26 March 2020
Digital innovations in mental health care can support more collaborative, recovery oriented and efficient ways of working, but can be challenging to integrate into routine care, research by the National Institute for Health Research Aplied Research Collaboration West (NIHR ARC West) has shown.
The UK’s mental health care policy recommends that mental health service providers involve service users in planning for their care. However, service users can feel they’re not fully involved in this process.
Research published in the Journal of Medical Internet Research evaluated the implementation of a new electronic tool – the Care Pathway Tool – co-designed by Otsuka Health Solutions and service users at Avon and Wiltshire Mental Health NHS Partnership.
The Care Pathway Tool was co-designed to support joint working on care and crisis plans, and to enable direct access to electronic care plans in order to support more efficient working. Staff and service users accessed this interactive tool on a touchscreen tablet.
Researchers investigated staff experiences of using the tool in their routine meetings with service users, during the development phase and early adoption of the tool. They wanted to understand what it was like to introduce the tool to service users and use it with them, including what helped or hindered their efforts.
Researchers spoke with 15 mental health practitioners and five service development and management staff, who identified several factors that influenced their use of the tool.
Overall, participants thought the tool was easy to use, and its components aligned with their professional priorities and their preferred care delivery approach. However, ease of use was influenced by the organisation’s resources, such as IT infrastructure. Mobile ways of working and security restrictions influenced staff’s ability to have a remote and “live” connection to the service user’s care information. Heavy workloads also made it difficult to spend time preparing before meetings as well as using the tool during meetings.
Generally, staff thought the tool allowed them to work towards achieving their goal of involving service users in their own care. But some staff with more clinically oriented priorities thought the tool did not align with these priorities.
Although staff reported positive attitudes, they did not always feel they had the knowledge to use the tool effectively with service users. Some staff were concerned about the impact using the tool might have on their therapeutic relationship with service users. Attitudes towards technology and its use in care provision – held by staff and service users – influenced whether staff introduced the tool in routine practice. Staff also considered individual service users’ needs and characteristics, for example their mental health state, their readiness to engage in recovery care and their literacy skills.
Staff felt they had ownership of the tool because both staff and service users had been involved in its design. Peers recruited staff to use the tool and trained volunteers on how the tool worked. But some staff thought training focused on the technical aspects of using the tool; they thought there should be more training on how to use the tool with service users in ways that enhanced and not compromised the therapeutic relationship.
Dr Christalla Pithara from the NIHR ARC West, a lead author of the study, said:
“We found that the Care Pathway Tool supported more collaborative, recovery-oriented and efficient ways of working. In practice however, challenges on all levels influenced efforts to integrate this digital innovation in routine practice.
“Understanding digital innovations, in the contexts of policy and the setting in which they will be used – and always in relation to the individuals who are intended to benefit from, and use, the tool – will help address some of the challenges our research has identified. Training and supporting staff and service users, during and after implementation interventions, will help embed these digital innovations in routine practice, (in order to deliver benefit to service users and service providers).”