Table 1 Implementation support package: strategy proposed in the participatory design process, description of the final strategy for inclusion, and delivery to service
Strategy proposed and suggestions | Description of strategy to be included | Weeka delivered to intervention serviceb |
|---|---|---|
(1) Champion/local opinion leaders | ||
Proposed: Designated mental health support ‘champion’ is recruited from within the service to promote the role of mental health clinicians’ in providing preventive care Feedback: Phase one of the participatory design process identified this strategy as not being appropriate due to the service manager wanting all staff to share an equal role in preventive care delivery | Not included after phase one of the participatory design process | Not included |
(2) Clinician educational meetings/training and educational materials | ||
Proposed: An education and training package will provide evidence regarding the relevance of each behavioural risk factor to the mental health and wellbeing of clients (in addition to their physical health), as well as address key clinician barriers to preventive care provision, such as misperceptions about client disinterest in changing behaviours and receiving preventive care Feedback: During phase one of the participatory design process, the implementation working group (service manager, clinical coordinator, psychiatrist, dietitian, senior mental health nurse, and the research team) identified training sessions and materials to be useful | Training sessions (sub-strategy 1): Six 45-minute training sessions were designed and delivered over six weeks (delivered oncea or twice) to cover six topics: (A) preventive care; (B) smoking cessation; (C) physical activity and nutrition; (D) motivational interviewing; (E) the Get Healthy Telephone Coaching Service; and (F) alcohol reduction. Session recordings were made available via Youtube link. Training contents, topics, and delivery frequency and timing were informed by clinician requests generated during phase two. Training sessions were delivered over a series of interactive workshops during the service’s existing time slots for educational meetings. Training sessions focused on specific behaviours (B, C and F) provided education on the links between such behaviour and mental health outcomes, examples of questions to ask to assess, and examples of referral avenue. The motivational interviewing training session provided guidance to clinicians on how to provide behaviour change assistance to clients, including, for example, strategies to keep smoking on the agenda, utilising OARS (open-ended questions, affirmation, reflective listening, summarise), scaling, and eliciting change talk (desires, abilities, reasons and needs) | (A) 1st (N = 28)c (B) 2nd (N = 30) (C) 3rd (N = 29) (D) 4th (N = 28) (E) 5th (N = 19) (F) 6th (N = 23) |
Educational booklets (sub-strategy 2): Four types of clinician educational resources booklets (one for smoking (A), nutrition (B), physical activity (C), and alcohol (D)) were developed and 200 × printed copies were provided to the service (50 copies for each behaviour). Booklet contents were informed by suggestions generated by clinicians during phase two. For example, guidance for clinicians on how to assist clients make behaviour changes was provided, including conversation starters, brief and achievable tips and strategies to change, motivational interviewing guidance with example phrases, visual aids and common misconceptions. Electronic copies of each booklet were made available online via the service’s network drive. Delivery of booklets occurred at multiple timepoints during the 4-month period | A: 7th B: 8th C: 8th D: 10th | |
(3) Enabling resources and prompts for clinicians (staff activation) | ||
Proposed: Enabling resources including educational information/materials for clinicians to provide to clients, paper-based assessment tools, clinical decision-making supports, referral forms and prompting posters Feedback: During phase one of the participatory design process, the implementation working group suggested enabling resources and prompts would be helpful. Clinicians requested referral forms and client resources to be placed in each consultation room for ease of access | Clinician assessment tool (sub-strategy 3)d: A tool for clinicians to assess client risk for all behaviours was adapted from a previously existing tool to be briefer and more client focused. Clinicians provided extensive input on multiple iterations of the assessment tool 50 × paper-based assessment tools were provided Referral forms (sub-strategy 4)d: Paper-based referral forms for NSW Get Healthy Service and Quitline were sourced and provided to the service. 50 × GHS and Quitline referral forms were provided Client resources (sub-strategy 5)d: Paper-based resources that could be given to clients by clinicians were sourced and provided to the service. This included: 350 × brochures of seven types (50 per type) including one for each of the four behaviours, a Get Healthy Telephone Coaching Service brochure, an alcohol-focused Get Healthy Telephone Coaching Service brochure and a smoking Quitline brochure; 50 × smoking information packs termed a ‘QuitKit’; and paper-based behaviour information leaflets (‘client handouts’) Clinician poster (sub-strategy 6)d: A poster was designed and placed in the staff meeting room to prompt clinicians and managers to provide preventive care and discuss preventive care in review meetings | Sub-strategy 3: 15th Sub-strategy 4: 12th Sub-strategy 5: 7th, 12th Sub-strategy 6: 12th |
(4) Client activation materials | ||
Proposed: These strategies are employed to engage the clients to be more proactive regarding asking for and receiving preventive care support from the clinicians Feedback: Client activation materials were appealing to members of the implementation working group, who suggested materials could be placed in the waiting room | Conversation cards (sub-strategy 7): Coloured conversation starter cards (four types for each behaviour) were placed in the waiting room by researchers. Forty coloured conversation starter cards were provided (10 for each behaviour) Client poster (sub-strategy 8): A poster was designed and placed in the client waiting room to prompt clients to ask their clinician about SNAP behaviours in upcoming appointments Client self-assessment form (sub-strategy 9): A double-sided, 10-item, paper-based form for clients to self-assess risk for all behaviours was designed and provided to the waiting room reception. 50 × printed pre-appointment forms (plus 10 × clip boards and pens) were provided. Clinicians suggested the assessment form for clients to fill in waiting room. The form was reviewed by a consumer representative for appropriateness and clarity | Sub-strategy 7: 7th Sub-strategy 8: 12th Sub-strategy 9: 16th |
(5) Audit and feedback | ||
Proposed: Tailoring of the locally prescribed generic preventive care assessment tool for mental health services which is revised based upon clinicians’ feedback and clinical relevance for the sessions with clients. Then feedback is provided to the staff members about the current preventive care progress of their clients may be incorporated on a regular basis during the staff meetings with the clinical manager Feedback: The audit and feedback strategies were primarily developed with implementation working group during Phase one, and refined during additional meetings with the team leader | Two streams of audit and feedback were identified as appropriate in the participatory design process: during client-focused 13-week review meetings (team leader or clinical co-ordinator reviews progress over last 13 weeks for 40 clients) (sub-strategy 10) and during clinician-focused caseload reviews (team leader or clinical co-ordinators reviews each clinician’s caseload with clinician every 13 weeks) (sub-strategy 11) Sub-strategy 10: Discussion from the client-focused 13-week review meetings are typed up as notes in the clinical review template. Preventive care discussion was to be recorded in the ‘summary’ section Sub-strategy 11: A tailored and brief preventive care assessment tool to capture AAR for each snap behaviour would be incorporated into the existing template used for each client during the clinician caseload reviews | Not delivered Although identified as appropriate by staff, both audit and feedback sub-strategies were unable to be implemented due to service changes, including reformatting of clinical case review forms, and COVID-19 limitations, including the significant reduction of review meetings to avoid face-to-face contact and align with COVID-19 protocols |