A psychosocial intervention for older adults with depression and multiple long-term conditions: Development utilising qualitative and co-design methods.
Long-term conditions (LTCs) are prevalent amongst older adults: 60% of people aged 70-79 years and 70% of people aged 80+ years report one or more LTCs. Demographic changes mean that LTC management is an increasing health priority. Depression is 2 to 3 times more common in people with LTCs, resulting in poorer health outcomes and increased mortality, increased treatment costs and a significant contribution to health inequalities. The study aimed to iteratively develop and refine a psychosocial intervention (Behavioural Activation within a collaborative care framework) for older adults with comorbid depression and LTCs to improve physical and psychological functioning. The effectiveness of this intervention will be tested as part of a larger programme of research: the Multimorbidity in Older Adults with Depression Study (MODS).
An iterative process of intervention development and refinement using interview and co-design methods was adopted, following O’Cathain et al’s., (2019) recommendations for developing interventions to improve health (1 Partnership; 2 Target population-centred; 3 Theory and evidence-based; and 4 Implementation-based). Semi-structured interviews were conducted with physical and mental healthcare professionals (HCPs), older adults (OAs) who had experienced low mood/depression and/or had two or more LTCs, and people who provided informal care to this OA population (Caregivers, CGs). Interviews explored OAs’ and CGs’ experiences of mental-physical multimorbidity, access to and experiences of care for physical and mental health symptoms, views on the proposed intervention; and, for HCPs, experiences of providing care for OAs with depression and/or LTCs. Data analysis utilised thematic analysis (TA) and Framework Analysis (FWA). Key questions generated from data analysis were presented and discussed at 3 stakeholder co-design workshops. The prototype intervention and OA materials were tested with two small samples of OA participants (“case series”), who were then interviewed to explore their experiences of the intervention.Ethical and regulatory approvals were obtained.
Practical features of the intervention, including number of sessions, mode of delivery, how to include a caregiver, liaison with other HCPs, who should deliver the intervention and methods of signposting to other services were agreed during the co-design process. The co-design workshops also contributed to the development of a self-help booklet for OAs which included patient diaries, goal setting, and ‘patient stories’; which were all further refined following the case series. Key features of the intervention, including the support worker training programme and accompanying intervention manual, were also agreed during the co-design process.
The value of co-design to develop a psychosocial intervention which aims to improve the mental and physical well-being of OAs with comorbid depression and LTCs will be discussed. The intervention is due to be tested in a future trial and, if acceptable and effective, can be applied across a range of healthcare settings.