An Asynchronous Peer Support Intervention for Men experiencing Unipolar Depression; Development of a Complex intervention.

Brydges, Sarah (2023) An Asynchronous Peer Support Intervention for Men experiencing Unipolar Depression; Development of a Complex intervention. PhD thesis, University of Nottingham.

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This study set out to develop a complex intervention, delivered in a community pharmacy setting that can support men prescribed antidepressants for depression.

Depression is a common and potentially long-term mental disorder. It can be debilitating for both individuals and society. Men experiencing depression can be considered a unique population of interest based on their different profiles; particularly their expression of depression, their risk profiles in depression, and how they navigate the healthcare system.

Antidepressants can be effective for treating depression, but there are barriers to their practical application. These may include psychosocial issues such as self-stigma, and information issues such as mismatched expectations on treatment duration. It has been suggested that gender, and views of masculinity, can underpin some negative attitudes. Holding negative beliefs about taking prescribed antidepressants and poor health literacy has been linked with poorer treatment outcomes. Increasing treatment engagement, however, can improve outcomes.

Community pharmacists are accessible healthcare professionals, with expertise on medication and who have good mental health literacy. They can potentially support these patients, yet little is known about what these male patients see as the role of the community pharmacist in their treatment journey. No interventions exist for these patients within a community pharmacy setting.

Guided by the Medical Research Councils guidance on developing and evaluating a complex intervention, this thesis takes a research through design approach, underpinned by qualitative methods to develop a complex intervention. Research through design is a relatively underdeveloped approach in healthcare, but it focuses research on preferred future states, supports incorporation of stakeholders in the design process of a complex problem, and presents design as a research contribution.

There are several key areas where this study makes an original contribution to knowledge. The first is qualitatively exploring men’s views of antidepressants, and the community pharmacist’s role. Thematic analysis of qualitative interviews found men in their depressed state are not seeking to get advice or support from the community pharmacist. The COM-B behaviour model has been used to help organise these findings. Men did, however, reflect on some unmet needs and that there could be a role for the community pharmacist in their care.

The second contribution is the development of a complex intervention. Findings from the above study and literature were used to support a theory-based approach to development. This work was built on by involving stakeholders in the design process. In the designed intervention, asynchronous communication is used to enable people newly prescribed antidepressants to ask questions of peers with more experience, either through audio or video, with facilitation by a community pharmacist. This intervention had a task focused mechanism of interaction and was designed to be gender sensitive. This was modelled in its real setting. Acceptability was measured using qualitative interviews and findings organised by the theoretical framework of acceptability. Overall the intervention was acceptable.

The final knowledge contribution is a methodological one, where the appropriateness of integrating the Medical Research Council guidance with research through design is discussed. Further work should involve evaluation, feasibility, and implementation studies, particularly addressing how this intervention links within a wider healthcare system, and exploring cost effectiveness.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Anderson, Claire
Rennick-Egglestone, Stefan
Keywords: Depression, Male health, Complex intervention, Pharmacy, Community pharmacy, Mental health, peer support service, research through design
Subjects: R Medicine > RA Public aspects of medicine > RA 421 Public health. Hygiene. Preventive Medicine
R Medicine > RM Therapeutics. Pharmacology
Faculties/Schools: UK Campuses > Faculty of Science > School of Pharmacy
Item ID: 72360
Depositing User: Brydges, Sarah
Date Deposited: 26 Jun 2024 14:20
Last Modified: 26 Jun 2024 14:20

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