Enhancing the quality of psychological interventions delivered by telephone (EQUITy)

Background: Telephone-delivered psychological interventions are clinically-effective treatments recommended by NICE for mild-moderate anxiety and depression. However, they are not used consistently across IAPT and when they are, patient engagement is often not sustained. Potential barriers include a lack of bespoke training for telephone treatments, professionals' beliefs about treatment consequences, variable organisational support and the expectations and experiences of telephone treatment among patients. Aim: To increase engagement in telephone-delivered psychological interventions for mild-moderate depression and anxiety in IAPT, and improve their clinical and cost-effectiveness. Methods: Our 5-year programme is organised into 5 separate, inter-related workstreams: Workstream 1 seeks to understand the clinical and organisational contexts in which telephone treatments are used. We will conduct interviews with patients, professionals (n=30 of each) and key informants (n=20). We will complete conversation analysis of 120 assessment and 120 telephone therapy calls, and analyse national routine datasets. Workstream 2 will use the Behaviour Change Wheel to explore the best ways to facilitate telephone treatment. We will iteratively develop with service users/carers, IAPT professionals and service leads (4 consensus meetings, n=36), a feasible and acceptable behaviour change intervention to enhance engagement in telephone therapy. Workstream 3 will develop a smartphone app to enhance information exchange during telephone treatment. We will work with patients and professionals (n=30 of each), conduct focus groups (12 patients, 12 professionals) and host co-design workshops (n=45 mixed stakeholders). Using agile software methodologies, we will rapidly develop a smartphone app, and combine this with our Workstream 2 outputs to produce a 'complex intervention.' We will iteratively evaluate the feasibility, usability and acceptability of our combined intervention in a minimum of three purposively selected IAPT sites. Workstream 4 will assess the clinical and cost-effectiveness of our complex intervention via a cluster-randomised trial (n=26 sites, 13 per arm). Our primary outcome will be mental health symptoms measured by the PHQ-9/GAD-7. We will combine data routinely collected within IAPT with bespoke research data to assess outcomes at baseline, 6 and 12 months follow-up. Economic evaluation will assess whether the intervention is cost-effective in the services and participants in ourtrial (within-study analysis) and outside the trial setting (decision analysis). Decision analysis will model effects over the longer term (5 and 10 years) and over the wider IAPT setting. A nested process evaluation will conduct semi-structured interviews to explore the impact of our intervention on service users (n=30) and professionals (n=30). Workstream 5 combines traditional dissemination with effective knowledge mobilisation. We will provide all our resources free of charge to IAPT services wishing to improve patient access to telephone treatments. We will host a one-day mixed-stakeholder dissemination conference and engage directly with national IAPT leads, service commissioners, and managers. We will link with accredited IAPT training programmes and national professional networks/organisations. Our social media strategy will raise awareness of best-practice, motivate staff to deliver high-quality telephone-delivered interventions, and stimulate patient choice. We will monitor the reach and impact of our intervention components. Deliverables: Our programme will increase engagement with telephone-delivered psychological interventions for depression and anxiety. Deliverables will include staff training and supervision, patient-mediated materials, a smartphone app and best-practice referral and implementation guidelines. We will have experience of embedding best practice across our trial sites, and will be well-placed