Developing and Delivering Disruptive Design-Based Interventions for the Management of Depression in Primary CareDr Mariesha Jaffray

Research FellowDivision of Applied Medicine (Psychiatry), University

of Aberdeen

Professor Paul RodgersProfessor of Design Issues

Department of Design, Northumbria University

Dr Mariesha JaffrayDr Isobel CameronProf Ian Reid Ms Nooreen Akhtar

Dr Steve MacGillvray

Dr Michela Tinelli

Dr Andrew Clifton

Prof Paul RodgersDr Andy TennantProf Amanda Clarke

Background: Depression• Common, debilitating, recurrent• NICE guidelines• Evidence of suboptimal treatment lengths• Poor adherence associated with:

Demographics : SES, gender (Burton, 2012) Attitudes & perceived support (Maxwell, 2005) ‘Impact on sense of self’ (Knudsen, 2002) Dependency fears (Grime & Pollock, 2003) Incorrect beliefs (Chakraborty, 2009)

• Discontinuers with predominance of negative attitudes (Van Geffen, 2011).

• Malpass (2009) Qualitative ethnographic study, three critical time points:

Return to function Adverse side effects Latency period (time lag)

Jaffray M., Cardy A.H., Reid I., Cameron I.M. EJGP (2013) [In Press]

Aims: To explore the views and experiences of patients newly initiated on antidepressants; And consider the influences on early discontinuation.

Design: Qualitative interview study over six months.

Setting: Four general practices in the North East of Scotland.

Method: A purposive sample of primary care patients, newly initiated on antidepressants, was interviewed to explore views and experiences with antidepressant therapy. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted using a consensus coding frame developed by two researchers.

Why Do Patients Discontinue Antidepressant Therapy Early?: A Qualitative Study (1)

Jaffray M., Cardy A.H., Reid I., Cameron I.M. EJGP (2013) [In Press]

Results: 29 patients participated. Three main factors influencing discontinuation were identified: ownership, knowledge and support. The treatment journey was characterised by four important time points where health care intervention may be helpful: initiation of therapy, experience of side effects, latency period, apparent return to function.

Conclusion: Health care professionals would benefit from exploring patient knowledge and views on depression and antidepressants at an early stage in treatment. Patients would welcome active involvement in treatment decision-making, the provision of information and ongoing support. Further research is needed to develop interventions enhancing ownership, knowledge and support at the time points identified.

Why Do Patients Discontinue Antidepressant Therapy Early?: A Qualitative Study (2)

Background: Disruptive Design• Disruptive design workshops are:

Aimed at breaking the cycle of well-formed opinions, strategies and ways-of-doing (unchallenged particularly in healthcare context).

Encourage the development of richer, more varied solutions to everyday issues.

Participants learn to view their personal situations in new ways.

Involve a series of creative activities (e.g. drawing from memory, problem solving, visually recording every day activities).

• Previous successful work between design and ADHD (Zender et al, 2011).

• Awareness of “Disruptive Design” is relatively limited outside the design arena.

Developing and Delivering Disruptive Design-based Interventions to Meet Information Needs in Mental Health Care (1)(a) Research Questions

1. What attitudes do patients have towards depression and being on antidepressants? Can these be challenged?

2. What research areas are important to service users?3. What are the information needs for patients recently initiated on

antidepressants to aid their treatment decision making?4. How do patients value information?5. How can the delivery of such intervention influence NHS, their patients

and society overall?

Developing and Delivering Disruptive Design-based Interventions to Meet Information Needs in Mental Health Care (2)(b) Methods - MRC Framework for Complex Interventions1

• Pre-clinical phase -Theory• Phase 1 -Modelling• Phase II - Exploratory Trial• Phase III – Definitive Randomised Controlled Trial (RCT)

• Phase IV- Long-term implementation1 http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC003372

Developing and Delivering Disruptive Design-based Interventions to Meet Information Needs in Mental Health Care (3)Pre-Clinical: Theory (Discontinuers work & literature reviews)

Phase 1: Modelling

• Focus groups &“disruptive” design-based methods including “User Narration” and “Try it Yourself” techniques.

• Explore patient knowledge and understanding of depression, antidepressants and their attitudes to both.

• Use findings from discontinuers study as basis for schedule.

Developing and Delivering Disruptive Design-based Interventions to Meet Information Needs in Mental Health Care (4)Phase II: Exploratory Trial• Aim: Evaluate the provision of written information (based on output from pre-clinical phase)• Patients: Recently initiated on antidepressants.• Setting: Scottish and English NHS sites. • Outcomes: Feasibility, acceptability of the design intervention. Feasibility of the overall study processes and material used (e.g. appropriateness of the cost/outcome measure tools to inform the economic evaluation modelling).

Developing and Delivering Disruptive Design-based Interventions to Meet Information Needs in Mental Health Care (5)Phase III: Definitive RCT

• Design will be informed by findings of Phase II;• Will compared the fully worked design intervention with control (treatment as usual).

Progress: Literature Review (1)‘Information Needs for Patients on

Antidepressants’

Research Questions:

1. To what extent has the design of patient information about depression been assessed in the current literature?

2. What types of information do patients consider when making decisions about their treatment for depression?

3. What are the information treatment preferences of people suffering from depression/taking antidepressants?

Progress: Literature Review (2)‘Application of Disruptive Design Techniques

in the Healthcare Context’

Research Questions

1. How can disruptive design approaches and methods be best utilised in healthcare contexts?

2. What exactly do designers need to do to fundamentally change or disrupt accepted ways of doing things? • Do rules and guidelines need to be completely removed? • Do the context and the environment in which these rules

operate need to be radically altered?

3. What are the most appropriate ways of design disruption in a healthcare context?

4. How might patients and other healthcare stakeholders disrupt their own methods?

Phase 1: Disruptive Design Workshop (1)

The proposed Disruptive Design interventions represent a boundary spanning, collaborative, novel research approach and we wanted involvement and representation from potential funders, stakeholders, service users, clinicians and other relevant organisations from the outset.

Phase 1: Disruptive Design Workshop (2)Who Attended? • Service User Representatives• Newcastle Clinical Trials Unit• The Health Foundation• Gateshead Mental Health User Voice• First Contact Carers Drug and Alcohol Network• Service User Research Enterprise (SURE), Institute of Psychiatry, London• Mental Health North East• Ethics Committee (Newcastle)• Huddersfield University

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (3)What did they do?

Phase 1: Disruptive Design Workshop (4)What did we learn?

Phase 1: Disruptive Design Workshop (4)What did we learn?

Phase 1: Disruptive Design Workshop (4)What did we learn?

Next Steps: Funding Proposal

Next Steps: Funding Proposal

To disrupt is good.