Adherence to group interventions in psychosis: do people attend? A systematic review.

Student thesis: Doctoral ThesisDoctor of Clinical Psychology


Background: There is now meta-analytic evidence in support of the efficacy of group therapy on symptoms and functioning for people with psychosis. However Medical Research Council guidelines also highlight the importance of establishing the feasibility of complex interventions. Adherence is an important indicator of feasibility, and this is an essential first step in supporting the development of the evidence base for group interventions. 
Objective: This study aims to: a) estimate adherence to psychotherapeutic groups, and b) assess adherence barriers and facilitators. 
Method: Embase, Ovid MEDLINE and PsycINFO databases were searched cross referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and a methodological quality assessment was undertaken. Relevant data was extracted from each paper including the average session attendance, demographic, clinical, study, and group-related factors. Quantitative analyses were conducted to assess the impact of each factor on adherence (attendance level). A narrative synthesis of studies which specifically commented on intervention adherence was also completed. 
Results: Fifty-eight original research papers were included, reporting on 51 independent studies which included 65 therapy groups (2097 participants). Participants average adherence was 76.4% (SD = 17.6). Adherence was improved by receiving incentives and participants being of older age. A larger sample size was associated with lower reported adherence levels; when the mean was weighted according to sample size the rate was 70.9%. Study quality was variable with approximately 61% found to be at risk of bias. 
Conclusions: The results support the feasibility of group therapy in terms of adherence for people with psychosis, with figures similar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis and suggest the need for further high-quality research to consolidate emerging evidence.
Date of Award1 Oct 2019
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorMatteo Cella (Supervisor), Richard Stott (Supervisor) & Amy Hardy (Supervisor)

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