PULSAR - RETAFORM Symposium Paper 1: PULSAR; a methodological perspective.

Graham MEADOWS^1,2,3,4,5, Lisa BROPHY^6,7, Elisabeth WILSON-EVERED ¹⁰, Enticott JOANNE^1,3,5

¹School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
¹⁰Mental Health and Physical Activity Research Group, Victoria University, Melbourne, Australia
²School of Primary and Allied Health Care, Monash University, Melbourne, Australia
³School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
⁴Centre for Mental Health, School of Global and Population Health, University of Melbourne, Melbourne, Australia
⁵Monash Health, Melbourne, Australia
⁶Social Work and Social Policy, Department of Community and Clinical Health School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
⁷The Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
⁸Department of Occupational Therapy, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
⁹Alfred Health, Adult Mental and Addiction Health, Melbourne, Australia

Where Recovery Oriented Practice (ROP) interventions are team or organisation-based, Stepped-wedge cluster-randomised Controlled Trials (SW-cRCT) designs can offer advantages including ameliorating some sources of bias that may arise in other parallel groups designs. Experience with such designs and their analysis has been accumulating in the ROP field, including through the positive findings from the PULSAR project. But settling on an SW-cRCT design can leave open many questions about design and analysis. The PULSAR study (1) was a SW-cRCT which featured stratified randomisation with a combination of Complete and Incomplete, repeated cross-sectional and longitudinal data collection strategies. These design features contributed to the study being able to demonstrate positive findings in ways that will be considered and reviewed in the presentation. Also, drawing on a healthcare-specific implementation model, ‘Promoting Action on Research Implementation in Health Services’ (PARiHS) the PULSAR project undertook a process evaluation to understand the implementation and contextual processes that contributed to impact of the REFOCUS-PULSAR staff training on personal recovery among consumers receiving specialist care services. This presentation will include description of application of a tool based on the PARiHS framework to identify those service teams and contexts most responsive to the training intervention. The application of this approach can add value to team-based research work, including in trials of training interventions. This method may be particularly useful where teams are already strongly aligned with the desired direction of change and may in turn guide adaptation of such interventions to team.

(1) Meadows, G., Brophy, L., Shawyer, F., Enticott, J. C., Fossey, E., Thornton, C. D., Weller, P. J., Wilson-Evered, E., Edan, V., & Slade, M. (2019). REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial. The Lancet Psychiatry, 6(2), 103-114.