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Supporting antidepressant discontinuation: the development and optimisation of a digital intervention for patients in UK primary care using a theory, evidence and person-based approach
University of Southampton, Southampton, UK.
University of Southampton, Southampton, UK.
Bournemouth University, Poole, UK.
University of Southampton, Southampton, UK.
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2020 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 10, no 3, article id e032312Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: We aimed to develop a digital intervention to support antidepressant discontinuation in UK primary care that is scalable, accessible, safe and feasible. In this paper, we describe the development using a theory, evidence and person-based approach.

DESIGN: Intervention development using a theory, evidence and person-based approach.

SETTING: Primary Care in the South of England.

PARTICIPANTS: Fifteen participants with a range of antidepressant experience took part in 'think aloud' interviews for intervention optimisation.

INTERVENTION: Our digital intervention prototype (called 'ADvisor') was developed on the basis of a planning phase consisting of qualitative and quantitative reviews, an in-depth qualitative study, the development of guiding principles and a theory-based behavioural analysis. Our optimisation phase consisted of 'think aloud' interviews where the intervention was iteratively refined.

RESULTS: The qualitative systematic review and in-depth qualitative study highlighted the centrality of fear of depression relapse as a key barrier to discontinuation. The quantitative systematic review showed that psychologically informed approaches such as cognitive-behavioural therapy were associated with greater rates of discontinuation than simple advice to reduce. Following a behavioural diagnosis based on the behaviour change wheel, social cognitive theory provided a theoretical basis for the intervention. The intervention was optimised on the basis of think aloud interviews, where participants suggested they like the flexibility of the system and found it reassuring. Changes were made to the tone of the material and the structure was adjusted based on this qualitative feedback.

CONCLUSIONS: 'ADvisor' is a theory, evidence and person-based digital intervention designed to support antidepressant discontinuation. The intervention was perceived as helpful and reassuring in optimisation interviews. Trials are now needed to determine the feasibility, clinical and cost-effectiveness of this approach.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2020. Vol. 10, no 3, article id e032312
Keywords [en]
antidepressants, depression & mood disorders, digital intervention, intervention development, primary care
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:liu:diva-164879DOI: 10.1136/bmjopen-2019-032312ISI: 000527389000001PubMedID: 32152159Scopus ID: 2-s2.0-85081543563OAI: oai:DiVA.org:liu-164879DiVA, id: diva2:1417742
Note

Funding agencies. Finnish Association of Woman Dentists

Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2020-05-06Bibliographically approved

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Andersson, Gerhard

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