Hayes, Daniel Paul;
(2018)
Developing an intervention to promote shared decision making in child and youth mental health: Integrating theory, research and practice.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
There is growing national and international interest around the process of shared decision making (SDM) between patients and clinicians. However, research in this area specific to child and youth mental health is still in its infancy. Whilst interventions to improve SDM are being developed in this area, many of them target parents rather than the young people affected. The five studies in this thesis contribute to the understanding of SDM and the development of a theory-led, evidence-based intervention to facilitate SDM with young people, parents and clinicians. Study 1 examined the theory, intervention functions (IFs) and behaviour change techniques (BCTs) that are being used in interventions designed to improve SDM. Across all of these studies, a lack of explicit theory was found. However, five possible IFs and fifteen BCTs that may facilitate SDM were identified. Study 2 explored predictors of SDM from the perspective of young people and parents. For young people, the severity of internalising difficulties and age were found to be predictors of gold standard SDM. For parents, both the severity of internalising and externalising difficulties, as well as ethnicity were predictors of gold standard SDM. Additionally, high levels of service variation were found in reported gold standard SDM for parents and young people. To better understand service variation and predictors of SDM, Studies 3 and 4 explored barriers and facilitators to SDM with clinicians, young people and parents using the Theoretical Domains Framework. For clinicians, 21 barriers and facilitators across ten domains were identified, whilst for young people and parents, 16 barriers and facilitators across eight domains were discovered. To guide intervention development, the Behaviour Change Wheel (BCW) was employed. Following this process, two decision aids (DAs) and a clinician educational and training package were developed. Both were co-produced in conjunction with the stakeholders at whom the interventions were aimed. Study 5 describes the process of testing the intervention in a London clinic for acceptability and usefulness. For DAs, changes were made to side effects and the diagnostic language on them. Clinicians interviewed after the DAs were embedded in the clinic found them to be both useful and acceptable. However feedback on the educational and training package received a more mixed response regarding its usefulness and acceptability.
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