Staff expectations for the implementation of digital remote monitoring in services for people with psychosis: A qualitative study using normalisation process theory.

Abstract

Digital remote monitoring (DRM) utilises devices such as smartphones and wearables to remotely collect health-related data, providing insights into the mental health of individuals with psychosis. This data can be shared with mental health services to aid clinical assessment. DRM has been found to effectively identify early signs of psychosis relapse, enabling clinicians to intervene earlier and improve outcomes for service users. However, there are challenges to its implementation in services. This study used Normalisation Process Theory (NPT) as a framework to examine mental health professionals' expectations regarding the barriers and facilitators to implementing DRM in psychosis care. Semi-structured interviews were conducted with 59 multi-disciplinary mental health professionals from nine UK National Health Service mental health Trusts/Health Boards. Interviews were inductively thematically analysed, then deductively analysed by mapping themes to the core constructs of NPT. Findings were similar across all settings and applicable to three NPT constructs (coherence, cognitive participation and collective action) and their subcomponents. One inductive theme, 'own experiences of technology' was not captured by NPT. Participants understood DRM's purpose for detecting early signs of relapse. However, several barriers to implementation were identified: uncertainty about professional roles, resource issues, concerns about inaccurate DRM data, complexity of the technology, security/privacy issues, and concerns about using DRM with certain clinical presentations. Suggested implementation strategies included staff training and ongoing technical support, developing guidance regarding professionals' responsibilities, using an in-house 'DRM expert' to lead its integration within services, enhancing clinician's knowledge of the evidence base for DRM in psychosis care, and actively involving both clinicians and service users in DRM system development. Interpretation Findings identify key factors and actionable implementation strategies essential for successful early adoption of DRM in routine care. By addressing these considerations, implementation effectiveness can be optimised, ultimately improving outcomes for people with psychosis. Funding Wellcome Trust, National Institute for Health and Care Research.