Background Despite a strong evidence base and policy recommendation supporting the implementation... more Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR dom...
International Journal of Mental Health Nursing, 2020
Despite health policy and research increasingly advocating for recovery‐enabling principles to be... more Despite health policy and research increasingly advocating for recovery‐enabling principles to be better integrated into mental health services, finding solutions to enhance the translation of recovery policy into practice remains a challenge. This study sought to understand whether a co‐facilitated group education intervention for service users and family members reached beyond the intervention and impacted the everyday recovery promoting beliefs and practices of the practitioners involved and the wider organization. The study employed a qualitative design involving semi‐structured interviews with a purposively selected sample of 28 participants (mental health nurses and other members of the multidisciplinary team) who were involved in delivering the intervention. Data were analysed using thematic analysis, with the assistance of NVivo. Participants reported that not only did involvement with the programmes help them reconnect with the contextual realities of service user and famil...
Background: Research to support the added value of including Epilepsy Specialist Nurses as member... more Background: Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. Aim: To describe the enabling and inhibiting factors to the implementation of the Epilepsy Nurse Specialist role in the Republic of Ireland. Methods: A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 epilepsy specialist nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigor is demonstrated using the COREQ checklist (See Supplementary File 1). Results: While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports, and competence of ESNs. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost saving measure, also emerged as potential barriers to future sustainability. Conclusion: The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. Relevance to clinical practice: In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability, and sustainability of services provided.
Background: Despite evidence to support the effectiveness of psychoeducation for people experienc... more Background: Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. Aim: The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. Methods: Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. Results: Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. Conclusions: The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability.
Background: Smoking is a leading cause of preventable morbidity and mortality in England. This fo... more Background: Smoking is a leading cause of preventable morbidity and mortality in England. This formative research involved the evaluation of SmokeFree Sports (SFS), a novel community sport intervention to prevent smoking among children and young people (CYP). Methods: SFS was implemented in five youth clubs situated in deprived communities, between February and June 2011, involving 246 CYP (6-18 years). Seventy-one CYP (median age=10.0 years, 56% male) and five youth club managers participated in this formative evaluation study, which utilised a mixed methods design. Results: Smoking prevalence at baseline and post-intervention did not differ significantly (2.8% vs. 1.4%). However, positive educational effects were observed: A lower proportion of respondents believed that smoking cigarettes was associated with weight gain or loss (80.0% to 66.2%). A higher proportion of respondents felt that once a person started smoking it would definitely be difficult to quit (52.1% to 62%). Quali...
Objective:We wanted to know whether adolescents with eating disorder not otherwise specified (EDN... more Objective:We wanted to know whether adolescents with eating disorder not otherwise specified (EDNOS) differ from those with bulimia nervosa (BN) in clinical features, comorbidity, risk factors, treatment outcome or cost.Method:Adolescents with EDNOS (n = 24) or BN (n = 61) took part in a trial of family therapy versus guided self‐care. At baseline, eating disorder symptoms, risk factors, and costs were assessed by interview. Patients were reinterviewed at 6 and 12 months.Results:Compared with EDNOS, BN patients binged, vomited and purged significantly more, and were more preoccupied with food. Those with EDNOS had more depression and had more current and childhood obsessive‐compulsive disorder. 66.6% of EDNOS versus 27.8% of BN patients were abstinent from bingeing and vomiting at 1 year. Diagnosis did not moderate treatment outcome. Costs did not differ between groups.Conclusion:EDNOS in adolescents is not trival. It has milder eating disorder symptoms but more comorbidity than BN....
Objective:This exploratory study focuses on the mental health (MH) and caregiving experience of c... more Objective:This exploratory study focuses on the mental health (MH) and caregiving experience of carers of adolescents with Bulimia Nervosa (BN)/Eating Disorder not otherwise specified (EDNOS), aiming to determine: levels of MH problems in carers and if a negative experience of caregiving predicts carer MH status and which factors predict a negative experience of caregiving.Method:Hundred and twelve carers and 68 adolescents with BN/EDNOS completed self‐report measures (General Health Questionnaire, Experience of Caregiving Inventory, Level of Expressed Emotion, Self‐report Family Inventory, Inventory of Interpersonal Problems).Results:Over half of the carers reported some MH problems and a minority (5.4%) were experiencing considerable difficulties. A negative experience of caregiving predicted carer MH status. Higher weekly contact hours and patient ratings of expressed emotion (EE) predicted a negative experience of caregiving.Conclusions:Interventions focusing on reducing EE and ...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study assessed the treatment of adolescents with bulimia nervosa using family therapy compared with cognitive behaviour therapy (CBT)-guided self-care. Family therapy consisted of up to 13 one-hour sessions with close others, and two individual sessions over a 6-month period. CBT-guided self-care consisted of 10 one-hour weekly sessions, three monthly follow-up sessions, and two optional sessions with a close other. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population comprised patients aged 13 to 20 years meeting the DSM-IV criteria for bulimia nervosa or eating disorder not otherwise specified, and with at least one "close other" to accompany them to family treatment. Patients with a body mass index below the 10th percentile for age and gender, poor knowledge of English, learning disability, severe mental illness, or substance abuse were excluded. Setting The setting was outpatient care at a tertiary care level. The economic study was carried out in the UK. Dates to which data relate It was reported that recruitment took place between September 2000 and May 2003. However, the dates during which the effectiveness and resource data were collected were not reported. The price year was not reported. Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data Study sample The authors reported that their study had an 80% power to detect abstinence from binging and vomiting at 6 months in 30% of the patients in the guided self-care group and in 60% of the patients on family therapy. The initial sample comprised 148 patients, of whom 63 (43%) were excluded. Reasons for exclusion were failure to meet the inclusion criteria (9), did not want a close other involved (15), did not have a close other willing to be involved (3), lack of time (4), treatment factors (5), lack of availability (3) and miscellaneous reasons (7). Ten patients did not give a reason, while 7 patients (4.7%) refused to participate in research. The remaining 85 patients were randomly assigned to a treatment group, 41 being allocated to family therapy and 44 to guided self-care. However, post randomisation, 6
2007 National Conference on Tobacco or Health, Oct 24, 2007
Learning Objectives: Describe seven steps of evaluation. Identify three techniques learned from s... more Learning Objectives: Describe seven steps of evaluation. Identify three techniques learned from state case studies to be applied in a state or local media campaign. Develop an aspect of a tobacco counter-marketing evaluation plan with participants based on a paid media campaign.
