EQUITy Intervention Feasibility
Research type
Research Study
Full title
Enhancing the quality of psychological interventions delivered by telephone (EQUITy) - Intervention Feasibility
IRAS ID
271710
Contact name
Penny Bee
Contact email
Sponsor organisation
University of Manchester
ISRCTN Number
ISRCTN36865046
Clinicaltrials.gov Identifier
N/A, N/A
Duration of Study in the UK
0 years, 7 months, 31 days
Research summary
Research Summary
Depression and anxiety are common. The NHS has a world-leading psychological therapy service, called ‘IAPT’ (Improving Access to Psychological Therapy), to help.
Many IAPT sessions are by telephone. Delivery by telephone is effective, and can help people who cannot travel because of illness, transport or feelings of stigma. Psychological therapy by telephone is recommended by the National Institute for Health and Care Excellence for anxiety and depression.
However, data suggests that many people are not starting or finishing telephone treatment. Part of the problem is that the professionals who deliver telephone treatments do not receive enough training. Sharing information with the therapist is also harder on the telephone.
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 were able to develop an intervention that has three components – professional training, information resources to help patients understand what telephone-delivered treatments are like and recommendations for services to help services to improve their quality.
We are now going to conduct an initial test of the intervention in a research study in three IAPT sites in England to see what professionals think about it, if there are any difficulties are using the intervention in services and if any changes are needed before we test it in a larger research study with more IAPT sites. We will also speak to patients to find out what they thought about the treatment/patient resources and preferences for study information and research communication to inform the future full trial.
The research is funded by the National Institute for Health Research.
Summary of Results
Enhancing the Quality of Psychological Interventions Delivered by Telephone (EQUITy): Designing an intervention to improve patient engagement and quality of telephone delivered psychological interventions: is the intervention feasible, usable and acceptable?
About EQUITy
EQUITy is a five-year research programme tasked with designing, implementing and evaluating an intervention that aims to improve the quality of psychological therapies delivered over the telephone at Step 2 (Guided Self-Help) in the UK’s Improving Access to Psychological Therapy (IAPT) services that supports people with anxiety and/or depression.Our progress so far
Our research programme started in April 2018. We have spoken with patients and professionals (i.e. practitioners, service leads, clinical supervisors) to understand their experiences of telephone treatments and the types of challenges they face. In gathering these experiences, we have developed an intervention package that aims to help services to improve the quality of and engagement with treatments delivered by telephone and maintain this mode of working overtime.What does the EQUITy intervention package include?
The EQUITy intervention package has therefore been developed based on the best research and clinical evidence available and is made up of three elements:1. Guidelines for Services
A booklet provided guidelines and recommendations for further changes to service delivery which had specifically been highlighted as being important in our exploratory work, but which could not be addressed directly via our training for practitioners or resources for patients. The booklet addressed five key areas of change which would improve the quality of telephone delivered self-help interventions: 1) Promoting telephone work 2) Incorporating key elements of telephone work 3) Addressing working environment and resources 4) Boosting practitioner telephone skills and 5) Promoting Reflection. An introductory section provided information on how services should use and get the best out of the booklet.2. Practitioner Telephone Training
The training materials had been developed prior to the COVID-19 pandemic so were amended to ensure their relevance to the ongoing COVID-19 situation (e.g. wording, images, case examples, and an accessible online format). The training consisted of two sessions of 3-hours each. The first session was made up of 5 sections: 1) Welcome and Introductions 2) Introduction to the EQUITy programme 3) Evidence of the effectiveness of telephone delivered psychological interventions 4) Telephone skills (Introduction and orientation) 5) Managing emotion.The second session focussed primarily on telephone delivery skills and practice including verbal communication skills; skills to deliver treatment with a personalised approach, delivering formulation and homework without visual aids, dealing with noise and the patient's environment.
3. Resources for Patients
Materials for patients were co-designed with service users and included a leaflet incorporating information about telephone treatment in IAPT and an appointment card. The leaflet included information on the advantages of telephone appointments; an explanation of ‘guided self-help’ and how it works, and a focus on the credibility of the practitioners who deliver it. It also included a section of ‘frequently asked questions’.Each of the three elements are equally important; they interact with each other, and the implementation of the three is most likely to enhance the quality of psychological interventions delivered by telephone.
The feasibility study
This report outlines the next stage of the programme, which aimed to evaluate if it is possible to implement the intervention successfully and to see what people thought about it.We tested the EQUITy package in three IAPT services and received feedback from patients and professionals (practitioners and service leads) about the different elements and made changes following their advice and feedback.
Evaluation of the Intervention
The evaluation of the content and implementation EQUITy Intervention consisted of three parts:1. Completion of measures and questionnaires before and after the training.
2. Interviews with and patients, practitioners and service leads after the intervention had been implemented.
3. Collection of patient data (such as depression and anxiety levels) collected at the start, during and end of treatment (no patients can be identified in this data).What did we learn and what did we change?
Implementing the EQUITy intervention
Service Guidelines Booklet
The relevance of some of the recommendations in the service guidelines differed between services; some of the actions had already been implemented in some services or the guideline was not appropriate for their specific situation. Also, some of the guidelines were more or less relevant depending on whether COVID restrictions were in place (eg related to working environment).Changes made
- Made into an interactive document so tasks can be prioritised, action plans drawn up and progress recorded and monitored. Minor changes to content
- addition of a workshop before the practitioner training to aid implementation of the guidelines and patient resources. Follow-up telephone meetings also offered if services need some additional help from the research team.Telephone Training for practitioners
Mixed views on how useful the training for newly qualified/trainees compared with those with more experience.Changes made
- more time to be spent on skill development, role play and practical exercises.
- Practitioners will be provided with more detailed information before the training about the content so that they can decide if it would be useful for them.Patient Resources
The patient leaflet was informative and well designed, so this was retained without change. There was a mixed response from practitioners and patients related to the usefulness of the appointment card, mostly dependent upon the reminder systems services had in place. – The appointment card will be retained so that patients have the option to use it if they find it helpful.Changes made
- During the workshop, services will discuss when it is best to provide the resources to patients.Evaluating the implementation of the EQUITy intervention Collection of routine data Collection of routine data from each of the services was successful.
Changes made
- some services may not much time to obtain this data for the research team and may not have an expert data analyst employed in the service. Need to make sure that the research team provide clear information to services so that they know exactly what data they need.
- A document outlining this would be useful.Patient and professional interviews
Interviews with patients and professionals went well, although the numbers of people interested in taking part was slightly less than anticipated.Changes
- introduce interviews during the workshop/training so that people know that they may be invited to take part.
- when the researchers are looking at what has been said in the interviews with people working in the services, they will focus more on how well the intervention has been implemented and also how it can continue to be implemented successfully.
- for patient interviews researchers will focus mostly on ways in which the intervention was or was not acceptable.What’s next?
The updated EQUITy Intervention will be evaluated in research trial. The trial will involve 26 services – half (13) of the services will receive the intervention and the other half (13) will not receive the intervention and continue delivering telephone treatment as they usually do. We will collect and analyse data to explore whether the intervention improves health outcomes, engagement with telephone therapy delivered at Step 2 in IAPT services. We will also explore if it is acceptable to patients, practitioners and services and is cost effective.REC name
North West - Preston Research Ethics Committee
REC reference
20/NW/0082
Date of REC Opinion
24 Mar 2020
REC opinion
Favourable Opinion