Refining a psychosocial intervention for older people with anxiety and/or depression to be delivered by third sector providers: a qualitative study
Anxiety and depression are prevalent among older people; however, both are sub-optimally managed, leading to increased use of health and social care services and mortality. The NICE guidelines for management of anxiety (NICE 2011) and depression (NICE 2009) advocate a stepped care approach. Patients with mild to moderate anxiety or depression are offered, at step 1 and 2, advice about lifestyle and low intensity interventions, respectively, which may include provision by non-statutory organisations and engagement in group activities. However, there is limited evidence of the effectiveness of such providers in improving patient outcomes. Behavioural Activation (BA), based on principles of cognitive behavioural therapy, and befriending have been shown to be effective in the management of anxiety and depression; and meaningful activity in groups has been shown to reduce loneliness. The qualitative study reported here aimed to inform the refinement of a proposed psychosocial intervention for older people with anxiety and/or depression. The psychosocial intervention will be based on BA, include sign-posting to other services/resources, and be delivered by third sector providers in a feasibility study.
The views of older people (65 years and over) and current third sector workers were explored. Participants were recruited through social activity groups via third sector organisations in North Staffordshire. One to one qualitative interviews explored older people’s personal views on: living with anxiety and/or depression, help seeking, access to services, and acceptable management approaches. Interviews with third sector workers explored views on: their potential role in supporting older people with anxiety and/or depression, training and skills needed to develop confidence and competence to deliver the intervention. Interviews were digitally recorded with consent and then transcribed. The transcripts were thematically analysed using principles of constant comparison by a team of researchers with cross-disciplinary backgrounds.
Nineteen older people and nine workers were interviewed. Initial analysis from interviews with older people indicates the importance of group activities in the prevention and management of symptoms of anxiety and/or depression, but “grim determination” was needed to overcome multiple barriers to accessing such groups. Third sector workers reported to engage often in supporting older people with anxiety and/or depression as part of their work in community groups, but rarely received formal training to support their work. They identified key competencies, suggested methods of training, and highlighted the importance of supervision. Older people and workers alike felt strongly that a psycho-social intervention delivered in the community by third sector providers would be acceptable to older people with anxiety and/or depression.
We will describe how findings from this qualitative study have informed the design of the psychosocial intervention and the training required for third sector providers, to be evaluated in a feasibility study.