Title: Remote delivery of an app-based intervention DIALOG+ in community mental health care – development of Remote DIALOG+
Funder: Department of Health and Social Care

Abstract: In the UK, an estimated 300,000 patients with psychotic disorders are cared for in secondary mental health services. Despite significant investment outcomes for this patient group remain poor. DIALOG+ is a face-to-face, app-based intervention that structures routine meetings between patient and clinician; the only intervention specifically developed to make such meetings therapeutically effective. A previous trial found this intervention to be clinically effective and cost-saving, however the reach of DIALOG+ continues to be limited due to the requirement to meet face-to-face. The aim of this study is to develop a system of remote delivery for the DIALOG+ intervention for patients with psychosis, and to see if such a method of delivery is feasible. Through Remote DIALOG+ it is predicted that service efficiency will be increased and patient choice widened. A series of work packages will: i) identify how to reproduce the important aspects of face-to-face DIALOG+ remotely, so that clinical communication is not negatively affected ii) elicit the views of patients and clinicians about remote delivery of care through focus groups iii) develop a prototype of Remote DIALOG+ and conduct preliminary testing on 20 patients, with post-intervention interviews to explore the experiences of patients and clinicians iv) develop clinician training materials, and v) test the feasibility of the final intervention by inviting 10 clinicians to offer Remote DIALOG+ to 30 adult patients with psychosis for three months. Patients will be assessed at baseline and at six months on outcome measures assessing subjective quality of life, symptom levels and social outcomes. A framework for cost-effectiveness analysis of Remote DIALOG+ will be developed. A panel of people with lived experience of psychosis will advise on all aspects of the study including the design of the intervention. Once developed the Remote DIALOG+ intervention will be freely available to download for NHS services.

Lay abstract: Psychosis is a serious mental illness and can be very distressing for individuals and their families. People with psychosis often struggle to manage their symptoms and have low recovery rates. To help these patients, a new intervention called DIALOG+ was developed. It is the only intervention specifically designed to make routine meetings between patients and clinicians to be therapeutically effective. It is delivered by an app on a tablet computer, helping patients to rate their satisfaction with different areas of their life. Patients and clinicians then use the information to identify specific concerns and find solutions to those concerns. Studies showed that using DIALOG+ helped patients to improve their quality of life and reduce symptoms. However, at present DIALOG+ requires all meetings between the patient and the clinician to be face-to-face. Face-to-face meetings have numerous problems and limitations. They can be difficult to organise, have high rates of non-attendance, generate travel costs and limit patient choice. We aim to address these problems through developing an option to use DIALOG+ remotely. Patients will stay at home and engage in DIALOG+ with their clinicians via smartphones or tablets using video, visual displays and texts to complete the session collaboratively. Remote DIALOG+ can be used in addition to face-to-face meetings but will be an option to accommodate patient preferences, to reach patients who have difficulty accessing clinics, or when social distancing is required. Our design process puts the needs of patients and the requirements of clinicians at the heart of the development. First, we will identify how to reproduce the most important aspects of face-to-face DIALOG+ remotely, so that communication is not negatively affected. After developing a prototype of Remote DIALOG+ and clinician training materials, we will test how it works in practice. Ten clinicians will be invited to offer Remote DIALOG+ to 30 adult patients with psychosis. Patients and clinicians will be given smartphones or tablets to use DIALOG+ for three months. We will ask them for their experiences to learn how to best use Remote DIALOG+ in clinical practice, and what improvements can be made. We will also assess the costs of delivering care in this way. It is integral to involve people with lived experience of community care at all stages of the research. A panel of people with lived experience of psychosis will advise on all aspects of the study including developing patient interview questions, analysing findings, developing the technology, and establishing a plan to disseminate research findings. Information about the study and its outcome will be made available through a variety of methods including academic publications, social media, and conferences.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH