Synthesising existing and developing new evidence on effective healthcare professional training that aims to improve the management of psychological distress in primary care

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Abstract

Objectives: The management of depression and anxiety in primary care in the UK is not consistent with clinical guidelines. This has led to training initiatives that aim to change practice by improving the implementation of research evidence, but little is known about what constitutes effective healthcare professional training in this area. This thesis addressed this issue by identifying what determines effective training to improve the management of psychological distress in primary care. Methods: The research was undertaken in three stages. A systematic review and narrative synthesis was conducted to investigate the effects of controlled trials of training interventions delivered to primary care practitioners (PCPs) to improve the management of psychological distress on process outcomes (practitioner behaviour, knowledge, attitudes). Then two qualitative studies using semi structured interviews with PCPs (n=18) and experts in training/behaviour change (n=16) were conducted to explore their perceptions of effective healthcare professional training in this area and in general. The qualitative data were synthesised to produce recommendations for designing effective healthcare professional training to improve the primary care management of psychological distress. The research findings were used to develop a taxonomy of training intervention components for use in the design and reporting of healthcare professional training interventions in this area and more widely. Results: Forty Papers (36 studies) were included in the systematic review. The papers reviewed provide a mixed picture of the effective characteristics of training interventions. Two components: the inclusion of skills practice (role-play) and the use of theory to inform intervention content were associated with positive outcomes. Limitations with outcome measures, absence of theory and poor descriptions of the interventions made it difficult to determine effective intervention components. The analysis of the qualitative studies resulted in the development of the Perceived Effectiveness of Training (PET) framework. It incorporates five themes or core areas that underpin effective training: social interaction, credibility, relevance, information processing, and practicalities. The PET framework was used to identify effective training intervention components. Finally, the qualitative synthesis led to the development of a taxonomy of training intervention components, which was evaluated for comprehensiveness by mapping the training components to the interventions identified in the systematic review. This culminated in a 171 item taxonomy with hierarchical groupings divided into three phases: pre-training, training delivery and post training. Conclusions: Healthcare professional training to improve the management of psychological distress in primary care can be optimised for effectiveness using the PET framework to address core quality training standards. It is recommended that the taxonomy of training intervention components should be used to improve the science of healthcare professional training interventions. Further research to develop the taxonomy and to establish valid training evaluation measures would provide further scope to identify which training components can predict healthcare professional behaviour change and improve the management of psychological distress in primary care.

Keyword(s)

healthcare professional training, psychological distress

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