Background: Improving the physical health of people with mental illness is a priority for the NHS. Compared with the general population, alcohol consumption among people with a mental illness is three times higher, yet people with mental illness have comparatively limited access to physical healthcare services. Since April 2017, alcohol screening, brief advice and referral has been incentivised for adult patients admitted to an inpatient ward as a strategy to achieve widespread delivery. This provides a timely context in which to explore the success of its implementation within a complex healthcare system.
This PhD will be approached from an implementation science perspective, by using a theoretical framework to guide the objectives and study design, focusing on implementation outcomes (i.e. acceptability, feasibility, reach, fidelity and sustainability) and exploring the impact of an implementation strategy (i.e. financial incentives). The consistent use of concepts and terminologies in this field helps generate generalisable knowledge that will facilitate wider scale-up beyond the East of England context.
Aim: To explore the implementation of alcohol screening, brief advice and referral for treatment among an inpatient mental health population. This PhD will use qualitative and quantitative research methods to address this aim, with a view to refining the patient pathway.
Year 1 (systematic review with narrative synthesis): to identify the barriers and enablers to alcohol screening, brief advice and referral for treatment in mental health settings, guided by the Consolidated Framework for Implementation Research.
Year 2 (qualitative interview study): to explore perceptions of the acceptability and feasibility of delivering and implementing alcohol screening, brief advice and referral for treatment in an inpatient mental health setting, and the fidelity to the proposed care pathway, from healthcare provider and other key stakeholder perspectives.
Year 3 (retrospective cohort study with interrupted time-series analysis): to determine the impact of the Commissioning for Quality and Innovation (CQUIN; i.e. financial incentive) for alcohol screening, brief advice and referral for treatment among inpatient mental health populations.
For more information on the project’s supervisor, please visit: https://people.uea.ac.uk/en/persons/z-khadjesari
Type of programme: PhD
Start date of project: April, July or October 2020
Mode of study: full time
Studentship length: 3 year studentships have a (non-funded) 1 year ‘registration only’ period
Location: UEA, Edith Cavell Building, Building 209, Norwich Research Park, Colney Lane, Norwich NR4 7UL
Entry requirements: Acceptable first degree in psychology, public health, epidemiology or other health-related discipline. The standard minimum entry requirement is 2:1.
(i) Boniface S, Malet-Lambert I, Coleman R, Deluca P, Donoghue K, Drummond C, Khadjesari Z. The effect of brief interventions for alcohol among people with comorbid mental health conditions: a systematic review of randomised trials and narrative synthesis. Alcohol Alcohol. 2018;53(3):282–293
(ii) Khadjesari Z, Hardoon SL, Petersen I, Hamilton FL, Nazareth I. Impact of Financial Incentives on Alcohol Consumption Recording in Primary Health Care Among Adults with Schizophrenia and Other Psychoses: A Cross-Sectional and Retrospective Cohort Study. Alcohol Alcohol. 2017;52(2):197–205
(iii) Hardoon SL, Khadjesari Z, Nazareth I, Hamilton FL, Petersen I. Monitoring of alcohol consumption in primary care among adults with bipolar disorder: A cross-sectional and retrospective cohort study. J Affect Disord. 2016;198:83-7.
(iv) Khadjesari Z, Vitoratou S, Sevdalis N, Hull L. Implementation outcome assessment instruments used in physical healthcare settings and their measurement properties: a systematic review protocol. BMJ Open. 2017;7:e017972
(v) Hull L, Goulding L, Khadjesari Z, Davis R, Healey A, Bakolis I, Sevdalis N. Designing High-Quality Implementation Research: Development, Application and Preliminary Evaluation of the Implementation Science Research Development (ImpRes) Tool and Guide. Implement Sci. 2019; 14, 80.