Background Despite a strong evidence base and policy recommendation supporting the implementation... more Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR dom...
International Journal of Mental Health Nursing, 2020
Despite health policy and research increasingly advocating for recovery‐enabling principles to be... more Despite health policy and research increasingly advocating for recovery‐enabling principles to be better integrated into mental health services, finding solutions to enhance the translation of recovery policy into practice remains a challenge. This study sought to understand whether a co‐facilitated group education intervention for service users and family members reached beyond the intervention and impacted the everyday recovery promoting beliefs and practices of the practitioners involved and the wider organization. The study employed a qualitative design involving semi‐structured interviews with a purposively selected sample of 28 participants (mental health nurses and other members of the multidisciplinary team) who were involved in delivering the intervention. Data were analysed using thematic analysis, with the assistance of NVivo. Participants reported that not only did involvement with the programmes help them reconnect with the contextual realities of service user and famil...
Background: Research to support the added value of including Epilepsy Specialist Nurses as member... more Background: Research to support the added value of including Epilepsy Specialist Nurses as members of the multidisciplinary team is developing, yet little information exists on factors influencing the translation of these roles into practice. Aim: To describe the enabling and inhibiting factors to the implementation of the Epilepsy Nurse Specialist role in the Republic of Ireland. Methods: A qualitative design involving semi-structure interviews, observation and analysis of documents, such as portfolios was used. The sample included 12 epilepsy specialist nurses, 24 multidisciplinary team members, and 35 individuals with epilepsy and family members. Data were analysed using the Consolidation Framework for Implementation Research. Reporting rigor is demonstrated using the COREQ checklist (See Supplementary File 1). Results: While there was overwhelming support for the role, barriers and enablers were identified across all domains of the Consolidation Framework for Implementation Research. Enablers included national policies and guidelines, leadership from senior nursing and medical colleagues, climate of learning and mentorship, networking opportunities, infrastructural supports, and competence of ESNs. Barriers included the limited consideration of service expansion and the increasingly complex nature of clinical cases on workload capacity. Deficits in infrastructural supports, challenges in relation to role preparation, role implementation and role responsibility, including concerns around lone practitioner models and concerns that the role was a cost saving measure, also emerged as potential barriers to future sustainability. Conclusion: The Consolidation Framework for Implementation Research offers researchers a pragmatic typology for analysing interrelationships between enabling and inhibiting factors that impact implementation of advanced practice roles, across different evidence sources, disciplines and boundaries. Relevance to clinical practice: In order to secure role sustainability, managers need to address the rate of service expansion, models of role development, deficits in supports and perceived motivations for role development on the quality, acceptability, and sustainability of services provided.
Background: Despite evidence to support the effectiveness of psychoeducation for people experienc... more Background: Despite evidence to support the effectiveness of psychoeducation for people experiencing mental health difficulties and their families, understanding issues around the implementation of such programmes is limited. Aim: The aim of this scoping review was to synthesise the peer-reviewed literature on barriers and enablers influencing the implementation of group psychoeducation in adult mental health services. Methods: Using a pre-defined search strategy and PRISMA guidelines, four databases were systematically searched. Two reviewers independently screened and applied exclusion/inclusion criteria. Qualitative, quantitative, and mixed-methods studies were included if they provided empirical evidence on the barriers and enablers. Three reviewers independently extracted data. Following this, data were analysed using a five-level implementation framework. Results: Eight articles met the inclusion criteria. Barriers to implementation were identified at all five levels of the framework: participant; practitioner; intervention; organisational; and structural level. Enablers to implementation were evident at four levels: participant; provider; intervention; and organisational level. Conclusions: The findings of the review provide preliminary information on factors that impact implementation. However, large-scale studies informed by implementation theories are required. In addition, other studies are needed to address the potential impact of different models of intervention and explore strategies to minimize obstacles and support sustainability.
