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Developing a theory-informed complex intervention to improve nurse-patient therapeutic engagement employing Experience-based Co-design and the Behaviour Change Wheel: an acute mental health ward case study

Research output: Contribution to journalArticlepeer-review

Sarah McAllister, Alan Simpson, Vicki Tsianakas, Nick Canham, Vittoria De Meo, Cady Stone, Glenn Robert

Original languageEnglish
Number of pages36
JournalBMJ Open
Early online date13 May 2021
Accepted/In press19 Apr 2021
E-pub ahead of print13 May 2021


  • bmjopen-2020-047114.R1_Proof_hi

    bmjopen_2020_047114.R1_Proof_hi.pdf, 30.1 MB, application/pdf

    Uploaded date:19 Apr 2021

    Version:Accepted author manuscript

  • e047114.full

    e047114.full.pdf, 565 KB, application/pdf

    Uploaded date:13 May 2021

    Version:Final published version

King's Authors


Objectives: Our objectives were threefold: 1) describe a collaborative, theoretically driven approach to co-designing complex interventions; 2) demonstrate the implementation of this approach to share learning with others and 3) develop a toolkit to enhance therapeutic engagement on acute mental health wards. Design and participants: We describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Our case study was informed by the results of a systematic integrative review and guided by
this integrated approach. We undertook 80 hours of non-participant observations, and semistructured interviews with 14 service users (seven of which were filmed), two carers and 12 clinicians from the same acute ward. The facilitated intervention co-design process involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data
analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development.
Setting: This study was conducted over 12-months at an acute mental health organisation in England. Results: The co-designed Let’s Talk toolkit addressed four joint service user/clinician priorities for change: 1) improve communication with withdrawn people; 2) nurses to help service users help themselves; 3) nurses to feel confident when engaging with service users; 4) improving team
relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design/behaviour change approach with service users, carers and clinicians to develop a toolkit to improve nurse-patient therapeutic engagement. Conclusions: Our theory-driven approach enhanced both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.

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