Understanding clinician attitudes towards implementation of guided self-help cognitive behaviour therapy for those who hear distressing voices: using factor analysis to test normalisation process theory

Cassie M Hazell,Clara Strauss,Kate Cavanagh,Mark Hayward

doi:10.1186/s12913-017-2449-z

Abstract

BackgroundThe Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. The current study aims to apply the NPT model to a secondary mental health context, and test the model using exploratory factor analysis. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention.MethodsMental health clinicians were asked to complete a NPT-based questionnaire on the implementation of a brief CBTp intervention. All clinicians had experience of either working with the target client group or were able to deliver psychological therapies. In total, 201 clinicians completed the questionnaire.ResultsThe results of the exploratory factor analysis found partial support for the NPT model, as three of the NPT factors were extracted: (1) coherence, (2) cognitive participation, and (3) reflexive monitoring. We did not find support for the fourth NPT factor (collective action). All scales showed strong internal consistency. Secondary analysis of these factors showed clinicians to generally support the implementation of the brief CBTp intervention.ConclusionsThis study provides strong evidence for the validity of the three NPT factors extracted. Further research is needed to determine whether participants’ level of seniority moderates factor extraction, whether this factor structure can be generalised to other healthcare settings, and whether pre-implementation attitudes predict actual implementation outcomes.

Highlights

The Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions
We have developed our own questionnaire measure based on the NPT model [20] that has been developed to investigate the prospective implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention
In light of this research, our study aims to: (1) test the validity of the four factor NPT model within our questionnaire using factor analysis; and based on the established factor structure, (2) identify mental health practitioner views on the implementation of guided self-help CBTp intervention for distressing voices (CBTv), and what sample characteristics may moderate these views

Summary

Introduction

The Normalisation Process Theory (NPT) has been used to understand the implementation of physical health care interventions. This study will consider the implementation of a brief cognitive behaviour therapy for psychosis (CBTp) intervention. Access to CBT for psychosis (CBTp) is poor, with recent figures from the UK suggesting only 10% of people with a psychosis diagnosis are offered CBTp [5]. One possible approach to increase access to CBTp is by developing interventions that can be delivered using comparatively less resources. A recent meta-analysis found briefer forms of CBTp (i.e. fewer than the recommended 16 therapy sessions) led to a significant reduction in psychosis symptoms compared to control conditions [13] These brief CBTp interventions typically targeted a specific symptom associated with psychosis (e.g. delusions or voices). In addition to investigating the effects of brief CBTp, we need to consider the potential challenges and facilitators to implementing this novel intervention

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