Background: Smoking is a leading cause of preventable morbidity and mortality in England. This fo... more Background: Smoking is a leading cause of preventable morbidity and mortality in England. This formative research involved the evaluation of SmokeFree Sports (SFS), a novel community sport intervention to prevent smoking among children and young people (CYP). Methods: SFS was implemented in five youth clubs situated in deprived communities, between February and June 2011, involving 246 CYP (6-18 years). Seventy-one CYP (median age=10.0 years, 56% male) and five youth club managers participated in this formative evaluation study, which utilised a mixed methods design. Results: Smoking prevalence at baseline and post-intervention did not differ significantly (2.8% vs. 1.4%). However, positive educational effects were observed: A lower proportion of respondents believed that smoking cigarettes was associated with weight gain or loss (80.0% to 66.2%). A higher proportion of respondents felt that once a person started smoking it would definitely be difficult to quit (52.1% to 62%). Quali...
Objective:We wanted to know whether adolescents with eating disorder not otherwise specified (EDN... more Objective:We wanted to know whether adolescents with eating disorder not otherwise specified (EDNOS) differ from those with bulimia nervosa (BN) in clinical features, comorbidity, risk factors, treatment outcome or cost.Method:Adolescents with EDNOS (n = 24) or BN (n = 61) took part in a trial of family therapy versus guided self‐care. At baseline, eating disorder symptoms, risk factors, and costs were assessed by interview. Patients were reinterviewed at 6 and 12 months.Results:Compared with EDNOS, BN patients binged, vomited and purged significantly more, and were more preoccupied with food. Those with EDNOS had more depression and had more current and childhood obsessive‐compulsive disorder. 66.6% of EDNOS versus 27.8% of BN patients were abstinent from bingeing and vomiting at 1 year. Diagnosis did not moderate treatment outcome. Costs did not differ between groups.Conclusion:EDNOS in adolescents is not trival. It has milder eating disorder symptoms but more comorbidity than BN....
Objective:This exploratory study focuses on the mental health (MH) and caregiving experience of c... more Objective:This exploratory study focuses on the mental health (MH) and caregiving experience of carers of adolescents with Bulimia Nervosa (BN)/Eating Disorder not otherwise specified (EDNOS), aiming to determine: levels of MH problems in carers and if a negative experience of caregiving predicts carer MH status and which factors predict a negative experience of caregiving.Method:Hundred and twelve carers and 68 adolescents with BN/EDNOS completed self‐report measures (General Health Questionnaire, Experience of Caregiving Inventory, Level of Expressed Emotion, Self‐report Family Inventory, Inventory of Interpersonal Problems).Results:Over half of the carers reported some MH problems and a minority (5.4%) were experiencing considerable difficulties. A negative experience of caregiving predicted carer MH status. Higher weekly contact hours and patient ratings of expressed emotion (EE) predicted a negative experience of caregiving.Conclusions:Interventions focusing on reducing EE and ...
This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NH... more This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study assessed the treatment of adolescents with bulimia nervosa using family therapy compared with cognitive behaviour therapy (CBT)-guided self-care. Family therapy consisted of up to 13 one-hour sessions with close others, and two individual sessions over a 6-month period. CBT-guided self-care consisted of 10 one-hour weekly sessions, three monthly follow-up sessions, and two optional sessions with a close other. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population The study population comprised patients aged 13 to 20 years meeting the DSM-IV criteria for bulimia nervosa or eating disorder not otherwise specified, and with at least one "close other" to accompany them to family treatment. Patients with a body mass index below the 10th percentile for age and gender, poor knowledge of English, learning disability, severe mental illness, or substance abuse were excluded. Setting The setting was outpatient care at a tertiary care level. The economic study was carried out in the UK. Dates to which data relate It was reported that recruitment took place between September 2000 and May 2003. However, the dates during which the effectiveness and resource data were collected were not reported. The price year was not reported. Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample that provided the effectiveness data Study sample The authors reported that their study had an 80% power to detect abstinence from binging and vomiting at 6 months in 30% of the patients in the guided self-care group and in 60% of the patients on family therapy. The initial sample comprised 148 patients, of whom 63 (43%) were excluded. Reasons for exclusion were failure to meet the inclusion criteria (9), did not want a close other involved (15), did not have a close other willing to be involved (3), lack of time (4), treatment factors (5), lack of availability (3) and miscellaneous reasons (7). Ten patients did not give a reason, while 7 patients (4.7%) refused to participate in research. The remaining 85 patients were randomly assigned to a treatment group, 41 being allocated to family therapy and 44 to guided self-care. However, post randomisation, 6
2007 National Conference on Tobacco or Health, Oct 24, 2007
Learning Objectives: Describe seven steps of evaluation. Identify three techniques learned from s... more Learning Objectives: Describe seven steps of evaluation. Identify three techniques learned from state case studies to be applied in a state or local media campaign. Develop an aspect of a tobacco counter-marketing evaluation plan with participants based on a paid media campaign.
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Papers by Rebecca Murphy