ORCID
- Gradinger, Felix: 0000-0001-8335-4047
Abstract
ObjectivesMindfulness-based cognitive therapy (MBCT) is an evidence-based approach for people at risk of depressive relapse to support their long-term recovery. However, despite its inclusion in guidelines, there is an ‘implementation cliff’. The study objective was to develop a better explanation of what facilitates MBCT implementation.SettingUK primary and secondary care mental health services.Design, participants and methodsA national two-phase, multi-method qualitative study was conducted, which was conceptually underpinned by the Promoting Action on Research Implementation in Health Services framework. Phase I involved interviews with stakeholders from 40 service providers about current provision of MBCT. Phase II involved 10 purposively sampled case studies to obtain a more detailed understanding of MBCT implementation. Data were analysed using adapted framework analysis, refined through stakeholder consultation.ResultsAccess to MBCT is variable across the UK services. Where available, services have adapted MBCT to fit their context by integrating it into their care pathways. Evidence was often important to implementation but took different forms: the NICE depression guideline, audits, evaluations, first person accounts, experiential taster sessions and pilots. These were used to build a platform from which to develop MBCT services. The most important aspect of facilitation was the central role of the MBCT implementers. These were generally self-designated individuals who ‘championed’ grass-roots implementation. Our explanatory framework mapped out a prototypical implementation journey, often over many years with a balance of bottom-up and top-down factors influencing the fit of MBCT into service pathways. ‘Pivot points’ in the implementation journey provided windows of either challenge or opportunity.ConclusionsThis is one of the largest systematic studies of the implementation of a psychological therapy. While access to MBCT across the UK is improving, it remains patchy. The resultant explanatory framework about MBCT implementation provides a heuristic that informed an implementation resource.
DOI
10.1136/bmjopen-2018-026244
Publication Date
2019-09-08
Publication Title
BMJ Open
Volume
9
Issue
9
ISSN
2044-6055
Embargo Period
2019-12-03
Organisational Unit
Peninsula Medical School
First Page
e026244
Last Page
e026244
Recommended Citation
Rycroft-Malone, J., Gradinger, F., Owen, G., Anderson, R., Crane, R., Gibson, A., Mercer, S., & Kuyken, W. (2019) '‘Mind the gaps’: the accessibility and implementation of an effective depression relapse prevention programme in UK NHS services: learning from mindfulness-based cognitive therapy through a mixed-methods study', BMJ Open, 9(9), pp. e026244-e026244. Available at: https://doi.org/10.1136/bmjopen-2018-026244
