COMPARE Establishing components of programmes to reduce restrictive practices: an evidence synthesis

Description

Aims

The aim of this study is to identify effective components of programmes that seek to reduce restrictive interventions in adult mental health inpatient settings using the BCT taxonomy. Our objectives are to:

1. Provide an overview of programmes aimed at reducing restrictive interventions;
2. Classify components of those programmes implemented in adult mental health inpatient settings in terms of behaviour change techniques and determine their frequency of use;
3. Explore the evidence of effectiveness by examining behaviour change techniques and programme outcomes;
4. Identify and prioritise behaviour change techniques showing most promise of effectiveness and that require testing in future high-quality evaluations.

Method

We will conduct an evidence synthesis of published and unpublished literature, including detailed coding of programme content using the BCT Taxonomy. This will involve: identifying all documented programmes and extracting data about the characteristics of each programme including participants, setting, programme type, costs, outcome measures, fidelity, acceptability, recommendations and quality (Objective i); extracting programme content and coding the components using the BCT taxonomy (Objective ii); and, extracting information about the outcomes of the programmes coded for BCTs (Objectives iii & iv). We will then analyse the evidence to produce a narrative synthesis of:

• Programme characteristics;
• Type and frequency of programme components described in terms of BCTs;
• Programme outcomes for identified BCTs and comparison of outcomes between programmes that contain a BCT or type of BCT with those that do not; 
• Acceptability;
• Recommendations for future trials.

Background

Restrictive interventions such as restraint, seclusion, injection of sedating drugs and constant observation are a frequent occurrence in adult mental health inpatient settings. Their use carries significant risk of physical and psychological harms to patients and staff. Restrictive interventions are also costly in terms of staff sickness and litigation as well as extra staffing resources required for their implementation. Numerous staff training programmes have been developed to try to reduce the use of restrictive interventions. These seek to modify practice using a variety of Behaviour Change Techniques (BCTs). Although some programmes have been evaluated, research into their effectiveness is hampered by a lack of attention to their specific components. Over recent years the MRC has supported work to develop a taxonomy of BCTs to standardise and improve the reporting of such non-pharmacological interventions. It provides a common language with which to specify the content and mechanisms via which behaviour is changed.