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STructured lifestyle education for people WIth SchizophrEnia (STEPWISE): mixed methods process evaluation of a group-based lifestyle education programme to support weight loss in people with schizophrenia

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posted on 2019-12-20, 10:30 authored by Rebecca Gossage-Worrall, Daniel Hind, Katharine D Barnard-Kelly, David Shiers, Angela Etherington, Lizzie Swaby, Richard IG Holt, Katharine Barnard-Kelly, Mike Bradburn, David Saxon, Paul French, John Pendlebury, Stephen Wright, Glenn Waller, Paul McCrone, Tiyi Morris, Charlotte Edwardson, Kamlesh Khunti, Melanie Davies, Marian Carey, Yvonne Doherty, Alison Northern, Janette Barnett, Richard Laugharne, Chris Dickens, Kathryn Greenwood, Fiona Gaughran, Sridevi Kalidindi, Shanaya Rathod, Najma Siddiqi

Background

STEPWISE is a theory-informed self-management education programme that was co-produced with service users, healthcare professionals and interventionists to support weight loss for people with schizophrenia. We report the process evaluation to inform understanding about the intervention and its effectiveness in a randomised controlled trial (RCT) that evaluated its efficacy.

Methods

Following the UK Medical Research Council (MRC) Guidelines for developing and evaluating complex interventions, we explored implementation quality. We considered causal mechanisms, unanticipated consequences and contextual factors associated with variation in actual and intended outcomes, and integrated treatment fidelity, using the programme theory and a pipeline logic model.

We followed a modified version of Linnan and Steckler’s framework and single case design. Qualitative data from semi-structured telephone interviews with service-users (n = 24), healthcare professionals delivering the intervention (n = 20) and interventionists (n = 7) were triangulated with quantitative process and RCT outcome data and with observations by interventionists, to examine convergence within logic model components.

Results

Training and course materials were available although lacked co-ordination in some trusts. Healthcare professionals gained knowledge and some contemplated changing their practice to reflect the (facilitative) ‘style’ of delivery. They were often responsible for administrative activities increasing the burden of delivery. Healthcare professionals recognised the need to address antipsychotic-induced weight gain and reported potential value from the intervention (subject to the RCT results). However, some doubted senior management commitment and sustainability post-trial.

Service-users found the intervention highly acceptable, especially being in a group of people with similar experiences. Service-users perceived weight loss and lifestyle benefits; however, session attendance varied with 23% (n = 47) attending all group-sessions and 17% (n = 36) attending none. Service-users who lost weight wanted closer monitoring and many healthcare professionals wanted to monitor outcomes (e.g. weight) but it was outside the intervention design. No clinical or cost benefit was demonstrated from the intermediate outcomes (RCT) and any changes in RCT outcomes were not due to the intervention.

Conclusions

This process evaluation provides a greater understanding of why STEPWISE was unsuccessful in promoting weight loss during the clinical trial. Further research is required to evaluate whether different levels of contact and objective monitoring can support people with schizophrenia to lose weight.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme (project number 12/28/05).

History

Citation

BMC Psychiatry volume 19, 358 (2019) doi:10.1186/s12888-019-2282-5

Author affiliation

Diabetes Research Centre, College of Life Sciences

Version

  • VoR (Version of Record)

Published in

BMC Psychiatry

Volume

19

Issue

1

Publisher

BMC

eissn

1471-244X

Acceptance date

2019-09-10

Copyright date

2019

Available date

2019-11-13

Publisher version

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2282-5#Abs1

Language

English

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