This series of studies, informed by the principles set out in the MRC guidelines, set out to investigate implementation processes of BFO within CRI and the subsequent normalisation of the programme throughout this real-world healthcare service, in order to inform further developments to the programme. Theories and models from within the disciplines of health psychology and implementation science were used to conceptualise these processes. Methods: Semi-structured qualitative interviews were conducted with staff, peer mentors and service users to investigate initial diffusion and subsequent normalisation of BFO within CRI, and the impact of BFO on peer mentors’ own substance misuse recovery journeys. Thematic analyses were conducted, and models derived from health psychology and implementation science used to conceptualise implementation processes from an organisational level. Further analyses using Interpretative Phenomenological Analysis (IPA) expanded investigation down to the level of individual people within CRI, and the role of peer mentors delivering the programme within the organisation. Results: ‘Diffusion of innovation theory’ conceptualised initial implementation and diffusion of BFO throughout CRI. Although there were perceived barriers to implementation, such as lack of IT equipment, anxieties around staff and service user IT skills and the impact on staff’s professional roles, intentions to continue using BFO were reported. Analyses investigating continued implementation processes of the programme used ‘normalisation process theory’ to demonstrate how a process of normalisation of the programme is underway following initial diffusion. Findings suggested that staff were beginning to take greater ‘ownership’ of BFO since it was initially introduced into the organisation, and that the programme was influencing changes to work-role responsibilities in delivering BFO. Data using the ‘trans-theoretical model’ also indicated that peer mentors benefited from implementing BFO to support others and assist their own recovery maintenance. Conclusion: Whilst the principal focus must always be on establishing clinical effectiveness when developing and evaluating complex behaviour change interventions, such as digital interventions, implementation process analysis is also key. This analysis is important in order for interventions to be translated into real-world outcomes, as without considering implementation, the potential impact of an intervention is compromised. This research has implications for the valuable roles of health psychology models and implementation science theories in understanding the complex processes of implementation of digital health innovations such as BFO. References Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ, 337, a1655. Elison, S., Davies, G., & Ward, J. (2015a). An outcomes evaluation of computerised treatment for problem drinking using Breaking Free Online. Alcoholism Treatment Quarterly, 33(2), 185- 196. Elison, S., Davies, G., & Ward, J. (2015b). Sub-group analyses of a heterogeneous sample of service users accessing computer-assisted therapy (CAT) for substance dependence using Breaking Free Online. Journal of Medical Internet Research, 2(2), e13. Elison, S., Humphreys, L., Ward, J., & Davies, G. (2013). A pilot outcomes evaluation for computer a assisted therapy for substance misuse- An evaluation of Breaking Free Online. Journal of Substance Use, 19(4), 1-6. Elison, S., Ward, J., Davies, G., Lidbetter, N., Dagley, M., & Hulme, D. (2014a). An outcomes study of eTherapy for dual diagnosis using Breaking Free Online. Advances in Dual Diagnosis, 7(2), 52- 62. Keywords: implementation science, Diffusion of innovation, Normalisation Process Theory, substance misuse, computer assisted therapy Conference: 2nd Behaviour Change Conference: Digital Health and Wellbeing, London, United Kingdom, 24 Feb - 25 Feb, 2016. Presentation Type: Oral presentation Topic: Academic Citation: Dugdale S, Elison S, Davies G, Ward J and Dalton M (2016). A comprehensive, multi-level investigation of the implementation of a novel digital substance misuse intervention, Breaking Free Online: conceptualising implementation processes within services using the MRC framework and health psychology theory.. Front. Public Health. Conference Abstract: 2nd Behaviour Change Conference: Digital Health and Wellbeing. doi: 10.3389/conf.FPUBH.2016.01.00053 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 02 Dec 2015; Published Online: 09 Jan 2016. * Correspondence: Mrs. Stephanie Dugdale, Breaking Free Online, Research, Manchester, M3 4JB, United Kingdom, sdugdale@breakingfreegroup.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Stephanie Dugdale Sarah Elison Glyn Davies Jonathan Ward Martha Dalton Google Stephanie Dugdale Sarah Elison Glyn Davies Jonathan Ward Martha Dalton Google Scholar Stephanie Dugdale Sarah Elison Glyn Davies Jonathan Ward Martha Dalton PubMed Stephanie Dugdale Sarah Elison Glyn Davies Jonathan Ward Martha Dalton Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page." @default.
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