Psychoeducational support for patients with prosthetic joint infection and their families

Research question What do guiding principles, a logic model and an intervention plan for a psychoeducational support intervention to reduce mental distress in prosthetic joint infection include, when co-designed by researchers, clinicians, patients and carers? Background Deep prosthetic joint infection (PJI) is a devastating condition that can result in pain, disability and death. It affects 1-4% of patients after joint replacement and has a five-year mortality rate of 22%. PJI has a major psychological impact on patients and their families. 12% of PJI patients rate their health-related quality of life as worse than death , and 58% report depression up to four years after surgery. However, they receive no mental health support. Guidelines state that PJI patients should receive mental health support, however, our previous research shows NHS centres do not have sufficient resources to provide it. There is good evidence to show that hybrid digital solutions are flexible and low-cost and have shown promise in addressing distress and anxiety. Aims and Objectives We aim to co-design guiding principles, an intervention plan, and a logic model for a hybrid digital intervention with patients that is accessible, meaningful, usable, and engaging for those with PJI and their families, to better inform and prepare patients for PJI treatment and recovery and reduce their psychological distress. Methods We will use a co-design approach, convening a diverse group of patients, carers, clinicians, and researchers to help design the intervention in three iterative phases: In Phase 1 we will conduct 3 linked co-designed reviews to i) understand the effectiveness of support interventions for PJI, ii) evaluate the psychological impact of PJI diagnosis and treatment, iii) and evaluate the evidence for online psycho-educational interventions in surgical populations, applicable to PJI. In Phase 2 we will analyse existing qualitative data to deepen our understanding of the psychological impact of PJI, unmet needs and target behaviours. In Phase 3 combining findings from phase 1&2 develop guiding principles, a detailed intervention plan and logic model, with input from the co-design group. By the end of the study, we will have a refined intervention plan and logic model that is acceptable and engaging. These will be used in a future NIHR study to test and evaluate the effectiveness of the intervention. Timelines for delivery Co-design Stakeholder Group (months 1-20) Phase 1: Evidence review & synthesis (months 0-15) Phase 2: Secondary Qualitative Analysis (months 0–5) Phase 3: Guiding principles, intervention plan and logic model (months 5–20) Dissemination: Months 5-20 Anticipated Impact and Dissemination The main output will be a rigorously developed intervention plan that is underpinned by a refined theory and evidence-based logic model, ready for evaluation in a future trial. Our research will be published as open-access peer-reviewed articles, a project final report, and summaries for stakeholders. Materials will be co-designed for diverse audiences using accessible methods. We will use existing media platforms including our own INFORM website to further disseminate materials. Co-design partners will be invited to participate in developing a future grant application to evaluate effectiveness.