EQUITy IAPT Patient Portal Study
Research type
Research Study
Full title
Enhancing the quality of psychological interventions delivered by telephone (EQUITy) IAPT Patient Portal Study
IRAS ID
288905
Contact name
Penny Bee
Contact email
Sponsor organisation
University of Manchester
Duration of Study in the UK
2 years, 6 months, 1 days
Research summary
Summary of Research
Depression and anxiety are common. In England, there is a world-leading psychological therapy service, called IAPT (Improving Access to Psychological Therapy), to help. Many IAPT sessions are by telephone, as recommended by the National Institute for Health and Care Excellence for anxiety and depression. Delivery by telephone is effective and can help people who find accessing treatment difficult/challenging. However, research suggests that many people are not starting or finishing telephone treatment.
The EQUITy (Enhancing the quality of psychological interventions delivered by telephone) research programme aims to improve the way that psychological interventions are delivered over the telephone. The first part of the programme is complete. We spoke to patients and professionals to understand their experiences of telephone treatments and any challenges faced. In gathering these experiences, we co-developed three patient resources to help patients understand more about telephone treatment - an animation, a frequently asked questions section, and treatment/formulation diagrams used in telephone sessions.
We will provide access to these resources to patients accessing telephone therapy who are using Patient Case Management Information System (PCMIS). Those in services using PCMIS have access to the IAPT Patient Portal online web application which allows them to complete their mental health outcome measures prior to their telephone sessions. Patients will be able to choose to access the resources via a ‘launch page’ in the portal which will link to the EQUITy webpage where they will be held. The resources aim to complement/enhance existing telephone therapy delivery. On accessing the resources, they will be informed that we are interested in gathering feedback about the resources and if they would be happy to provide their views and experiences that they can contact the research team. Those who are interested and consent will take part in a one-off telephone interview lasting up to 60 minutes.
Summary of Results
Please note: the summary which follows is based on our initial analysis of the data. We are currently working with our patient and public advisory group to review the findings and identify the most appropriate and effective ways to disseminate.
The EQUITY Patient Portal Study originated in a pre-COVID landscape with the primary objective of developing a smartphone application aimed at supporting the delivery of telephone-based treatment at step 2 (guided self-help) in the Increasing Access to Psychological Therapies (IAPT) services in England. Work with patients and practitioners had highlighted areas where improvements could be made to the way sessions were carried out over the phone, such as completion of outcome measures during sessions. Between 2018 and early 2020, a co-development process involving patients and professionals resulted in the creation of an app that encompassed several features intended to enhance telephone-based treatment. These features included the capability to collect outcome data, treatment diagrams for use during sessions, and components designed to address patient understanding and expectations for treatment, such as a co-designed animation and frequently asked questions page.
However, the onset of the COVID-19 pandemic brought about significant changes in the way IAPT services had to work, and there was a substantial increase in the utilisation of online platforms provided by IAPT software service providers. As a result, it became evident that a reassessment of the EQUITY app was necessary to ensure its relevance, utility, and compatibility with the new service delivery approaches. In discussions between the research team and PCMIS, one of the largest software providers to IAPT services, it was determined that integrating certain aspects of our app, which could complement the existing features available through the Patient Portal provided by PCMIS, would be the most effective way forward. This integration not only facilitated a broader reach but also ensured alignment with the evolving service landscape.
Consequently, the resources originally developed for our app were relocated to a dedicated EQUITY Patient Portal Study page, which was linked from the PCMIS Patient Portal. All patients using the Patient Portal via services who agreed to the link being present on their portal were then able to freely access our resources.
The Resources
The development of the resources was guided by valuable insights gained from focus groups conducted with both patients and practitioners during the initial stages of the project. One prominent issue that emerged from these discussions was the importance of providing comprehensive information regarding telephone-based treatment. This finding aligned with previous research conducted within the EQUITy program, which revealed inconsistent and often inaccurate patient understanding and awareness about treatment over the telephone (Rushton et al., 2019). Patients exhibited gaps in knowledge regarding the nature of treatment, the individuals delivering it, and how telephone-based treatment compares to face-to-face therapy. Such misunderstanding and misconceptions can lead to disappointment and disengagement once patients become aware of the delivery method for their treatment.To address this issue, we conducted workshops with patients to develop an animation and compile a list of frequently asked questions (FAQs) specifically tailored to meet the needs of patients lacking knowledge and understanding of telephone-based treatment. The animation was thoughtfully designed to be concise, straightforward, and easily accessible, offering patients a clear overview of the treatment process. The FAQs provided supplementary information to further enhance patients' understanding.
Additionally, our resources included two commonly used treatment diagrams. During our early interactions with practitioners, the challenges of describing these diagrams to patients over the phone became apparent, creating a barrier during treatment sessions. Patients themselves expressed difficulties in understanding and visualising the diagrams when explained to them over the phone. As a result, two of the most commonly used treatment diagrams – The ABC Model and the 5 Areas Model – were included as images which could be viewed and/or printed by patients to use for reference during telephone sessions.
The Study
Patients from 5 PCMIS services were able to access the resources via the link from the Patient Portal and could opt-in to take part in an interview to share their views of the resources if they wished. From June 2022 to March 2023, the EQUITY Patient Portal Study page was accessed a total of 1076 times by individual users. Among them, 107 individuals expressed their interest in participating in the study. Ultimately, 35 individuals provided their consent, and out of those, 22 completed an interview.
