Using the COM-B model to explore health care professionals' experience of working towards a collaborative care model within Long Term Conditions, Improving Access to Psychological Therapies Services (IAPT-LTC)

Sanders, Samantha

Abstract

Objectives: Improving Access to Psychological Therapies Services have been implementing pathways for long term conditions (IAPT-LTC) since their pilot in 2016. An aim of these pathways is to integrate more closely with NHS physical health care teams. Time to Talk Health is an IAPT-LTC service in the Southeast of England. This study aimed to explore the experiences of Time to Talk Health staff and physical health care professionals to gain insight into the barriers and facilitators to collaborative care. The study also aimed to explore the experiences of those who were part of setting up the joint working model to gain an understanding at implementation level. The final objective of the study was to explore the potential of the COM-B model (capability, opportunity, motivation, behaviour) as a framework for understanding the findings.
Methods: A qualitative design using semi-structured interviews was adopted. Twenty-one members of staff from IAPT-LTC and physical health care teams were recruited. Interview transcripts were first analysed using an inductive approach through thematic analysis to generate themes. A deductive approach was subsequently adopted to map the identified themes onto the COM-B model.
Findings: An analysis of pooled qualitative data identified four themes: (1) the culture of ‘them and us’; (2) ‘can they see the value in it?'; (3) ‘it wasn’t new to me’ and (4) joint working seen as costly vs. enabling. A final theme which fell outside of the COM-B model was identified: collaborative working seen as unsustainable. Sociocultural factors linked to COVID-19 and challenges with staff retention are explored as part of this.
Conclusion: COM-B constructs were found to overlap, providing an understanding of bidirectional links between barriers and facilitators. The study highlights novel findings around the perceived sense of threat linked to loss of job role amongst physical health care clinicians. The current findings also highlight the need for further system-level consideration around targets and adaptions put in place for IAPT-LTC sites. The COM-B model may benefit from additional constructs ‘collective action’ and ‘reflexive monitoring’ from the Normalisation Process Theory which can support us to evaluate the continued implementation of organisational innovations. Interventions based on the COM-B model to enhance collaborative care practice and suggestions for future research are considered.

• Thesis Type: Thesis
• Deposit Date: Feb 28, 2022
• Publicly Available Date: Jun 13, 2022
• Public URL: https://uwe-repository.worktribe.com/output/9081283
• Additional Information: Faculty of Health and Applied Sciences
• Award Date: Jun 13, 2022