Mitigating the psychological impacts of COVID-19 restrictions in older people with long-term conditions: a qualitative study using the Theoretical Framework of Acceptability

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2D.2

Presenter:

Leanne Shearsmith

Twitter:

@CizCG

Co-authors:

Peter Coventry, Claire Sloan, Elizabeth Littlewood, Leanne Shearsmith, David Ekers, Della Bailey, Dean McMillan, Andrew Henry, Samantha Gascoyne, Lauren Burke, Suzanne Crosland, Eloise Ryde, Gemma Traviss-Turner, Rebecca Woodhouse, Simon Gilbody

Author institutions:

4. School of Medicine, Keele University, Staffordshire, ST5 5BG, Department of Health Services, Seebohm Rowntree Building, University of York, Heslington, York, YO10 5DD,Tees, Esk and Wear Valleys NHS FT. Research & Development Office, Flatts Lane Centre Flatts Lane, Normanby, Middlesbrough, TS6 0SZ, School of Medicine, Leeds University, Leeds, LS2 9NL

Problem

Older people with long-term conditions (LTCs) are at increased risk from COVID-19 (C19) infection. Older adults with LTCs are already at increased risk of mood disorders and risk of depression is increased by 2-3 times. Social isolation and loneliness are well established risk factors among older adults for cognitive impairment, depression, and mortality. The government’s strategy on loneliness sets reducing social isolation and improving well-being among older adults as a public health priority. COVID-19 restrictions could impact negatively on older adults’ mental health.The Behavioural Activation in Social IsoLation (BASIL) pilot trial evaluated the feasibility and acceptability of a brief psychosocial intervention (Behavioural Activation within a Collaborative Care framework) to prevent or ameliorate depression and loneliness in older adults with multiple LTCs. The intervention was delivered remotely by BASIL Support Workers (SWs).

Approach

Qualitative study, using semi-structured telephone interviews, to explore older adults’ and BASIL SWs’ views of the intervention. We interviewed 16 participants who had completed the BA intervention (‘completers’), one participant who did not complete the intervention (‘non-completer’) and 9 BSWs who delivered the intervention. An initial thematic analysis was followed by a framework analysis using the TFA (Theoretical Framework of Acceptability)* across the data-sets.Our Patient and Public Involvement (PPI) group contributed, in online meetings, to intervention development, public-facing materials and topic guides and commented on the findings.** Sekhon M et al. BMC Health Serv Res. 2017 doi: 10.1186/s12913-017-2031-8.

Findings

Older adults and BASIL SWs described a positive Affective Attitude towards the BASIL study. This was attenuated by some participants who did not feel they were experiencing low mood, but also the limitations on activity-planning (a key component of the BASIL intervention) due to the C19 context. Participation had low Opportunity Cost for BSWs and older adults. There was manageable Burden associated with both delivering and participating in the BASIL intervention. The intervention was understood, perceived to be relevant and likely to achieve its aims by all respondents (Perceived Effectiveness), particularly if tailored to those older adults already struggling with low mood. Self-efficacy for BSWs appeared to grow with experience of delivering the intervention. For older adults, experience and involvement promoted Self-efficacy. In terms of Ethicality, both BSWs and older adults discussed participating in the study for altruistic reasons. Older adults discussed valuing positive changes they had made by taking part in the intervention, and BSWs reflected on they how valued observing these changes and participants' progress.

Consequences

Use of the TFA provided valuable insights into the acceptability of study processes, how the BA intervention was experienced by older adults and BASIL SWs, and the refinements and modifications needed to be taken forward for a larger, definitive randomised controlled trial (BASIL+).

Submitted by:

Carolyn A. Chew-Graham

Funding acknowledgement:

This work presents independent research funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme [RP-PG-0217-20006]. The views expressed in this work are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.