We interviewed people at various stages of treatment (waiting (10), currently receiving (6), finished (6)) who had either had or were waiting for treatment over the phone (14). We also included people who had received treatment by video (5) or face-to-face (3). This enabled us to gather a comprehensive range of perspectives on the resources.Participant Views
Patient feedback primarily centred around the theme of reassurance. The Frequently Asked Questions (FAQs) and the animation received a positive response from participants, with individuals at different stages of treatment emphasising various benefits offered by these resources. In contrast, opinions on the treatment diagrams varied among participants, largely depending on their specific stage of treatment. This outcome was anticipated, based on consideration of the transition of resources from the app to the PCMIS patient portal. Originally designed for use during treatment sessions, the diagrams had comparatively less relevance for patients waiting for treatment to commence, compared to the other resources available.Animation
The animation was well received by participants, who reported that it was clear, concise, easy to understand, and offered a sense of reassurance, especially to those awaiting treatment. The participants described how watching the animation helped them understand what to expect, both practically for their sessions, but also in terms of alleviating pre-treatment anxiety."I think with any anxiety, if you're informed and you know, that goes a long way to help you, that's what I find. It's when you don't know, or you're in limbo... whereas if you know, well this is what's going to be even if you did have a bit of anxiety about oh, you know, that you did want it to be in person... It does relieve a little bit... I think it does help in that aspect." (Participant 17, ongoing treatment).
The animation provided patients with reassurance, particularly regarding the effectiveness of treatment. Several participants reported that they had not been aware that they would receive the same type of treatment over the phone as they would during face-to-face sessions, or that the treatment would be administered by the same practitioners.
"It [animation] helped because, I mean, going into this, I had no idea how all this stuff worked, the only stuff I'd seen is on TV... like American private therapy sort of stuff, and it's all pre-COVID. So coming out of COVID I was like, well, how does it all work now, and it did help to see confirmation that it will be the same thing, because once they explained what it is, it's like, okay, I can see why it would be exactly the same thing as if you went in person" (Participant 5, awaiting treatment).
Gaining this information through the animation was beneficial, as it increased patients' confidence that they would receive treatment that was on par with face-to-face sessions. Moreover, this knowledge contributed to improved engagement in treatment. One participant highlighted the impact of the animation, stating that watching it was "the only reason I answered the phone" for their appointment.
Frequently Asked Questions
Participants considered the frequently asked questions (FAQs) to be of real value, for some, the most useful component of all of the resources: "[it was] the one section I wish I had before treatment had started" (Participant 2, ongoing treatment). The FAQs were also identified as being a means to address questions that individuals might feel hesitant or embarrassed to ask openly:"Sometimes you do feel stupid asking some really basic questions about things. So, just to have that there so you think, oh that's good, other people do think of that kind of thing and do worry. So, yeah, and having the answer so you don’t need to ask it that just takes that bit of pressure off" (Participant 11, completed treatment)
Like thoughts about the animation, participants highlighted the reassuring nature of the information pertaining to practitioner qualifications and the efficacy of telephone treatment in the FAQs. It was emphasised that knowing they would have the same practitioner throughout the treatment process was particularly beneficial:
"I think it's quite good to know that you'll have the same practitioner throughout that time. Because when I was first doing it... because I spoke to somebody different for the pre-assessment, than for the actual sessions, and so I was already dealing with two or three different people and I was thinking oh dear, am I going to be jumping... pushed from one person to the next. But knowing that I was going to be with the same person throughout the sessions would have been helpful from the start."
(Participant 2, ongoing treatment).Treatment Diagrams
Some participants faced challenges when accessing the treatment diagrams independently through the portal. As the diagrams were originally intended for in-session use as a tool for collaborative working between patient and practitioner, no specific instructions or further details were included alongside them on the portal. Some participants described feeling confused by the diagrams as a result of this, particularly those who were waiting for treatment, who reported ‘skipping over’ them on the portal page.“I’ll start with the ABC because I think that’s quite a simple model picture, and without context, and I think to date nobody’s really talked through what that is. I can see what it is, and I can see somebody’s suggesting that those things are all linked together, but as a picture it doesn’t really give me anything. But I can understand how if I was in that physical session and I was talking to somebody and somebody drew that out in front of me or presented it to me whilst we were talking about stuff then it would probably be much more of a powerful image. But because I’ve got nothing to relate to that at this moment it kind of gets a little bit lost. It’s just a picture.” (Participant 7, awaiting treatment).
However, participants who were currently undergoing or had completed treatment acknowledged the diagrams' value within sessions. It was proposed that an animated explanation of the diagrams, following the concise and easily comprehensible format of the initial animation, would have enhanced understanding. Participants believed that an animated explanation could have provided additional support in comprehending the treatment process.
“I think the treatment diagram could be explained in a video as well possibly. That might be useful…. I mean, the images themselves don’t exactly explain anything but maybe a video explaining different aspects of each model would be useful... And also still having the images to refer back to as well later on, it’s still useful once you’ve started treatment but initially, like an animation would help to explain the different models to someone and how they could use them while doing therapy or even after therapy as well.” (Participant 1,ongoing treatment)
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
21/NW/0153
Date of REC Opinion
22 Jun 2021
REC opinion
Further Information Favourable Opinion